Mental-health apps work

Therapy apps have been coming ever since the invention of the smart phone. Really, since the Internet age began, so it’s been simply a matter of time before we figured out how to do mental-health care online.

Today, there are a growing number of apps and websites offering various forms of therapy for mental-health issues. In many ways, this is in response to the way we communicate via social media or text message.

It makes sense for established mental-health organizations to reach out by these media, especially for younger clients who are comfortable communicating by phone or computer rather than in person.

The rise in online mental-health services also has the potential to make this kind of care much more accessible both here and abroad, where there is often a real shortage of trained, healthcare professionals.

Most effective treatments for mental-health conditions recommend an element of psychological therapy led by a highly qualified professional, such as a clinical psychologist or psychiatrist. Unfortunately, even in North America, we have a shortage of these professionals and it is difficult for those who need health care to get it in a timely fashion.

In developing countries, the situation is often much worse. For example, in India, there are roughly 5,000 mental-health professionals to service 1.2 billion people. Obviously, this is nowhere near sufficient.

Although we need to continue training more specialists, this will not be the only solution to the problem of accessing mental-health services. Creating a new clinical psychologist or psychiatrist takes years and a lot of resources; we simply can’t catch up to demand. 

Some countries are looking into task shifting — training less qualified people to take on a specific task in therapy. This is interesting and may prove useful in certain settings, but there is a concern about compromising quality of care.

Moving mental-health services online will perhaps prove to be the most effective way to dramatically improve access to these services and to stretch professional expertise through program-led treatments.

Therapist-free interventions have been around for a while in the form of self-help books and some have good evidence to show they can be effective. Now, with smartphones and high-speed Internet, these resources can be enhanced to be more interactive and expanded.

The development and use of these therapy apps and other online mental-health resources will need to be monitored and researched more fully, but studies show promise – particularly for depression and anxiety disorders.

One consistent finding is that these programs are most effective when there is additional external support. Ideally, this support would come from a call centre or non-specialist to ensure the intervention is still program led.

Online resources have the potential to be a useful tool if they are developed by professionals with a nuanced understanding of the complex issues involved in mental-health conditions.

I would also caution that although online, program-led treatments may be useful for some issues, they will likely not replace the need for thoughtful, professional care in many cases.

Another difficulty will likely be sifting out the good, quality programs from cheap imitations, which may not be helpful, and could be damaging.




Bullying's echo

Long-term effects of childhood bullying

With another school year winding down, it may seem a strange time to bring up a subject often affecting our kids when they’re out on the schoolyard.

But just as there is no one season for childhood bullying, there is also evidence to suggest its effects last far longer than the school year.

A longitudinal study out of the U.K. followed 8,000 people for up to 50 years to determine the long-term effects of childhood bullying.

Being a victim of childhood bullying was associated with persistent and pervasive negative effects well into middle age.

Researchers examined data concerning bullying exposure between the ages of 7 and 11 and then followed up between the ages of 23 and 50. Bullying was fairly common for this population who grew up in the 1960s with more than a quarter of subjects experiencing some bullying and 15 percent reporting frequent bullying.

Victims of bullying had higher rates of depression, anxiety and suicidal ideation at age 45 than those who had not been bullied. They were also less likely to be living with a partner or having other social relationships and were more likely to experience financial strain, have a poor perceived quality of life and self-report poor cognitive functioning at age 50.

Although the results are stark, they are not all that surprising given our knowledge of the lasting impact of any childhood trauma. Childhood is an important and formative time for individuals and lays a foundation for future mental health.

It is important to realize the potential for childhood bullying to harm the mental health and well being of adults well into middle age. Although bullying has received wider attention from schools, parents and the media in recent years, we now have one more convincing reason not to ignore it.

We must do all we can to prevent bullying at a young age and ensure we provide safe, friendly spaces at schools and other places where kids get together.

When we become aware of bullying behaviour, we cannot hide our heads in the sand. We must face it and do what we can to not only stop the behaviour, but also to mitigate the lasting impact it can have on victims.

Researchers in this study suggest psychiatrists need to take a more active role in schools and be willing to work alongside school staff to manage the victimization that can and does occur.

When a psychiatrist or other mental health professional is working with a school-aged patient experiencing bullying, it would be helpful to ensure the issue is being addressed in a coordinated fashion between the health professionals, school staff and parents.

This is a preventable problem when we work together.

Can flu make baby bipolar?

Prenatal infection and bipolar disorder

When it comes to establishing exactly what causes most psychiatric conditions, we still have a lot to learn. We know most disorders appear to arise from a complicated interplay between nature and nurture.

