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Your Mental Health

Alcohol is a deadly force

Although it’s an important part of our social culture, alcohol is also a deadly force in this world. According to a report released by the World Health Organization earlier this year, alcohol is more deadly than AIDS, tuberculosis or violence.

Actually, at 2.5 million alcohol related deaths each year, unsafe alcohol use is responsible for nearly four percent of deaths worldwide.

Alcohol is the world’s third largest risk factor for disease burden after childhood malnutrition and unsafe sex – but it is the leading risk factor in many higher income nations such as the Americas and the Western Pacific. In Europe, it is the second largest.

In its Global Status Report on Alcohol and Health, the WHO suggests rising incomes have spurred more drinking in some of the heavily populated countries in Africa and Asia over recent years. Along with this, binge drinking is becoming more of a problem in many developed countries. In Russia, alcohol is responsible for one in every five deaths.

At the same time, many countries have weak control policies surrounding alcohol and this is not a priority for governments in spite of the rising human cost of excessive alcohol consumption.

Of course, here at home we are aware of some of the dangers of excessive alcohol use. Our government has put in place many of the recommended policies to reduce the impact of harmful alcohol use – including minimum legal age, legal limits on blood alcohol levels when driving and taxes on alcoholic beverages.

Still, the dangers are not gone. Most of us have met someone affected by a drunk driving incident and we know about increased violence when alcohol is involved as well as chronic illness such as cirrohsis of the liver due to long term alcohol abuse.

Alcohol abuse also increases the likelihood of various cancers, cardiovascular disease, sexually transmitted infections and suicide. It weakens the immune system and also lowers our inhibitions so that we engage in more risky behaviours.

Young adults are particularly at risk when it comes to problem drinking. Around the world, 320,000 people between the age of 15 and 29 die from alcohol-related causes each year – representing nine percent of deaths in that age group. Alcohol is the leading risk factor for death among young men aged 15-59.

Unfortunately, alcohol abuse has the ability to reach far beyond simply the health and safety of the individual doing the drinking. Friends, family and bystanders can all be put at risk.

Most adults are able to enjoy alcohol in moderation and do so safely. If you feel you are unable to indulge in a social drink without remaining in control, I urge you to speak with someone about the possibility of an alcohol abuse problem. Potential costs to yourself and others are too great to ignore. Help for alcohol abuse is out there.



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Empathy on the decline

Empathy is one of the finer human traits. We like to think of it as a hard-wired aspect of our humanity and one of the things that sets us apart from some other species – our ability to understand and care about the feelings of others.

Certainly, it is very important in the function of a fair and compassionate society. If we can put ourselves in the shoes of someone else, we are more likely to help that person out during a difficult time and when we do this on a large scale we can raise the quality of life for all.

This is why some recent data is concerning. One US study out of the University of Michigan examined data from 14,000 college students who had filled out a self-report questionnaire between 1979 and 2010 and found young people today are considerably less empathic than they were 30 years ago.

According to this study, 75 percent of students today rate themselves as less empathic than their peers of 30 years ago. Empathy has declined in each of the last three decades with the sharpest decline occurring since 2000.

At the same time, other research points to a significant rise in self-reported narcissism and emphasis on the self. The lead researcher from this empathy study reported that many consider the current group of college students to be the most self-centered, competitive and individualistic in recent history.

It does seem to follow that a growing emphasis on self would correspond with less concern or care for others.

So what is making people have less empathy today?

Although a definitive answer is not available, there are several theories being posed by those in the field. Mostly, an increase in social isolation is blamed for the recent drop in empathy. People today are more likely to live alone and less likely to be part of groups than they were in the past. Social isolation has been linked to having less empathic feelings toward others.

Increased media exposure to violence through news, television and video games is also posited as one way in which we have become numbed to the pain of others.

Of course, no modern theory would be complete without the effects of social media playing into it as well. Some believe social media such as Facebook contributes to the problem because we can have the illusion of many friends with not much depth of relationship while also being able to ignore or tune out if a person’s problems make us feel uncomfortable.

People today are also far less likely to read than they were in previous decades. In the US, some recent data suggests less than 50 percent of today’s adults read literature for pleasure with the sharpest decrease occurring in young adults. A study out of York University suggests reading is connected to empathy – children who read more stories are better able to understand the emotions of others and those who read less fiction tend to report themselves as less empathic.

Still, empathy has been shown as a trait that is somewhat in-born among humans – and researchers from this study find a silver lining to the decline in recent years to show that our social context and environment can have a large impact on even innate traits.

If we can have a sharp decline, we can surely also make changes and choices that will have a positive effect on empathy. These are where the research should lead so that we can foster a caring, compassionate society where we are not solely concerned about number one.



Higher death rate in mentally ill

Seriously mentally ill individuals have a much higher death rate than the general population.

