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Your Mental Health

'Chemo brain'

If you or someone you love has gone through the trial of chemotherapy for treatment of cancer, you have no doubt heard about many unpleasant side effects.

Nausea, tenderness, hair loss, weakness and fatigue are just a very few common side effects during treatment. The list of difficult symptoms is long and daunting. Once the final round of treatment is complete, the body slowly begins to recover and regain some strength. But even after the bulk of side effects have subsided, many survivors will talk about a phenomenon called ‘chemo brain’.

For some reason, after chemotherapy, between 20 and 30 percent of people experience some cognitive impairment. Symptoms can include: confusion, difficulty concentrating, fatigue, mental fogginess, fatigue, poor attention, difficulty finding the right word, poor memory and others. Symptoms typically last for a few years after treatment.

Until recently, there was some debate about the existence of this ‘chemo brain’ phenomenon but studies have indeed shown it to be a real and measurable side effect of chemotherapy in some people.

Although many people experience temporary cognitive impairment due to the stress, fatigue and depression that goes along with cancer diagnosis and treatment, the longer term symptoms of ‘chemo brain’ are another matter. Interestingly, they seem to mostly affect people experiencing breast, ovarian, prostate or other cancers of the reproductive system.

Studies have now shed some light into what may be causing these symptoms. Researchers at West Virginia University conducted brain imaging studies using PET/CT scans to show a physiological basis for post-chemotherapy cognitive impairment.

In the study, brain metabolism was compared before and after chemotherapy in 128 breast cancer patients. Results showed two brain regions with decreased metabolism after chemotherapy. The affected areas – the superior medial frontal gyrus and the temporal operculum – are known to be involved in prioritizing, problem solving, organizing and long-term memory. Not surprisingly, these are the areas often affected in ‘chemo brain’.

Since we now have more people surviving cancer and also receiving more aggressive chemotherapy treatment, this condition has become increasingly clinically important. Cognitive function can be measured. Ideally a person could have their cognitive functioning assessed before chemotherapy and then again after. This would allow comparison of before and after functioning for a specific individual. Alternatively, if one measures only when symptoms are noticed, one can compare functioning of that individual to an age and education matched control group. This is not as precise, but better than nothing. Cognitive impairment is very hard to assess from interview alone, except in very severe cases.

More research is needed to fully understand the condition, the prognosis for those who experience it and to determine if there are ways it can be prevented, treated or minimized while still effectively targeting the cancer.



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Untreated bipolar disorder

Bipolar disorder can be difficult to diagnose. Hallmark symptoms of moodiness and irritability are common to many other conditions and it is rare for the disorder to present in an immediately obvious manner.

Occasionally, an individual with bipolar disorder will present with psychotic symptoms or mania early in their illness – when this happens, an accurate diagnosis can happen quickly, but otherwise the process often takes years.

Researchers in France have studied more than 400 individuals with bipolar disorder to determine how long it took for them to accurately be diagnosed and properly treated.

Results showed it generally takes almost 10 years from the start of symptoms to the initiation of appropriate treatment of bipolar disorder.

In this group of patients, the mean age for symptoms to begin was 25.3 while the mean age for psychiatric treatment of any kind was 28.6. Appropriate treatment took much longer with the mean age being 34.9 years.

Children with bipolar disorder are often not recognized and, indeed, some people still believe, incorrectly, that children cannot be bipolar. They can present as attention deficit, oppositional, depressed or anxious. Adults can present as depressed, anxious or irritable. They are often diagnosed as having Borderline Personality Disorder.

Bipolar disorder is difficult to diagnose and also difficult to treat. When it is undiagnosed for many years, individuals suffer many adverse consequences such as substance abuse problems, legal problems, marital failure, educational and vocational failures.

By the time treatment begins, most patients and those around them will have come up with other explanations for all of these problems. These other explanations are often not very flattering and may lead to poor self-esteem, hopelessness and frustration.

A diagnosis, as serious as it is, may be accompanied by a sense of relief in finally having an explanation for a myriad of problems that previously seemed unrelated. A chaotic life comes into perspective and there is now at least hope for solutions.

It may also be a relief for loved ones who have been coping with (and sometimes blamed for) difficult, irrational behaviour for years without an understanding of what is happening.

I wish I could tell you a simple strategy to shorten the duration of this undiagnosed and untreated period. There is no simple way. The diagnosis requires skill and interest. If one doesn’t ask the right questions the diagnosis will not be made except in the most extreme cases.

I do believe the chances for an accurate and timely diagnosis are improved for those who see a psychiatrist. As trained specialists in mental illness, psychiatrists have the most experience with this group of patients. Nevertheless, it is not uncommon even for psychiatrists to miss this diagnosis or to make the wrong diagnosis. The two most common wrong diagnoses will be unipolar depression and Borderline Personality Disorder.

Wrong diagnoses do more than delay appropriate treatment. Incorrect treatment can make things worse. For example, treatment for depression or attention deficit disorder can induce mania or a mixed state if mistakenly given to someone with bipolar disorder.

