Category: Mental Health

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Calorie Labels on Menus could Make Eating Disorders Worse

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Calorie labels on restaurant menus are negatively impacting people with eating disorders, according to a new study published in the BMJ Public Health.

The review, which is the first of its kind, is led by researchers at King’s College London. It found that individuals who have been diagnosed with an eating disorder changed their behaviours if presented with a menu featuring calorie labels.

This included avoiding restaurants, triggering eating disorder thoughts and paying more attention to calorie labels as identified by eye tracking research.

The research found that some people with eating disorders reported that seeing menu labels reinforced their eating disorder beliefs.

The study evaluated existing research to help build a picture of how nutritional labels on menus impact people with a lived experience of eating disorders or disordered eating. It reviewed 16 studies from the UK, US, Canada and Saudi Arabia which included 8,074 participants in total.

The study highlights that people with eating disorders can feel that eating disorders are perceived as less important in the light of obesity prevention policies.

However, physical health cannot be measured by a single indicator such as weight. Some argue that calorie labels can be seen as a blunt instrument to fix a complicated problem and that people with eating disorders could be losing out.

Food labelling came into force in England in 2022. Restaurants, take-aways and cafes with 250 employees or more must display the calories of the food and drink they sell on menus, online menus and take-away platforms. The measure was an attempt to curb rising obesity levels. The United States and Canada have also made calorie displays mandatory, however, few policies targeting obesity have considered the potential impact on eating disorders.

The eating disorder charity Beat estimates that at least 1.25 million people in the UK have an eating disorder. The number of people admitted to hospital with an eating disorder has risen approximately 7% each year since 2005 – 2006.

Senior author Dr Tom Jewell, Lecturer in Mental Health Nursing at King’s College London, said: “Our study highlights that people with lived experience of eating disorders are frustrated at being left out of the conversation around calorie labels.”

Striking a balance between the positive and harmful impacts of calorie labels on menus is vital in any public health policies.Dr Tom Jewell, Senior author and Lecturer in Mental Health Nursing at King’s College London

“Policymakers should consider the impact on both obesity and eating disorders when making decisions about nutrition labelling. A recent review found that calorie labelling has a modest effect on people’s behaviour but this needs to be counterbalanced with the potential harm it does for people with eating disorders.”

Co-author Dr Nora Trompeter, Research Fellow University College London, said: “Our study provides an important addition to the evidence base around calorie labels.”

Typically, there is a lot of focus on whether policies are effective in reducing obesity, but it is also critical to investigate whether these policies inadvertently harm people with eating disorders.

“Our review also shows that more research is needed to fully understand the impact of calorie labels on individuals with eating disorders. For example, none of the studies included young people.”

Source: King’s College London

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Scientists Discover Brain Mechanism that Helps Override Fear

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Coronal brain slice showing projections from different visual areas in the cerebral cortex to the ventrolateral geniculate nucleus (vLGN). These pathways are part of the circuit identified as mediating the suppression of instinctive fear responses.

Researchers at the Sainsbury Wellcome Centre (SWC) at UCL have unveiled the precise brain mechanisms that enable animals to overcome instinctive fears. Published today in Science, the study in mice could have implications for developing therapeutics for fear-related disorders such as phobias, anxiety and post-traumatic stress disorder (PTSD).

The research team, led by Dr Sara Mederos and Professor Sonja Hofer, mapped out how the brain learns to suppress responses to perceived threats that prove harmless over time. 

“Humans are born with instinctive fear reactions, such as responses to loud noises or fast-approaching objects,” explains Dr Mederos, Research Fellow in the Hofer Lab at SWC. “However, we can override these instinctive responses through experience – like children learning to enjoy fireworks rather than fear their loud bangs. We wanted to understand the brain mechanisms that underlie such forms of learning”.

Using an innovative experimental approach, the team studied mice presented with an overhead expanding shadow that mimicked an approaching aerial predator. Initially, the mice sought shelter when encountering this visual threat. However, with repeated exposure and no actual danger, the mice learned to remain calm instead of escaping, providing researchers with a model to study the suppression of fear responses. 

