Jan 17

Neuroplasticity (src:goconqr)For a long time, the brain of an adult was considered as a rigidly fixed, hard-wired organ. The latest scientific findings, however, show just the opposite, proving not only something that Buddhists have always known, but also illustrating why psychotherapy ‘works’ ‚Ķ and that many of our weaknesses might actually be more changeable than we had dared to hope.

One of the most fascinating areas of research in neurobiology is the one dealing with the so-called ‘neuroplasticity’, or ‘neural plasticity’. This term refers to the ability of synapses, nerve cells or entire areas of the brain to change and adapt depending on their use. Depending on the neural system referred to, it may also be called ‘synaptic plasticity’ or ‘cortical plasticity’. The basis for the discovery of the adaptability of the brain and nerve cells was the research of psychologist Donald O. Hebb (1904-1985).

Researchers at the University of Zurich showed for example that for someone who experienced a right humerus fracture and was restricted to use only his left hand, striking anatomical changes could be proven in specific brain areas after just 16 days: the thickness of several sections of the left brain hemisphere was reduced, while parts of the right hemisphere compensating for the injury increased in size. Also, the fine motor skills of the compensating hand had improved significantly.

Simple, but amazing results in tests confirm that even the basic act of imagination can enlarge areas of the human brain: brain researcher Pascual-Leone, for instance, asked volunteers to practice a simple piano piece and then analyzed the motor areas of their cerebral cortex. He found that the area which is responsible for controlling the finger movements had increased in size. So it appears that the popular comparison by teachers to see the brain as a muscle is actually not that far-fetched: if certain areas of our brain are continuously used and ‘exercised’, they seem to develop – and our skills and the information that can be stored in these cerebral areas will increase accordingly.

In another experiment, the subjects should just imagine to play the piano piece for a certain amount of time. The astonishing result: exactly the same areas of the brain had been found changing as in the volunteers who had actually practicioned the piece on the piano. So just by thinking or by mental training alone – by an activation of the involved neural circuits -, physiological changes of the brain can apparently be stimulated.
Quite an amazing story in this context is the one of painter Esref Armagan, who has been blind from birth. Nevertheless, he is able to create realistic images of buildings and landscapes that he knows only from descriptions. Although the visual areas of his brain had never received an external visual stimulus, the associated brain areas are as active as the ones of someone who can see: just by the descriptions of the objects he later paints on paper, his brain is recognizing mental images.

Mere imagination can seemingly have enourmous effects on our brain, and actually we already know such effects from psychotherapy : it’s range of methods allows to ‘try’ new behaviors and mental concepts in the client’s imaginagion or the therapeutic practice. Later on, they can ultimately be implemented in the life ‘out there’. Piece by piece, old and hindering concepts of thinking are replaced by others that can make us happier, more confident and help us to achieve our personal goals and needs in more successful ways than before. It explains why psychotherapy can achieve supportive effects even with severe mental illnesses and neurological disorders.

To Buddhists experienced in meditation, all this will not sound new at all: if someone is able to concentrate on one thought for a long time, negative thoughts can gradually be overcome. By overcoming those thoughts that cause mental suffering, however, a physiological and permanent adaptation of the brain circuits may be achieved that had caused these negative thoughts before. What can be achieved by the external and professional guidance of a trained psychotherapist, Buddhist monks can reach only by themselves through years of meditation practice.

Therapeutic effects of neuroplasticity have been documented after strokes, in pain treatment, in autism, for symptoms of paralysis, learning difficulties, phantom pain and many more (many of which are mentioned in detail in the videos and the bibliography linked below). Just as epigenetics, neuroplasticity seems to be an evolutionary factor by which humans can gradually adapt to the demands of the environment they live in.

Resources and links:


The Brain That Changes Itself – short documentary: Canadian psychiatrist and psychotherapist Norman Doidge about the adaptability of the human brain.

Neuroplasticity and Rehabilitation   by Sarah A. Raskin
The Brain That Changes Itself   by Norman Doidge
The Mind and the Brain: Neuroplasticity and the Power of Mental Force   by Sharon Begley
Books about Neurobiology   (german)

(Sources: N. Langer et.al, Effects of limb immobilization on brain plasticity in: Neurology, Jan 17, 2012;
Image sources: goconqr.com, persoenlichkeits-blog.de)

Blog entry first released in 08/2010 in german language (‘Neuroplastizit√§t’); continuously updated, last update: Jan 18, 2012)

Dec 31

To a high extent, the work of a psychotherapist consists of the treatment of the various forms of depression, so I’ve always tried to improve my understanding of this particular form of mental disorder – and of its most extreme form, the idea to commit suicide. So I’ve continuously gathered data on suicide – here you will find a compendium of the information I found, a sort of overview of the currently known facts and figures on this subject.

