We trawl the world’s journals so you don’t have to:

Precursors and diverse pathways to personality disorder in children and adolescents (Development and Psychopathology).

Individual differences in emotion components and dynamics (Cognition and Emotion). 

http://bps-research-digest.blogspot.com/2009/11/special-issue-spotter.html

 

Dr Michael Fitzpatrick, author most recently of Defeating Autism: A Damaging Delusion, was invited by the Progress Educational Trust to speak at the debate ‘From Autism to Asperger’s: Disentangling the Genetics and Sociology of the Autistic Spectrum’ which took place in the UK Houses of Parliament on the evening of 20 October. His speech, in which he addresses the search for a gene for autism, is published below.

Scarcely a week goes by without the announcement of another breakthrough in research into the genetics of autism. Such studies are now commonly reported in the mainstream media as well as in scientific journals and are invariably followed by speculation about the possibilities for screening tests to detect autism in fetal life or for the development of therapeutic interventions in people with autism. The quest to discover the cause of autism through research in genetics and neuroscience – and hopes that this research will lead to a cure – have captured the imaginations of many parents of children with autism. In the US and in the UK, the charity Autism Speaks has brought parents and scientists together with the aim of raising funds and promoting research in these areas.

Yet, from the perspective of parents (like me) or jobbing family doctors (also like me), the yield from more than a decade of intensive genetic research into autism has been negligible. Just as autism manifests itself as a complex condition with a wide range of presentations, so it appears to be genetically heterogeneous, with a number of different genes on a number of different chromosomes contributing to the emergence of the disorder. Though there have been impressive discoveries, in genetics and epigenetics, and in neurophysiology, according to one leading authority, ‘in essence, we know very little about the changes in brain development and brain organisation that underlie autistic spectrum disorders’ (1).

The direction of scientific research into autism has been challenged from different directions, by groups of parents and by people with autism. Let’s take these in turn before suggesting how we might begin to move beyond the narrow focus on the quest for cause and cure.

Read in Full:  http://www.spiked-online.com/index.php/site/article/7671/

Genes And Environment May Interact To Influence Risk For Post-Traumatic Stress Disorder

Article Date: 04 Nov 2009 – 1:00 PST

Individuals who experience both childhood adversity and traumatic events in adulthood appear more likely to develop post-traumatic stress disorder than those exposed to only one of these types of incidents, according to a report in the November issue of Archives of General Psychiatry, one of the JAMA/Archives journals. In addition, the risk was further increased in individuals with a certain genetic mutation.

Although 40 percent to 70 percent of Americans have experienced traumatic events, only about 8 percent develop PTSD during their lifetimes, according to background information in the article. PTSD is a complex anxiety disorder that involves re-experiencing, avoidance and increased arousal following exposure to a life-threatening event. “In addition to the obvious effect of environmental factors, PTSD has a heritable component,” the authors write. Recent studies estimate that genetic factors account for approximately 30 percent of the difference in PTSD symptoms.

Pingxing Xie, B.S., of Yale University School of Medicine, New Haven, Conn., and VA Connecticut Healthcare Center, West Haven, and colleagues studied 1,252 individuals who had experienced childhood adversity (including abuse or neglect), adult trauma (such as combat, sexual assault or a natural disaster) or both. Participants age 17 to 79 (average age 38.9) were interviewed and assessed for a variety of psychiatric and substance use disorders. DNA was extracted and used to differentiate between versions of a particular polymorphism or gene mutation-known as the 5-HTTLPR genotype-previously found to be associated with emotional response after stressful life events.

About one-fifth of the participants (229, or 18.3 percent) met criteria for PTSD. A total of 552 of the 1,252 participants (44.1 percent) experienced both childhood adversity and traumatic events in adulthood. These individuals were more likely to have a lifetime diagnosis of PTSD than were those who experienced trauma in only one life stage (29 percent vs. 9.9 percent).

“Although the 5-HTTLPR genotype alone did not predict the onset of PTSD, it interacted with adult traumatic events and childhood adversity to increase the risk for PTSD, especially for those with high rates of both types of trauma exposure,” the authors write. The genotype may influence the way the brain processes the neurotransmitter serotonin, affecting an individual’s anxiety levels and changing the way neurons react to fearful stimuli, they note.

“It was only in the group of subjects who could be characterized as having had the highest rates of trauma exposure (i.e., in both childhood and adulthood) that an impact of 5-HTTLPR could be detected,” the authors conclude. “This suggests that there may be many neurobiological (including genetically determined) ‘buffers’ to PTSD; only in instances of extreme and/or repeated trauma exposure (which, it should be pointed out, characterizes those trauma ‘types’ with the highest conditional risk for PTSD, e.g., domestic violence and military combat), in which these buffers are overwhelmed, can the impact of specific genes such as 5-HTTLPR be detected.”