Based on the lab’s previous work, the team knew that the ventrolateral geniculate nucleus (vLGN) could suppress fear reactions when active and was able to track knowledge of previous experience of threat. The vLGN also receives strong input from visual areas in the cerebral cortex, and so the researchers explored whether this neural pathway had a role in learning not to fear a visual threat. 

The study revealed two key components in this learning process: (1) specific regions of the visual cortex proved essential for the learning process, and (2) a brain structure called the ventrolateral geniculate nucleus (vLGN) stores these learning-induced memories.

“We found that animals failed to learn to suppress their fear responses when specific cortical visual areas were inactivated. However, once the animals had already learned to stop escaping, the cerebral cortex was no longer necessary,” explained Dr Mederos.

“Our results challenge traditional views about learning and memory,” notes Professor Hofer, senior author of the study. “While the cerebral cortex has long been considered the brain’s primary centre for learning, memory and behavioural flexibility, we found the subcortical vLGN and not the visual cortex actually stores these crucial memories. This neural pathway can provide a link between cognitive neocortical processes and ‘hard-wired’ brainstem-mediated behaviours, enabling animals to adapt instinctive behaviours.”

The researchers also uncovered the cellular and molecular mechanisms behind this process. Learning occurs through increased neural activity in specific vLGN neurons, triggered by the release of endocannabinoids – known to regulate mood and memory. This release decreases inhibitory input to vLGN neurons, resulting in heightened activity in this brain area when the visual threat stimulus is encountered, which suppresses fear responses. 

The implications of this discovery extend beyond the laboratory. “Our findings could also help advance our understanding of what is going wrong in the brain when fear response regulation is impaired in conditions such as phobias, anxiety and PTSD. While instinctive fear reactions to predators may be less relevant for modern humans, the brain pathway we discovered exists in humans too,” explains Professor Hofer. “This could open new avenues for treating fear disorders by targeting vLGN circuits or localised endocannabinoid systems.”

The research team is now planning to collaborate with clinical researchers to study these brain circuits in humans, with the hope of someday developing new, targeted treatments for maladaptive fear responses and anxiety disorders.

Source: Sainsbury Wellcome Centre

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Postpartum Depression Discovery Opens Door to Blood Test, Earlier Treatment

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Photo by Alina Matveycheva

New postpartum depression research from the School of Medicine and Weill Cornell Medicine could lead to a blood test to identify women at risk and possibly even to a preventive treatment.

The research, published in Neuroposychopharmacology, suggests that pregnant women may have characteristic levels of certain molecules in their blood that can warn that they are at risk of developing postpartum depression (PPD). These molecules, called neuroactive steroids, are derived from progesterone.

Measuring those molecules via a simple blood test could let doctors get women treatment for PPD sooner – possibly even before symptoms appear, the researchers say. “Studying postpartum depression gives us a way to identify biological changes that occur before someone becomes depressed because the timing of postpartum depression is predictable,” said researcher Jennifer Payne, MD, an expert in reproductive psychiatry at UVA Health and the University of Virginia School of Medicine.

Understanding Postpartum Depression 

Postpartum depression affects 10% to 15% of new moms.

“Postpartum is the only time in people’s lifespans when we know there is a biological trigger which guarantees that a certain percentage of people will become ill,” said Weill Cornell’s Lauren Osborne, MD, who co-led the study with Payne. “If we can untangle this biology and find predictors for it, not only will we be helping women, but it may give us a step up in trying to find predictors for other psychiatric illnesses also.”

It’s unclear why some women develop postpartum depression, but the new findings suggest that an imbalance in the body’s metabolism of progesterone may be a factor. 

About the Study

To better understand the role of progesterone, the researchers focused on the hormone and on its “metabolic pathway” in the body. The scientists measured levels of neuroactive steroids derived from progesterone in the blood of 136 women during their second and third trimesters. Of these, 33 went on to develop postpartum depression after giving birth.

Two neuroactive steroids seem to affect the risk of developing PPD – pregnanolone and isoallopregnanolone. Pregnanolone acts on a particular cellular receptor to reduce stress. Isoallopregnanolone, on the other hand, acts on the same receptor to increase stress.

In the third trimester, women who went on to develop PPD had a lower pregnanolone/progesterone ratio and a higher isoallopregnanolone/pregnanolone ratio compared with those who did not, the researchers found. Elevated progesterone levels in late pregnancy were also associated with a higher risk of PPD.