Frequency

It is estimated one million people a year die by suicide, which equals about one every 40 seconds – but that number may actually be even significantly higher, since the official numbers released by many countries are too low. Suicide thus contributes at least 1.5 percent of the global deaths and is the tenth leading cause of death. In 2006, 140,000 people had taken their lives, that equals 11.1 per 100,000 people. People under 25 years of age are most vulnerable (there was no significan change compared with previous years), and the elderly (where a significant decline in suicides was found).

Trends in some OECD countries, graph: OECD

Regional differences: within Europe, the rates in the northern countries are generally slightly higher than in the southern ones. An effect of latitude on the suicide rate was found in Japan, suggesting an influence of the daily duration of sunshine. Nevertheless, other countries can have significantly different rates of suicide compared to Japan at the same latitudes, like Great Britain or Hungary for example. Suicide is a significant problem in the former Soviet states, and more than 30 percent of suicides worldwide occur in China, where 3.6 percent of all deaths are attributed to suicide.
Regarding the impact of light/solar radiation by correlating the suicide rate with the number of hours of sunshine a day, a seasonal clustering of cases of suicides could be proved in 2011 in a study by the Medical University of Vienna that was published in the journal “Comprehensive Psychiatry”.

Particularl attention deserves South Korea where in recent years, the suicide rates have increased drastically, namely by 172% to 21.5 per 100,000. The number of suicides by men has almost tripled from 12 per 100,000 (1990) to 32 per 100,000. With 13 of 100,000, the suicide rate among women is also the highest. The OECD attributes the rise in suicides on the economic decline, dwindling social integration and the disintegration of traditional family bonds. But it may be doubted whether this is really something that extraordinary compared to Mexico (+43%), Japan (+32%) and Portugal (+9%), which also reported an increase in the suicide rate. In Hungary, the suicide rate has declined by 41 percent, but the country, with 21 suicides per 100,000, is still second only to South Korea. Finland’s numbers are also above average with a high suicide rate of 18, followed by France (14.2), Switzerland (14), Poland (13.2) and Austria (12.6, 27/100,000 in men, in women 10/100,000). Germany, where the number of suicides compared to 1990 decreased by 37 percent, with 9.1 in the lower third. Apart from Great Britain (6.1) and Mexico (3.1) the situation appears on the Mediterranean people to do well. In Spain (6.3) and Italy (4.8), far fewer people kill themselves than in other OECD countries. And the Greeks are drawn the least to commit suicide: here, just 2.8 per 100,000 kill themselves

Conflicting data on the so-called happiness research was revealed by a remarkable study analyzing the correlations between life satisfaction and suicidal tendencies. In a comparison with the average satisfaction of people according to the “World Values ‚Äč‚ÄčSurvey” and the suicide rates according to the WHO, the suicide rate is not only very high in the Scandinavian countries in spite of their high satisfaction but also in Iceland, Ireland, Switzerland, Canada or the U.S. The conclusion of the study was that the relation between high life satisfaction and high suicide rates was independent of harsh winters, religious and cultural differences in different countries (more)

One possible explanation for this ostensible contradiction could be that in an environment where many other people are ‘happy’, own discontent, own suffering is felt more strongly. If there is also despair of beign able to achieve a change, certain personality types may see suicide as a way out.

A few more details about Austria: in Salzburg, the Crisis Intervention Center (‘Kriseninterventions-Zentrum’; of others, I don’t have any data) recorded a significant increase in patients in their teens in 2010. In Austria, about twice as many people die by their own hand than after traffic accidents every year. In 2002, 1.551 chose to commit suicide, including 50 children and adolescents aged ten to 20 years. Self-injuries in children are also on the rise. At the whole of Austria, the suicide rate of the early 1960’s has risen sharply until the mid-1980’s – to 24 suicides per 100,000 of the population. Since then, the rate decreased and it is now (as already mentioned above), at 13 per 100,000 per year. This equals about 1,300 suicides per year.