Counseling is always recommended for everything and there is no doubt that most people feel better having someone who will listen and be supportive. This, however, can be mistaken for effective treatment and they may spend years exploring issues that are not really as important as they believe. This is both time consuming and expensive. Counseling can also cause harm when it is misdirected.

Keep an open mind, read, ask lots of questions, seek other opinions and hopefully you will get appropriate diagnosis and treatment early.



Character leads to success

Do you remember being disappointed about something as a kid and having a well-meaning adult tell you not to worry – that disappointments build character?

Those words of wisdom are not always welcomed when in the throes of some childish catastrophe, but they are wise nonetheless.

Author and speaker Paul Tough published a book on the subject – How Children Succeed: Grit, Curiosity and the Hidden Power of Character.

According to Tough, it is character more than IQ and standardized test scores that determines an individual’s success - and I agree with him.

Character is made up of a variety of non-cognitive qualities including perseverance, curiosity, conscientiousness, optimism and self-control. They have to do with a person’s ability to adapt, to work through disappointment and failure and to set and reach goals.

In today’s world it often seems as though these skills are overlooked in favour of teaching children to master the more easily measured abilities prized in the school setting – reading, writing, math and science. Ask any parent of a pre-school or school aged child and you will no doubt get an ear-full about their child’s progress in mastering language, reading and numbers. To be sure, these academic pursuits are important, but they do not define a person’s overall ability to succeed in the world.

Research indicates that although IQ and cognitive ability are part of the package, temperament or character traits are also critical and we ought to be spending more time thinking about how to develop these skills in our children.

In Tough’s book, he highlights the research by several American and Canadian scientists in the field and also follows the stories of children and the educators helping them.

He points out that one of the primary ways we develop skills like persistence is through failure – something from which we go to great lengths to shield our children.

Recently there has been much media attention surrounding the ‘no-zero’ policies within school systems in different parts of our country. These well-intentioned policies aim to give everyone the chance to succeed but they have stirred up controversy partly because they don’t reflect the way things work in the rest of life.

It is inevitable that we will not always get what we want – that we won’t be good at everything we try – that disappointment is part of the human experience.

An absolutely vital part of parenting, teaching and coaching is to teach our children how to manage negative experiences, to take away the lessons when they need to and put things behind them when necessary.

Although it is right to want to protect our kids from too much disappointment, there are times when we need to stand back a little and let them fall down so they can learn to pick themselves back up.



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Brain myths

In spite of our easy access to information in this technological age - or perhaps partly because of it – myths about the human brain abound.

You have undoubtedly heard people say that we use just a fraction of our brain. Imagine how much smarter we would be if we were only able to figure out a way to unlock the 90 percent of our brain’s potential that simply sits idle as we muddle through our lives.

This, of course, is false. Contrary to this widely held myth, we actually do use our entire brain. Different areas in the brain serve different functions and certain places are more active at times than others, but brain cells that are inactive will die.

Although I am not certain where this myth originated, it may be in part because when we look at brain images we often see just a small area ‘lit up’. Depending on what is being imaged, this does not mean that only one area is active or being used while the rest of the brain lies dormant.

Another very popular idea about the way our brains learn is the notion that providing a lot of rich stimulation to preschoolers will improve their brain or learning capabilities.

If you go into a toy store today you will be bombarded with myriad educational toys and products designed with this in mind.

It is true that studies in animals have found that rats kept in isolation fare worse than those in more stimulating cages with other rats for company or an exercise wheel. However, this study would translate better to a comparison between a severely neglected child and children exposed to the amount and types of stimulation one could expect in a normal household with human interaction.

Although educational toys and videos are just fine to use, it does not follow from existing scientific research that children without these latest fads will fail to keep up with their peers at school or in life.

Another commonly held belief about the human brain is that children learn better when they receive information in their preferred learning style.

While people certainly do prefer different kinds of instruction - whether auditory, visual or kinesthetic, these preferences actually have little to do with how effectively we learn. Several studies have shown there is little to no correlation between these preferences and learning performance. In spite of the published data on this topic, a staggering 94 percent of teachers still believe students perform better when taught in their preferred style.

Of course this is not to say that a good teacher should not try to make learning more appealing to students by adjusting lessons to suit various preferences. This practice undoubtedly leads to more engaged learners who will appreciate their educational experience and pursue it further.

These were just a few of the almost ubiquitous myths about the human brain and the way we learn. There are many more out there.



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About the author...

Paul Latimer has over 25 years experience in clinical practice, research and administration. After obtaining his medical degree from Queen's University in Kingston, Ontario, he did psychiatric training at Queen's, Oxford and Temple Universities. After his residency he did a doctorate in medical science at McMaster University where he was also a Medical Research Council of Canada Scholar. Since 1983 he has been practicing psychiatry in Kelowna, BC where he has held many administrative positions and has done numerous clinical trials. He has published many scientific papers and one book on the psychophysiology of the functional bowel disorders. He is an avid photographer, skier and outdoorsman.

 

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The views expressed are strictly those of the author and not necessarily those of Castanet. Castanet presents its columns "as is" and does not warrant the contents.


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