Next Steps

The researchers plan to attempt to replicate their results in a larger, more diverse group of women in hopes of developing a clinical test to predict the risk of PPD. Further, they say their work could lead to a preventive treatment – possibly one of two prescription drugs, brexanolone and zuranolone, already available to treat PPD.

“We don’t know if these drugs would work as a preventive measure for people who are at risk of developing postpartum depression, but based on our findings, they have the potential to prevent [its] development,” Osborne said.

Source: University of Virginia Health System

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Coping with the Fear of Breast Cancer Recurrence

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Breast cancer is the world’s most prevalent cancer. Although earlier detection and targeted treatment have resulted in high survival rates, many breast cancer survivors experience fear of cancer recurrence. For some survivors this fear is occasional, for others it is persistent and often debilitating.

A new study of breast cancer survivors has found this psychosocial challenge impacts almost every important domain of their lives – the emotional, behavioural, cognitive, relational and professional. A larger number of domains was affected, and they were affected more frequently in those with greater fear of recurrence.

“Study participants were reportedly disease free and trying to rebuild their lives during their post-treatment survivorship,” said senior author Shelley Johns, PsyD, a researcher-clinician with the Regenstrief Institute, the Indiana University School of Medicine and the IU Melvin and Bren Simon Comprehensive Cancer Center. “Our findings provide clarity about how breast cancer survivors are impacted by fear of recurrence and insight into how they cope with this understandable fear.”

The study was published in Supportive Care in Cancer.

The impact of fear of recurrence ranged from mildly to severely disruptive. Women experiencing mild fear reported sporadic occurrences. Those with significant fear described it as persistent and/or easily triggered across multiple life domains.

Disturbed sleep prior to mammograms was reported by survivors with mild fear, while frequent need to absent themselves from social activities, get into bed and pull the blanket over their eyes to avoid thinking about cancer was an example of severe, also known as clinical, fear of recurrence. Approximately 74 percent of study participants were experiencing clinical fear of recurrence.

347 women completed the study’s open-ended survey:

  • Many reported feelings of stress, irritability and sadness.
  • Some said fear of recurrence frequently interrupted their train of thought, for example interfering with their job when their disease popped into their mind.
  • Survivors who thought that they were more worried than they should be compared to other breast cancer survivors reported feelings of embarrassment.
  • Some indicated it was too hard to be around their family because they were constantly wondering how many more Christmases and birthdays they were going to have with their children.

The paper’s title includes the phrase, “out of a dark place,” a direct quote from a breast cancer survivor who said that she joined the study to support “getting out of a dark place.”

Other survivors noted the specific impact of fear of cancer recurrence on daily life:

  • “It motivates me to maintain healthy habits. Such as eating five servings of fruits and vegetables, working out and drinking less alcohol. It also motivates me to maintain mental health and physical health.”
  • “Whenever I feel any kind of pain or discomfort in the area where I had cancer it concerns me and I feel anxious and irritable.”
  • “Cancer is all around us. Everything is a trigger. Anniversaries, other family/friends’ diagnosis, commercials about drugs, social media, etc. …it’s a daily thought or a daily emotion.”
  • “Sit for hours doing nothing, do not turn on TV, sleepless, find hours pass by and I am in the same place just thinking, do not participate in activities, get lost driving because I’m deep in thought, compulsive online shopping, collecting things.”

Survivors offered specifics on their coping mechanisms:

  • “Just trying to be positive, eat healthy, take my meds, get enough sleep, exercise three times a week, and hope for the best.”
  • “I try to avoid things that make me think about recurrence. For example, unfollowing social media accounts, fast forwarding or leaving the room when commercials about cancer medications are on.”
  • “I try not to focus on it. I also speak with family members who have lived with cancer longer than myself.”
  • “Prayer, meditation, staying in the moment, and focusing on making the best of each day.”

While many survivors cited avoidance of thoughts and feelings as their primary coping behaviour, Dr Johns, a health services researcher and clinical health psychologist, observes that research is needed to probe the function of various coping behaviours’ to determine if they are helpful.