However, there are growing doubts within the Austrian scientific community as to the accuracy of these statistics, and I want to outline them a bit further to help you, the reader, understnad the underlying problems of suicide studies: fewer and fewer autopsies are performed as in Austria, which decreases the possibility to distinguish suicides from natural deaths. Thus, in countries with the highest autopsy rates as in the Baltic states or Hungary, the suicide rates are generally higher than in countries with low autopsy rates. Similarly, in countries where autopsy rates are declining, at the same time there are also increasingly fewer registered suicides (Source: Archives of General Psychiatry 2011 (Link). So with statistics like these, there is always reason to question whether such statistics can be trusted at all.

More gender-related details: is in the developed countries, the gender ratio of suicides is roughly 2-4 (men) : 1 (women) and seems to be increasing. Asian countries show a smaller ratio, but it seems to be increasing as well. Only China has more women than men dying from suicide.

Risk factors for suicide

Among the many factors that may raise the risk of suicide, the most important known ones currently seem to be:

  • male gender (OECD: 17.6 per 100,000 males, 5.2 for women)
  • a history of self harm
  • psychiatric disorders and / or
  • Alkohol-/Medikamentenmissbrauch
  • upbringing and education
  • suicide depictions in the media
  • smoking

Genetics and Neurobiology

Autopsies of suicide victims showed changes in central neurotransmission functions, such as the serotonin system (mood-regulating hormones). Low cholesterol concentrations are associated with higher suicide risk, but the risk is greater if the lower cholesterol level was reached with diets rather than by using statins. The authors suppose that this may stem from the fact that dieting people have a higher risk of mental problems, but so far, there was no corroborating evidence for this theory. Furthermore, family histories of suicide at least double the risk for girls and women. Although the evidence is scanty here as well, a number of researchers suggest that high levels of aggressive behaviors and impulsiveness may also be associated with an increased risk of suicide. Especially in young boys, suicide rates increase over the years of their growing up, while a higher suicide risk because of hereditary components was primarily detected on the maternal side.

Professional guilds

Suicide rates are higher among non-workers (unemployed, retired etc.) than among employed persons/professionals. Higher rates are also partly linked to mental illness, which in turn has a connection with unemployment.

Among the professionals, however, some groups show an increased risk: medical practitioners have a high risk in most countries, and doctors (and related jobs in the health professions) generally have the highest risk. Nurses also have a high risk. Particularly in these groups, the easy access to venoms seems to be an important factor influencing the high rates. Anesthesiologists are particularly vulnerable among physicians because narcotic drugs are used in many suicides. Several other high-risk professions are dentists, pharmacists, veterinarians and farmers.

Age Groups, Ethnicity, ..and Seasons

In most countries, suicide rates are highest amongst elder people, however, in the past 50 years, the rates among the younger population has increased as well, especially in men. Suicides are committed most frequently in spring, especially among men as well. People born during spring or early summer have an increased risk of suicide, especially women. Americans of European descent have higher suicide rates than Americans of Latin American or African origin, with this difference increasingly leveling out amongst young African Americans due to the increased suicide rate among young African Americans slowly. Indigenous groups such as Aborigines in Australia and Native Americans also have higher suicide rates, possibly due to cultural, social exclusion and greater alcohol abuse.

Suicide Methods

Quite generally, men prefer more violent means of suicide (for example, by strangulation or shooting themselves), and women ‘softer’ forms (self-poisoning), which is probably the explanation for the sharp difference in successful suicides between men and women (see above) and the suicide attempts that both sexes undergo in about equal rates. Different cultures show different preferences in methods, in South Asia for example, women typically burn themselves. Access to specific methods could be the factor that finally leads to putting suicidal thoughts into action. In the U.S., firearms are used for by far the most suicides, with the risk of using them for this purpose being the highest where guns are found in households. In the rural areas of many developing countries, the ingestion of pesticides is the most common method, which reflects the toxicity, easy availability and the lack of storage. At up to 30 percent of suicides worldwide, pesticides are involved.

Comorbidities und Connections with Mental Disorders

Mental health problems are a major factor in suicides. It is believed that of about 90 percent of people who kill themselves, they suffered from a kind of psychiatric disorder. Depression increases the risk to the 15- to 20-fold, and about 4% of patients suffering from depression die by suicide – but only about 20-30% of depression are recognized (!). But even for those, in most cases many years are passing to the correct diagnosis, and then, still, less than 50% of the diagnosed patients ever starts looking for a psychotherapy and/or receives pure pharmacological support. This means that most people suffer on a chronical basis, but don’t search – or can’t find – adequate help.