Arch Gen Psychiatry. 2009;66[11]:1201-1209.

Source
Archives of General Psychiatry
http://www.medicalnewstoday.com/articles/169719.php

Associated Conditions of PTSD

By Harold Cohen, Ph.D.

Persons with PTSD often have other disorders as well, which makes it difficult for clinicians to diagnose the PTSD. In particular, major depression and substance abuse are common in people with PTSD. There may also be an increased risk of panic disorder, agoraphobia, obsessive-compulsive disorder, social phobia and somatization disorder. Scientists are not sure to what extent these co-occurring disorders are present before or come after the traumatic event and the development of PTSD.

When exposure to trauma has been long-standing (as for badly abused children), persons may develop certain enduring patterns of behavior or traits. These include difficulty in trusting others, irregular moods, impulsive behavior, shame, decreased self-esteem and unstable relationships. Many of these traits are also seen in persons with borderline personality disorder, and people with this disorder often have histories of childhood physical and sexual abuse, which are possible causes for PTSD.

Persons with posttraumatic stress disorder (PTSD) also often have physical symptoms. They may go to a primary care physician with many physical complaints, rather than psychological concerns. Studies have also shown that people with PTSD are at increased risk for a number of medical conditions, such as hypertension and asthma.

Significant interpersonal difficulties are common in persons with PTSD. Symptoms of estrangement, irritability and anger, or associated depression, may take their toll on a person’s relationships. Persons with PTSD may find it difficult to talk about symptoms with those who did not go through the same trauma. Sometimes, guilt about surviving or about acts done in order to survive can also cause increased isolation and tension in interpersonal relationships.

http://psychcentral.com/lib/2006/associated-conditions-of-ptsd/

 

Article Date: 04 Nov 2009 – 3:00 PST

A new website aimed at the nation’s stressed out workforce is being launched today, on National Stress Awareness Day (4 November). The new resource, produced by the national anti-stigma programme Time to Change, provides practical advice on how mental distress can be managed professionally at work. It uses a wide range of inspiring films to show how line managers and employees can work together by being more flexible and supportive.

Source
MIND
http://www.medicalnewstoday.com/articles/169781.php

 

By Claudia Wallis
THE NEW YORK TIMES
Tuesday, November 03, 2009

It is one of the most intriguing labels in psychiatry. Children with Asperger’s syndrome, a mild form of autism, are socially awkward and often physically clumsy, but many are verbal prodigies, speaking in complex sentences at early ages and acquiring expertise in some preferred topic — stegosaurs, clipper ships, interstate highways — that astonishes adults and bores their playmates to tears.

This once obscure diagnosis is increasingly common. Much of the growing prevalence of autism, which now affects about 1 percent of American children, according to federal data, can be attributed to Asperger’s and other mild forms of the disorder.

But no sooner has Asperger consciousness awakened than the disorder seems headed for psychiatric obsolescence. Though it officially joined the medical lexicon only in 1994, the experts who are revising psychiatry’s diagnostic manual propose to eliminate it from the new edition, due in 2012.

If they have their way, Asperger’s syndrome and another mild form of autism will be folded into a single diagnosis, autism spectrum disorder.

“Nobody has been able to show consistent differences between what clinicians diagnose as Asperger’s syndrome and what they diagnose as mild autistic disorder,” said Catherine Lord, director of the University of Michigan’s Autism and Communication Disorders Centers, a member of a group evaluating disorders for the manual.

Taking Asperger’s out of the manual, known as DSM-V for the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders, does not mean the term will disappear. “It’s just not a diagnostic term,” Lord said.

Recent books by people with Asperger’s give insights into the workings of some oddly beautiful minds. In “Look Me in the Eye,” John Elder Robison describes a painfully lonely childhood and an ability to look at a circuit design and imagine how it will transform sound — a talent he used to invent audio effects and exploding guitars for the band Kiss.

Not all people with Asperger’s have such abilities, and some who do suffer from anxiety and social limitations.

The change, if approved by the manual’s editors, is likely to be controversial. The Asperger’s diagnosis is used by insurers, state agencies and schools, not to mention people with the disorder.

People with Asperger’s and mild autism were divided on the prospect of losing the label. Temple Grandin, an animal scientist who is perhaps the best-known autistic American, said Asperger’s was too well-established to be discarded.