In a question seldom posed to participants in a clinical trial, when asked what they hoped to gain by participating in the study, the majority indicated that they sought senses of purpose, belonging, control and connection with others.

The paper concludes, “Fear of cancer recurrence is one of the most common psychological challenges for cancer survivors. Understanding affected life domains, coping strategies employed prior to intervention, and reasons for seeking guidance can inform the development and implementation of evidence-based interventions to effectively address fear of cancer recurrence among persons living with breast cancer.”

Source: Regenstrief Institute

Categories : Mental Health Metabolic DisordersTags :

What’s the Mechanism behind Behavioural Side Effects of GLP1RAs?

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Glucagon-like peptide 1 receptor agonists (GLP1RA) – medications for type 2 diabetes and obesity that have recently been making headlines due to a rise in popularity as weight loss agents – have been linked with behavioural side effects. A large population-based analysis in Diabetes, Obesity and Metabolism assessed whether certain genetic variants might help explain these effects.

GLP1RA mimic the GLP-1 hormone in the body that helps control insulin and blood glucose levels and promotes feelings of satiety. GLP-1 binds to GLP1R on cells in the brain and pancreas.

Observational and epidemiological studies have shown that there may be neutral or protective effects of GLP1RAs on mental health symptoms. However, a study based on individuals taking GLP1RA suggests there is increased prescription of anti-depressants when used for treatment of diabetes. Early evidence in animal models suggest GLP1RA may decrease depressive and anxious symptoms, potentially presenting new treatment pathways; however, comparing these studies to human clinical evidence will not be possible for some time.

For the analysis, investigators examined common genetic variants in the GLP1R gene in 408 774 white British, 50 314 white European, 7 667 South Asian, 10 437 multiple ancestry, and 7641 African-Caribbean individuals.

Variants in the GLP1R gene had consistent associations with cardiometabolic traits (body mass index, blood pressure, and type 2 diabetes) across ancestries. GLP1R variants were also linked with risk-taking behavior, mood instability, chronic pain, and anxiety in most ancestries, but the results were less consistent. The genetic variants influencing cardiometabolic traits were separate from those influencing behavioral changes and separate from those influencing expression levels of the GLP1R gene.

The findings suggest that any observed behavioral changes with GLP1RA are likely not acting directly through GLP1R.

“Whilst it is not possible to directly compare genetic findings to the effects of a drug, our results suggest that behavioural changes are unlikely to be a direct result of the GLPRAs. Exactly how these indirect effects are occurring is currently unclear,” said corresponding author Rona J. Strawbridge, PhD, of the University of Glasgow, in the UK.

Source: Wiley

Categories : Mental Health NeurologyTags :

Elevated Opioid Neurotransmitter Activity Seen in Patients with Anorexia

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A study conducted at Turku PET Centre in Finland and published in showed that changes in the functioning of opioid neurotransmitters in the brain may underlie anorexia.

Anorexia nervosa is a serious psychiatric disorder characterised by restricted eating, fear of gaining weight, and body image disturbances, which may lead to severe malnutrition, depression and anxiety. This new study from Turku PET Centre, published in Molecular Psychiatry, shows how changes in neurotransmitter function in the brain may underlie anorexia.

“Opioid neurotransmission regulates appetite and pleasure in the brain. In patients with anorexia nervosa, the brain’s opioidergic tone was elevated in comparison with healthy control subjects. Previously we have shown that in obese patients the activity of the tone of this system is lowered. It is likely that the actions of these molecules regulate both the loss and increase in appetite,” says Professor Pirjo Nuutila from the University of Turku.

Number of opioid receptors in the brain (top row) and sugar intake (bottom row) in patients with anorexia nervosa. Credit: University of Turku

In addition, the researchers measured the brain’s glucose uptake. The brain accounts for about 20% of the body’s total energy consumption, so the researchers were interested in how a reduction in the energy intake affects the brain’s energy balance in anorexia.

“The brains of patients with anorexia nervosa used a similar amount of glucose as the brains of the healthy control subjects. Although being underweight burdens physiology in many ways, the brain tries to protect itself and maintain its ability to function for as long as possible,” says Professor Lauri Nummenmaa from Turku PET Centre and continues:

“The brain regulates appetite and feeding, and changes in brain function are associated with both obesity and low body weight. Since changes in opioid activity in the brain are also connected to anxiety and depression, our findings may explain the emotional symptoms and mood changes associated with anorexia nervosa.”