Often, there is a strong genetic component to a particular disorder, which is why we usually see relatives in one family who seem to be susceptible to an illness. When a parent is depressed or anxious, it is likely you will find other first-degree relatives with similar symptoms or medical histories.

We also know that environment plays a role in many conditions. Exposure to trauma in childhood can pre-dispose people to mental health issues later in life. Many other, subtler environmental stimuli also seem to be involved with triggering the onset of mental health symptoms.

One study examining influenza infection in pregnant women found a relationship between infection and the development of bipolar disorder with psychotic symptoms in the women’s offspring.

Pregnancy is a sensitive time and fetuses are vulnerable to many health issues as a result of environmental factors affecting the mother. There has been some evidence to suggest maternal infection during pregnancy is an environmental risk factor for some psychiatric conditions.

For this study, serum samples from pregnant women in California were examined to identify whether there was a connection between documented influenza infection during pregnancy and risk of bipolar disorder in the offspring.

From the women and offspring studied, 85 cases of diagnosed bipolar disorder were identified. Of those, 36 had psychotic features and 49 did not. These were compared against 170 subjects.

Researchers found maternal gestational exposure to influenza does not generally increase the risk of bipolar disorder in offspring. It was, however, associated with a five-fold increased risk of bipolar disorder with psychotic features. This was interesting because there was no significant association between maternal influenza and bipolar disorder with no psychotic features.

Additional analysis also uncovered that risk appears to be highest if influenza is experienced during the first or second trimester of pregnancy – although small sample size means this will need more research to determine accurately.

Although some previous studies have also asserted a link between maternal infection and psychiatric conditions in offspring, this is a unique study because the infection was confirmed through serum samples during each trimester.

Much more research is needed to further determine risk factors and what symptoms or conditions are most affected by maternal infections. It will be very interesting to learn more.

In the meantime, this could be one more good reason to get your annual flu shot, especially if you are a pregnant woman.


New hope for schizophrenia

New hope in schizophrenia research

Research out of Johns Hopkins University may be the start of a promising development for the treatment of schizophrenia. 

While studying an anti-cancer drug in mice, researchers found it reversed behaviours associated with schizophrenia and even restored some lost brain cell function in mice affected by the rodent version of the disease. 

The medication is part of a class of drugs called PAK inhibitors, also shown to offer some protection in other brain conditions such as Fragile X syndrome and Alzheimer’s disease. 

In this study examining effects on adolescent mice whose condition mimics the progression of human schizophrenia, the experimental compound appeared to stop a biological ‘pruning’ process, which occurs in schizophrenia and needlessly destroys neural connections. Using the PAK inhibitor compound, researchers were able to partially restore disabled neurons in young mice. 

By stopping the out of control pruning, the researchers were also able to normalize the rodents’ behaviour. Achieving these results in such young mice was a particularly hopeful development since schizophrenia in humans typically begins to show up in late adolescence or early adulthood and tends to get worse over time. 

To date, we are not sure that PAK operates the same way in humans as it does in mice, so more work is definitely needed before we can be sure it will have a similar effect for humans. 

However, if we are able to replicate these findings in later stage clinical trials and in humans, it may improve the prognosis for those diagnosed with schizophrenia.

Schizophrenia affects roughly one percent of the population. It is a chronic disease characterized by disordered thinking and symptoms such as delusions and hallucinations. In addition, people with schizophrenia can have an altered sense of self, a lack of motivation, blunted emotions and confused communication and thinking. Depression and social withdrawal are also very common. 

Symptoms typically begin in adolescence or early adulthood and generally progress as a gradual deterioration in the brain’s ability to process information or communicate with itself. Because of its gradual onset, it can take quite a while for family or friends to realize there is a serious problem. 

Some early warning signs to be aware of include: bizarre or unusual behaviour; an inability to sleep or mixing up of day and night; social withdrawal or isolation; hyperactivity or inactivity; inability to concentrate; unusual preoccupation with religion or the occult; hostility, suspicion or fearfulness; over-reaction to peer or family disapproval; deterioration in personal hygiene; excessive writing or childlike printing with no clear meaning; flat, expressionless gaze; and peculiar use of language.

There is no cure for schizophrenia. For now, anti-psychotic medication can control symptoms such as delusions and hallucinations, but lack of motivation and blunted emotions may not respond as well to medication. 

Hopefully, in time we will come up with treatments that can stop disease progression or reverse damage caused and restore people to full functioning. Continued research is needed until we can reach this goal. 

In the meantime, if you are concerned for yourself or a loved one, speak with your doctor about options available now.

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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 conducted 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 does not warrant the contents.

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