Clinical signs of suicide where depression was involved, are patients with previous self-harm, hopelessness and suicidal tendencies. About 10-15% of patients with bipolar disorder die by suicide, but the risk is highest at the beginning of the disease. About 5% of schizophrenia patients also die by suicide. Alcohol abuse, anorexia, attention deficit-hyperactivity disorder (ADHD) and body dysmorphic disorder (KDS) all increase the risk of suicide. Especially the last example explains in part why the risk increases in women after breast-enlarging surgeries.

Physical health also plays a role, but with some strange results. Surprisingly, people with higher body mass index (BMI) have a significantly greater risk of depression, however, their risk of suicide is lower (15% decrease in suicide risk per 5 kg per square meter of body surface area increase in BMI). The reasons for this are unknown. Cancers, particularly of the head and neck, HIV / AIDS, multiple sclerosis, epilepsy and several other diseases also increase the risk of suicide.

Other factors that increase the risk of suicide include physical abuse and sexual abuse over the childhood, or events that affect the entire population (such as natural disasters or the deaths of celebrities). After the death of Diana, the Princess of Wales, in 1997, the suicide rate rose by 17%, most clearly in her age group. War involvements reduce suicide rates, possibly due to the social cohesion that is generated in the communities. People who have suffered a loss by suicide, are themselves at increased risk, and suicide clusters may occur in communities or through Internet contacts. The authors add: ‘A significant proportion of the evidence shows that certain types of media that report on or present suicidal behavior, may influence suicidal behavior and self-harm in the general population.’

A ‘hot potato’ in the psychiatric community are recent studies showing that even antidepressants can induce suicidal thoughts not only in adolescents, but also in adults. I already posted a few articles related to these studies in this blog.

(Sources for the aforementioned numbers: Health at a Glance 2009: OECD Indicators; MedAustria)

Suicide und Self-Injury

In addition to rising suicide rates, there is also an increase in self-harm among young people, as pedagogues report in many Western countries. The reasons for this may be traumatic experiences in early childhood. The brain has a high plasticity and very vulnerable to external factors during this stage of development. Serious diseases, sexual abuse, neglect and lack of communication in bringing up – often caused by hours in front of the television or computer games – are also considered to be significant risk factors for later suicide attempts. They may also cause children and adolescents to harm themselves physically. Burned skin from cigarettes or scratches from knifes or razor blades must be understood as a cry for help.

While in 1950, only 40% of people who attempted suicides were under 45 according to the WHO, we were already at 55% in 2004. A reason for depression occurring at earlier stages of life might be the earlier onset of puberty and the decaying of family structures. If there is healthy communication within the family, and if common concerns and problems can be expressed and discussed, it is much easier for young people to overcome a crisis.

(Source: Der Standard, 06/2004)

How can suicided be prevented?

Suicide preventionThe claim to be able to prevent suicides would be a difficult one to fulfill because of the large number of factors that are involved until it actually comes to a suicide attempt. Strategies could be aimed at high-risk groups or trying to reduce the risks for the population as a whole. Firstly, any person with depression should be checked for suicide risk by professionals specifically asking about suicidal thoughts and plans. This shows the importance of specific training and sensitivity of physicians who are often enough the only ‘professionals’ many depressive persons might have contact to at the first place. Studies from the Nordic countries show a decline in suicide rates by 20 to 30% after general practitioners were trained to recognize depression properly and to help patients to get appropriate therapy (psychotherapy and supportive pharmaceutical measures).

In cases of high or imminent suicide risk, immediate action is necessary, including vigilance and monitoring of those affected, possibly through hospitalization. In addition, potential tools that may be used for suicide attempts have to be removed and an aggressive treatment of the associated psychiatric disorder be initiated.

A restriction of access to potentially lethal substances or tools can indeed help to prevent suicides. The introduction of security cameras on bridges and increased control of firearms, as well as the safer storage of pesticides and poisons (especially in rural areas of developing countries) has been proven to significantly reduce the risks. Education programs to improve the mental well-being as well as stricter control of the media reporting of suicides could also have preventive effects. On the objection that persons who wish to commit suicide would find ways and means to realize their goal in any case it may come as a surprise that for example when switching from toxic coal gas to non-toxic North Sea gas in the UK, the suicide numbers declined dramatically, while, for example in Japan right after the release of two films that were romantically idealizing the issue of suicide, the corresponding numbers increased significantly. Helsinki had the world’s highest suicide rate in the 90s and was able to cut it to 18 per 100,000 through prevention programs.