Source: University of Turku

Categories : Mental HealthTags :

Challenges in Caring for Adopted Patients with Limited Family Medical History

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A study based on interviews with primary care physicians has found that treating patients who were adopted is challenging due to limited access to their family medical history. The study, published in Annals of Family Medicine, also found that there was a desire by physicians to fill the information using genetic testing.

Adopted individuals often only have limited information about their biological family, or even none at all, complicating their treatment. The growing availability and popularity of direct-to-consumer genetic testing kits amplifies the need for physicians to be prepared to address genetic testing for adoptees with limited family medical history. To address this, the present study explored the approaches of primary care physicians when caring for adult adopted patients with limited family medical history.

In-depth interviews were conducted by the researchers, including hypothetical clinical scenarios,  with 23 primary care physicians from Rhode Island and Minnesota to understand their experiences, practices, knowledge, and training gaps when addressing limited family medical history and adoption-related issues.

The researchers found that primary care physicians report knowledge gaps and receive little training or resources on adult adoptees with limited family medical history. As a result, they seek guidance around appropriate preventative screening and genetic testing. Limited interaction with adoptees compared to non-adopted patients also influenced perceptions. There was also an over-reliance on stereotypes and the danger of inaccurate media representation affecting how physicians interacted with adoptee patients. Likewise, those physicians who had experience with adoption might be at risk of over-generalising those experiences, especially given how heterogeneous adoptees are as a population.

Furthermore, the researchers found that mental illness and trauma are under-recognised and under-addressed. Care for adoptees includes trauma-informed care which can address factors such as loss, grief, identity development, and to helping adoptees in searching for biological family, reunion, or with complex family dynamics.

To make matters worse, primary care physicians often obtain family medical history imprecisely, risking miscommunication, microaggressions, and damage to the patient-physician relationship.

The findings of this study highlight the significant gaps in knowledge and training for primary care physicians caring for adult adopted patients with limited family medical history. Addressing these gaps may improve the quality of care and strengthen physician-patient relationships. 

Source: EurekAlert!

Categories : Mental Health Obstetrics & GynaecologyTags :

PTSD and Anxiety may Affect Reproductive Health in Female Firefighters

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Source: CC0

A new study led by University of Arizona researchers in collaboration with fire service partners and other researchers around the country through the Fire Fighter Cancer Cohort Study showed that post-traumatic stress disorder and anxiety are associated with lower levels of anti-Müllerian hormone, a marker of ovarian reserve, among women firefighters.

The ovarian reserve, a measure of fertility, is the number of healthy eggs in a woman’s ovaries that could potentially be fertilised.

“These findings highlight the negative effect that mental health conditions can have on health – specifically, reproductive health,” said first author Michelle Valenti, MPH, a doctoral student in epidemiology at the Zuckerman College of Public Health and program coordinator of the Fire Fighter Cancer Cohort Study’s Women Firefighter Studies.

The paper was published in the Journal of Women’s Health.

Firefighters are exposed to high stress and traumatic situations in addition to chemical exposures and have a higher prevalence of PTSD compared with the general population. Previous research showed that women firefighters have lower levels of anti-Müllerian hormone compared with women who are not firefighters; however, the reason why was unknown.

The research team, which included personnel at the Zuckerman College of Public Health’s Center for Firefighter Health Collaborative Research, led this analysis to determine whether anxiety, depression or PTSD were associated with anti-Müllerian hormone levels. They found that clinical diagnoses of PTSD and anxiety among women firefighters were associated with reductions in anti-Müllerian hormone levels of 66% and 33%, respectively.

These findings highlight a potential mechanism through which adverse mental health conditions could lead to adverse reproductive outcomes. Further research is needed to identify potential areas for intervention.

“The work of this AMH study within the broader context of the FFCCS is imperative to taking care of all of our firefighters,” said Captain Caitlin St. Clair of the Puget Sound Regional Fire Authority. “These findings provide scientific leverage to fire departments to implement programs to reduce stress and improve the lives of our firefighter women.”