But some involved in the growing autism self-advocacy movement see things differently. “My identity is attached to being on the autism spectrum, not some superior Asperger’s identity,” said Ari Ne’eman, 21, who founded the Autistic Self-Advocacy Network. “I think the consolidation to one category of autism spectrum diagnosis will lead to better services.”

Source:   http://www.statesman.com/news/content/news/stories/nation/2009/11/03/1103asperger.html

Related Articles 

 

By Therese J. Borchard
October 27, 2009

In the spirit of Halloween, I thought you’d all appreciate some vampire talk. In her new book, “Emotional Freedom,” UCLA psychiatrist Judith Orloff identifies five kinds of vampires that are lurking around and can zap our energy if we’re not careful. Here is an excerpt adapted from her book.

Emotional vampires are lurking everywhere and wear many different disguises–from needy relatives to workplace bullies. Whether they do so intentionally or not, these people can make us feel overwhelmed, depressed, defensive, angry, and wiped out.

Without the self-defense strategies to fend them off, victims of emotional vampires sometimes develop unhealthy behaviors and symptoms, such as overeating, isolating, mood swings, or feeling fatigued.

Here are five types of emotional vampires you’re likely to encounter, and some “silver bullet” tips for fending them off.

Vampire 1: The Narcissist.

This vampire is grandiose, self-important, attention hogging, and hungry for admiration. She is often charming and intelligent–until her guru status is threatened.

Self-defense tips: Enjoy her good qualities, but keep your expectations realistic. Because her motto is “me-first,” getting angry or stating your needs won’t phase her. To get her cooperation, show how your request satisfies her self-interest.

Vampire 2: The Victim.

This vampire thinks the world is against him, and demands that others rescue him.

Self-defense tips: Don’t be his therapist, and don’t tell him to buck up. Limit your interactions, and don’t get involved in his self-pity.

Vampire 3: The Controller.

This vampire has an opinion about everything, thinks he knows what’s best for you, has a rigid sense of right and wrong, and needs to dominate.

Self-defense tips: Speak up and be confident. Don’t get caught up in bickering over the small stuff. Assert your needs, and then agree to disagree.

Vampire 4: The Criticizer.

This vampire feels qualified to judge you, belittle you, and bolster her own ego by making you feel small and ashamed.

Self-defense tips: Don’t take what she says personally. Address a misplaced criticism directly. Don’t get defensive. Express appreciation for what’s useful. Bounce back with a massive dose of loving-kindness.

Vampire 5: The Splitter.

This vampire may treat you like his BFF one day, and then mercilessly attack you the next day when he feels wronged. He is often a threatening rageaholic who revels in keeping others on an emotional rollercoaster.

Self-defense tips: Establish boundaries and be solution-oriented. Avoid skirmishes, refuse to take sides, and avoid eye contact when he’s raging at you. Visualize a protective shield around you when you’re being emotionally attacked.

http://psychcentral.com/blog/archives/2009/10/27/5-emotional-vampires-and-how-to-combat-them/

comments (2)

1. Azulejo left…

Monday, 9 November 2009 6:21 pm

This is useful information. My father fits into the “needy family member” category of Emotional Vampires…

He is a semi-retired asperger male who expects his two adult children to spend all their free time with him. He puts zero effort into making his own friends and will only spend time with the friends my mother made for them when she was alive.

I have to limit my time and interaction with him since he constantly talks and does not ever listen to me. My function is only to listen to his repetetive monologues. He provides no emotional support to me whatsoever but expects me to sympathize with him and he regularly “plays the victim – poor me…”

2. Julie left…

Tuesday, 10 November 2009 3:27 pm

Azulejo,

My father used to present with this very same behaviour, though coupled with the essential ‘alone time’ at intervals to recharge. One day, he woke up to find he was totally alone. It wasn’t that no-one cared for him, but his behaviour had well and truly pushed everyone away. He became a bitter recluse for awhile, then realised that if he wanted any kind of genuine social contact, he would have to take the leap out into the unknown. He started going to dances once a fortnight. Something he’d greatly enjoyed in his youth. Made all the difference. It’s as though he has re-learned the give and take of conversation he’d managed earlier in his life(though minimally) in order to be a part of the dance environment he so enjoys. As a result, life is so much better now for him and family are gradually reconnecting with him, and with greater understanding of Autism/Aspergers. I know what it is to be on the receiving end of those monologues, and that ‘poor me’ attitude, etc, even to the point of being woken in the night to listen to a spiel. You’re doing well to self-preserve and maintain this relationship. Takes a lot of patience and understanding. Hope your father manages to find a life outside of the safety of what he currently knows, which can be a difficult step. He has to want and need it though. Have to say, many on the spectrum prefer the reclusive existence and are quite happy with minimal external contact. I learned to self-support on pretty much all levels from a young age. I hope you have found the emotional support you need, elsewhere.