Because on the internet – in addition to advice and instructions for suicide in ‘suicide forums’ – a new trend had been detected in Japan to arrange collective suicides online, the government of South Korea (which had recently suffered the world’s largest increase of suicides, see above) will block related Internet sites, and there are also plans to make it more difficult to find information about suicide on Internet portals by blocking specific keywords such as suicide, ‘how can I die’, ‘collective suicide’, ‘suicide techniques’ and others. In addition the government plans to create a legal basis for the police to request the personal information of Internet users from their service providers who promote suicide or offer advice to persons willing to undergo suicide.

The challenges to prevent suicides in developing countries requires special attention, as most of the suicide-related research is done in developed countries, while the highest suicide rates are in fact found in developing countries. On nation-wide measures it is also worth mentioning that after a recent meta-analysis of randomized studies ([1], [2]) had suggested that the risk of death and suicide in people with mood disorders receiving lithium has been reduced by 60 percent, researchers have brought up the idea of adding small doses of Lithium to tap water.

Family members and the social environment in general also have an essential role. Relatives may be the first ones who can notice that someone might isolate himself or is depressed. It is of utmost importance to recognize these signs (see article about presuicidal syndrome) and to talk to the affected person about it. Nevertheless, the options and means of family members and friends are often limited – it is therefore important to involve external help (a psychotherapist, counselor, psychiatrist or at least a family doctor) if one feels overwhelmed or feels no longer able to reach the person.

Treatment of Depression

That psychological treatment can prevent a suicide in many cases is a well known fact that has been proven in numerous studies. The World Health Report 2001 already reported, quoting several studies, that some mental disorders may be chronic and of long duration, but that with proper treatment, those suffering from mental disorders can now lead a productive life and participate in their communities. Up to 60% of people suffering from severe depression can get well with the right combination of psychotherapy and antidepressants. I’ve written a detailed article on this topic in the publications section of my German-language website, which specifically describes and comments the latest standards for the treatment of depression.

(Further sources: APA, AZ, Der Standard 03.06.04, The Lancet Vol. 373, Issue 9672, p.1372-1381, 18 April 2009, Telepolis [1], see also links to sources right within the article.
This blog entry was first published in 12/2009; continuously updated as soon as I get aware of new facts. Last updated: 12/2012).

more blog articles about suicide

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Dec 08

Image: WikiCommons licenseAdolescents who were abused and neglected have less gray matter in some areas of the brain than young people who have not been maltreated, a new Yale School of Medicine study shows. The brain areas impacted by maltreatment may differ between boys and girls, may depend on whether the youths had been exposed to abuse or neglect, and may be linked to whether the neglect was physical or emotional.

The results, published in the Dec. 5 issue of the Archives of Pediatric Adolescent Medicine, show that 42 adolescent subjects who reported being either abused or neglected show a reduction in gray matter — the tissue containing brain cells — even though they had not been diagnosed with a psychiatric disorder.

“Here we have teenagers who may not have a diagnosable illness but still have physical evidence of maltreatment,” said Hilary Blumberg, associate professor in the Departments of Psychiatry and Diagnostic Radiology and in the Yale Child Study Center, who is senior author of the study. “This could help to explain their trouble with school performance or increase their vulnerability to depression and behavioral difficulties.”

The reduction of gray matter was seen in prefrontal areas, no matter whether the adolescent had been physically abused or emotionally neglected. However, in other areas of the brain the reductions depended upon the type of maltreatment the youth had experienced. For example, emotional neglect was associated with decreases in areas that regulate emotions.

The researchers also found gender differences in patterns of gray matter decreases. In boys, the reduction tended to be concentrated in areas of the brain associated with impulse control or substance abuse. In girls, the reduction seemed to be in areas of the brain linked to depression.

Blumberg stressed these deficits found in adolescents are likely not to be permanent.

“We have found that the brain, particularly in adolescents, shows a great deal of plasticity,” she said (neuroplasticity; comment by R.L.Fellner). “It is critical to find ways to prevent maltreatment and to help the youths who have been exposed.”