The Women Firefighter Study, a subgroup of the Fire Fighter Cancer Cohort Study, aims to identify causes of stress, cancer and adverse reproductive health effects in women firefighters that would inform effective interventions to mitigate these conditions.

“This study demonstrates the power of the Fire Fighter Cancer Cohort Study’s Women Firefighter Study to evaluate exposures that lead to adverse gynaecologic conditions,” Valenti said. “The Women Firefighter Study would not be possible without our amazing fire service partners who have championed women firefighter research.”

Source: University of Arizona Health Sciences

Categories : Mental HealthTags :

New Research Reveals Recent Trends in ADHD Diagnoses

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Source: Paul, et al. 2024, Psychiatric Research and Clinical Practice

New research has identified differing trends in attention-deficit/hyperactivity disorder (ADHD) diagnoses among adolescents and adults, including an increase among adults from 2020 to 2023. The study, published in the American Psychiatric Association Journal Psychiatric Research and Clinical Practice, found a significant downward trends in ADHD incidence among adults from 2016 to 2020 and adolescents from 2016 to 2018. The ADHD incidence rate remained stable for adolescents in subsequent years.

ADHD is a neurodevelopmental disorder involving inattention and/or hyperactivity and impulsivity that interferes with a person’s functioning and ability to perform daily activities, including at school or work. ADHD is often viewed as a condition primarily impacting childhood and adolescence; however, it can also affect adults. Research on the prevalence of ADHD in adults remains limited, with findings varying considerably.

The large retrospective cohort study, conducted by researchers at Saint Louis University and SSM Health, involved more than 140 000 adolescents and adult patients who used services with a large healthcare system located in four states. New ADHD diagnoses were identified using patient charts. Regression analysis was used to determine incidence rates and trends in ADHD diagnoses by age group.

They found a significant downward trend in ADHD incidence among adults from 2016 to 2020 and an upward trend from 2020 to 2023. Among adolescents, a significant downward trend was observed between 2016 and 2018, and the incidence rate remained stable between 2018 and 2023.

“Fluctuations in incidence rates are likely due to a complex interplay of various factors,” the authors write. For example, increased awareness and destigmatisation of ADHD can lead to more diagnoses. Changes in diagnostic criteria, such as the expansion of ADHD criteria in the DSM-5 compared to previous editions, may have contributed to an increase in diagnoses. Variations in diagnostic practices and assessment methods can contribute to differences in incidence rates. In addition, there are some indications, the authors note, that the COVID-19 pandemic may have contributed to new ADHD diagnoses and worsening symptoms.

The authors suggest that this research can support future efforts to identify modifiable risk factors, ensure sufficient treatment resources, develop targeted interventions, and address diagnostic disparities.

Source: American Psychiatric Association

Categories : Mental HealthTags :

Job Strain Compromises Sleep Quality Years Later

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In a recent study published in the American Journal of Industrial Medicine, middle aged workers in the US who reported high job strain at the start of the study experienced significantly more sleep disturbances over an average follow-up of nine years.

The study analysed data from 1721 workers, with an average age of 51 years, who participated in the Midlife in the United States (MIDUS) study. Sleep disturbances were assessed with an established scale, based on four sleep-related symptoms: trouble falling asleep, waking up during the night and having difficulty going back to sleep, waking up too early in the morning and being unable to get back to sleep, and feeling unrested during the day no matter how many hours of sleep.

The team used six different formulations to quantify job strain based on Karasek’s Job‐Demand‐Control model, which defines job strain as a combination of high job demand and low job control. All formulations showed significant associations between higher job strain at baseline and increased sleep disturbances over time.

“Our findings also suggest that the continuous formulations of job strain demonstrate better model performance with consistent and robust results, offering empirical evidence for future psychosocial occupational health research in the United States,” said the first author Yijia Sun, an MS candidate at the University of California, Los Angeles.

Corresponding author Jian Li, MD, PhD, a professor of Work and Health at the University of California, Los Angeles, noted that there is an urgent need for workplace interventions to reduce stress. “Strategies such as redesigning workloads and promoting worker autonomy could play an important role in improving sleep health and workers’ well-being,” he said.

Source: Wiley