 

 

The UK National Institute for Health and Clinical Excellence (NICE), has updated its clinical guideline for the treatment of depression in adults.

The guidelines were developed by the National Collaborating Centre for Mental Health, which is based at the Royal College of Psychiatrists and the British Psychological Society.

Jennifer Burke Labriola, Burke PR
Anne-Louise Oliphant, American College of Gastroenterology

In two new studies, presented at the American College of Gastroenterology’s (ACG) 74th Annual Scientific meeting in San Diego, researchers explored the connection between high stress, high exposure occupations and long-term gastrointestinal disorders.

The studies, performed by the United States Navy and the State University of New York (SUNY), Stonybrook examine the long term effects of infectious gastroenteritis (IGE) among active duty military and the interaction between gastroesophageal reflux (GERD) and mental health disorders among World Trade Center workers, respectively.

Dr Mark Riddle, of the United States Navy, led the study that examined functional gastrointestinal disorders within the active military population and their connection to infectious gastroenteritis. Infectious gastroenteritis can be caused by a variety of factors, including exposure to bacterial pathogens, protozoa and/or certain viruses, and active duty military personnel are at high risk during deployments.

Using electronic medical records obtained through the Defense Medical Surveillance System, Dr Riddle and his colleagues identified 31,866 cases of functional gastrointestinal disorders, including irritable bowel syndrome, functional constipation or diarrhea, and dyspepsia, in active duty personnel between 1999 and 2007. Matching each case to four corresponding non-FGD controls, the team calculated functional gastrointestinal disorders incidence rates, as well as performed an assessment of differential risk for functional gastrointestinal disorders associated with the type of infectious gastroenteritis exposure.

The researchers found a significant association between infectious gastroenteritis and all functional gastrointestinal disorders, with the highest risk of functional diarrhea and irritable bowel syndrome and moderate risk with functional constipation and dyspepsia. They also found that risk of functional gastrointestinal disorders generally increased nearer to infectious gastroenteritis exposure and that exposure to bacteria was associated with the highest risk overall. Importantly, 28.8 percent of active duty personnel studied still received functional gastrointestinal disorders related-care two years after their initial diagnosis.

“In both historical and modern times, wherever and whenever military personnel have been placed into the austere environments of combat operations or humanitarian relief missions, the acute impact of infectious gastroenteritis is present,” explains Dr Riddle. “Until now, the long term consequences of infectious gastroenteritis exposure and the resultant consequences have not been documented or considered. Given the self-limited nature of infectious gastroenteritis and effective antibiotic therapy, we tend to relegate these infections to mere ‘battle-field’ nuisances. However, our view of disease burden must extend beyond the deployment time-horizon and consider the health of the sailors, soldiers, marines and airmen who return home and become veterans. Consideration of both the acute illness and chronic sequelae reinforce our need to enhance current strategies and develop novel solutions to limit and prevent exposure at the outset.“

Shortly after September 11, 2001, high frequencies of gastroesophageal reflux (GERD) and mental health disorders were reported among exposed World Trade Center (WTC) responders. Dr Douglas Brand and Dr Yvette Lam were part of a team at the Long Island WTC Responder Center that examined the results of 697 WTC responders who were seen in 2005 to determine whether these conditions persisted over time and whether they were related to one another.

Among these responders, 41 percent of those examined had GERD, more than twice the 20 percent incidence rate among the general population. Furthermore, patients with GERD also had a higher prevalence of mental health disorders, including Post-Traumatic Stress Disorder and depression. In fact, patients with greater numbers of mental health disorders had progressively higher rates of GERD at their assessment: one mental health disorder 47.27 percent, two disorders 64.4 percent, 3 disorders 69.7 percent, and 4 disorders 72.2 percent.

The researchers also evaluated other environmental and lifestyle factors commonly associated with GERD, including smoking and obesity, but found no association with the increased frequency of GERD among WTC workers. However, length of exposure at the WTC site correlated with the diagnosis of both PTSD and GERD.

“Eight years after 9/11 we are still realizing the after-effects on those who responded and participated in the massive clean-up efforts,” said Dr Brand. “Shortly after this highly stressful and toxic exposure, the appearance of GERD characterized by high co-morbidity with mental health disorders, but no relation to obesity or smoking, suggests that mental health disorders may play an important role in the persistence of GERD among these workers. Thus, treatment of the underlying mental health disorder may be necessary to resolve the physical manifestation of GERD.

“Hopefully, these insights will help us better understand the mind-body connection and to treat other first responders following high-stress, high exposure deployments.“