(Source: YaleNews; E. E. Edmiston, F. Wang, C. M. Mazure, J. Guiney, R. Sinha, L. C. Mayes, H. P. Blumberg. Corticostriatal-Limbic Gray Matter Morphology in Adolescents With Self-reported Exposure to Childhood Maltreatment. Archives of Pediatrics and Adolescent Medicine, 2011; 165 (12): 1069 DOI: 10.1001/archpediatrics.2011.565)

Aug 18

A nice friend just sent me a link to this article:

Addiction is a brain disease, experts declare
(Source: L.A. Times, August 16, 2011)

But wait: addiction is now ‘a brain disease‘?!

Well, be warned – here comes a therapist’s viewpoint on that! ūüėČ

The scientific community in the US and Europe is highly influenced (or corrupted?) by the money invested into neuronal and neurochemical research (especially by the pharma and the genetic research industry, but also the American government and the EU for various reasons).

As a result, there are only comparably little funds available for more research on utilizing psychotherapy or even neuroplasticity, because with those becoming more effective, these huge money-maker industries would lose cash and stock value.

That’s why a huge part of this particular scientific community is still seeing us as machines (just like in the 18th and 19th century!), which just need the correct surgery or pill in order to work ‘as intended’ (whatever that is..) again.

The simplified claim that the brain is ‘responsible’ for addiction is actually ridiculous and just possible if such a scientist is wearing blinders, completely blinding out all other research fields related to human behavior. If these theories were right, it would not be possible for patients to successfully stop taking drugs, gambling, over-eating etc. within just 2-3 months during a successful psychotherapy.

But it is.

It would be as if I would announce that I have found prove that ants are only able to crawl because they have legs. Yeah right, but there is a little bit more to ants than just legs.

And even though I would agree that our consciousness, our psyche is at least to a large extent -if not completely- a product of our brain, it would still be incorrect to blank out all the other means this ‘computer’ has to repair itself apart from pills or a scalpel.

Aug 05

“What can I do, it’s in my genes!” In recent years, this has become a standard explanation for many of the health problems we have to face in our lives. Indeed, there are few human diseases without scientific studies trying to pinpoint ‘genetical causes’ as the root. Consequently, there are efforts to find genetic roots of mental problems as well. But 150 years after Mendel (the ‘father of modern genetics’) had outlined his ‘Laws of Inheritance’, we have still to see significant therapies that could wipe out major human burdens like cancer, addictions, diabetes or violence by purely genetical means. This is not to say that genetic science doesn’t have potential; but all the other influential factors should not be forgotten.

One of the weirdest aspects of the notion that all things human are genetically predetermined is that it takes everyone completely out of the context of their environment. We might as well not put personal or societal energies into trying to improve ourselves or others, because it’s inevitable and unchangeable anyway… But in fact there is just a very small number of very rare diseases that are truly genetically determined. Most complex conditions like ADHD, schizophrenia, a tendency to violence or addiction might have a predisposition that has a genetic component, but a predisposition is not the same as a predetermination. Genes just seem to give us different ways of responding to our environment. Some of the childhood influences and the method of child rearing in turn also affect gene expression; they can actually turn on or off various genes to put us on a different developmental track which may suit the kind of world we’ve got to deal with.

For example, a study done in Montreal with suicide victims looked at autopsies of the brains of these people and it turned out that if a suicide victim had been abused as a child, the abuse actually caused a genetic change in the brain that was absent in the brains of people who had not been abused. That’s an epigenetic effect: an environmental impact that is capable to either activate or deactivate certain genes.

So, in adaptation to the famous quote of Shakespeare, “There are more things in heaven and earth than are dreamt of in our scientific world.” And there are more things we can do to change ourselves than we might imagine.

(This short article is part of a weekly series dealing with psychological expat problems and general mental health issues and was published in various newspapers and magazines in Thailand, 2011)

May 03

Brain doping / drug abuseIt’s very simple now to order drugs over the Internet, and most pharmacies in Asia will sell medicines over the counter that are only available by prescription in the West. Most popular products in the online catalogs are amphetamines, potency pills and antidepressants. But self-medication is actually risky, particularly with amphetamines (such as Ritaline / methylphenidate),¬† which can enhance performance and concentration leading to dependency and requiring withdrawal treatment at specialized clinics or psychotherapists after months or years of abuse.

According to a study of U.S. pediatricians, the number of ‘doping’ students has increased by 75 percent over the last 8 years. Often the drugs are used incorrectly, like when the cause of poor concentration or erection problems lies somewhere else than where the drug attaches. Erectile dysfunction in men aged less than 55 years, for instance, mostly has purely psychological causes. Habitual intake often leads to overdosing and increased susceptibility to disease-causing side effects. At some point, the user might in fact just treat the withdrawal syndrome (for erectile dysfunction this is often fear of having sex without first taking the drug) – they feel no significant effect of the drug anymore but can not discontinue its use and thus enter a vicious circle. Multiple dependencies, like the use of amphetamines during the day and then in the evening intake of alcohol and / or tranquilizers or sleeping pills, makes everything even more complicated and dangerous. Abuse of prescribed medications causes more accidental deaths in the United States than anything else except automobile crashes, which kill more than 30,000 Americans every year.

The first signs of psychological dependence on drugs can be feelings of insecurity or fear if no intake is possible, or if there is an increase of the dose over time, but the effect of the drug doesn’t feel the same or is completely absent. Another alarm signal could be if over the years, more and more substances are taken in without consulting a medical doctor (this also includes food substitution drugs, injections of hormones, tranquilizers, sleeping pills, nose drops, etc.).

In most cases, drug dependence is admitted very late, after diseases of the organs have developed or accidents occured (often caused by a lack of concentration). For the psychological withdrawal, a combination of psychotherapy and support groups is very effective, but a medical checkup for possible physical damage is also essential.

(This short article is part of a weekly series dealing with psychological expat problems and general mental health issues and was published in various newspapers and magazines in Thailand, 2011)

May 30

Can we ‘modify’ our brain structure? Until recently, the general consensus among neuroscientists was that tbe brain structure is relatively immutable after a critical period during early childhood. But new findings reveal that many aspects of the brain remain plastic even into adulthood.
Neuroplasticity is a fascinating discovery referring to the ability of the brain and nervous system in all species to change structurally and functionally as a result of input from the environment. Naturally, this concept can explain much of why psychotherapy can be very effective to improve our mental wellbeing on a long-term basis, but it also has consequences the other way round:

German neuroscientists found out that cortical brain maps are shrinking and the sense of touch is waning when brain regions are not used for some time. Of professional musicians and braille readers we know that a more frequent and intense use of the hands can result in an astounding improvement of sensorimotor abilities. The representation of the hands on the “body map” of the brain is increased by training – but the process also works in reverse, as the neuroscience research group found.

If a hand – for example due to a broken arm – is not used for a while, its representation is reduced in the brain its sense of touch as well. With the affected hand, subjects took two needle points as a single one, even though they could clearly feel that there were two peaks with their good hand. However, these effects are also reversible: a few weeks after the plaster was took off, the sense of touch and the activity in the somatosensory cortex were back at the previous level. This leads to interesting hypotheses regarding the necessity of stimulation and an extent of challenge in our lives to keep our brains functional, maybe even to keep up our mental health in general.

Source: Current Biology, “Immobilization Impairs Tactile Perception and Shrinks Somatosensory Cortical Maps” (doi: 10.1016/j.cub.2009.03.065)

Dec 11

For mental illness, pretty much the same rules apply as for the body: the sooner you treat it, the better the prognosis. Researchers at the Department of Psychiatry of the RUB clinic in Bochum, Germany developed a concept for early detection and treatment of schizophrenia that already “clicks” at the first signs of the disease. An early treatment of schizophrenia patients in preliminary stages of the disease also reduces the risk of the disorder turning chronic.

For early detection, delusional symptoms, fleeting hallucinations, cognitive flexibility and general intelligence are analyzed. But until recently, one important factor often remained unconsidered according to the researchers: ‘social cognition’. The ability to empathize with others and to process emotional stimuli is often significantly impaired in the early stages of schizophrenia, regardless of other symptoms. Accordingly, psychoeducative methods are often more effective for treatment that antipsychotic drugs. Imaging studies demonstrate that the brain areas responsible for social cognition also show reduced activity in schizophrenic patients. It is the first time such research has been done for patients in the early stages of psychoses.

Source: MedAustria, Ruhr-Universitätsklinik Bochum (www.lwl.org)

More on the topic: Literaturtipps zum Thema “Psychosen” (german language)

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06.01.16