On the surface, this may just seem like a probable consequence of having a serious mental illness. For example, much attention is paid to the increased suicide risk among those with major depression, schizophrenia or bipolar disorder.

Although this does contribute to the higher likelihood of death among the mentally ill, it is not the primary cause. In fact, those with psychiatric conditions are more likely to die from a lot of different causes than the general population – most notably from chronic physical illness such as heart and lung disease or cancer. There are 10 times as many deaths from these causes as there are from suicide among the mentally ill.

It has long been known that physical and psychiatric illness often go together. When one is present, it seems to worsen the other – in both directions. For example, depression is known to worsen outcomes in physical illness such as heart disease and at the same time, when physical illness begins, it tends to have an immediate effect to worsen symptoms of depression.

According to researchers in the field, the death rate for people with mental illness is about 70 percent higher than in the general population – and worse for those with schizophrenia. People with major mental illness often die up to 25 years earlier than their non-mentally ill peers.

In a review paper examining the scale of this problem, researchers learned that the highest death risk is among patients with severe mental illness and that 72 percent of the excess deaths occur in patients who have only ever attended general practice for their psychiatric care.

The problem of excess mortality is present in all clinical settings and has been around for centuries. All of this begs the question – why do we have so many unnecessary deaths among the mentally ill?

A few theories exist about the reasons for this problem. For one thing, many of the risk factors for chronic illness are preventable and involve lifestyle modification. Things like smoking, obesity, high blood pressure and cholesterol.

We know that some of these issues are particularly common among the mentally ill. For example, up to 80 percent of people with schizophrenia also smoke and some of the medications commonly used to treat this condition can cause significant weight gain. People with mental illness are more likely to smoke, drink and use drugs and less likely to exercise at recommended levels than the general population.

Perhaps individuals dealing with severe mental illness are missing out on opportunities to prevent or treat these issues when the rest of the population is not.

But lifestyle factors are not the only explanation. When it comes to cancer, the incidence of many forms is no higher than in the general population, but those with co-existing mental illness are more likely to die from their cancer.

Some other explanations for an increased death rate could include a lower compliance with treatment for chronic illness, issues with communication or an overlap between psychiatric and physical symptoms which could make it harder to diagnose chronic illness.

All of this simply points to the importance of educating health care providers in all settings about increased risks and ensuring regular health screening for patients dealing with mental illness. We could do a lot toward preventing as many as 33,000 unnecessary deaths each year in Canada.



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Exercise is good for your brain

Newsflash – physical exercise is good for you. Obviously, we all know this and have been given many reasons why lacing up the walking shoes or heading to the gym on a regular basis are beneficial activities.

In past columns I have even mentioned that exercise can also be great for reducing stress and improving mental health by getting those endorphins flowing. It has also been shown to improve memory and mental ability and was theorized to be useful in the maintenance of cognitive functioning as we get older.

Finally, a couple of new studies have shed a bit more light onto the specific ways in which physical exercise may protect our brains from deterioration and possibly even prevent the onset of dementia or Alzheimer’s disease.

Researchers at the University of Pittsburgh have published a couple of studies examining the effects of physical exercise on the brain. One study examined 299 cognitively normal adults with a mean age of 78. At baseline, the volunteers’ exercise levels were assessed based on the average number of blocks walked each week. Researchers then gave them MRI scans two or three years later, another high resolution MRI after nine years, and cognitive assessments at nine and 13 years after baseline.

During this time, 116 of the volunteers experienced mild cognitive impairment or dementia.

Study results found that the baseline weekly walking predicted gray matter volume at the nine year follow up – those with the most physical exercise had significantly higher gray matter volume than those who exercised less frequently.

In this study, walking six to nine miles a week was associated with the greatest gray matter volumes – associated with reduced risk of cognitive impairment or dementia. Walking more than that did not make a further difference.

Another study by the same group of researchers and published this year in February found even beginning a moderate exercise program late in life led to increased brain volumes and improved memory function.

A different group of researchers from Washington University examined the relationship between exercise and four known Alzheimer’s biomarkers in 69 normal adults aged 55 to 88.

Researchers analyzed exercise levels in volunteers over the last 10 years and found that those with the lowest amount of physical exercise had elevations in one biomarker associated with increased risk of Alzheimer’s disease (Pittsburgh Compound B binding). Those who exercised more frequently experienced lower levels of this as well as higher amyloid B42 (a protective biomarker).

All of these studies seem to associate physical exercise with brain health in older adulthood. More research is needed to better understand what it is about the exercise that provides the protective effect – some theories suggest aerobic exercise sends oxygen-rich blood into the brain, which is the organ that needs the most blood. This kind of exercise is also known to increase levels of a chemical called brain derived neurotrophic factor, which promotes growth of new brain cells and protect them from age-related damage.

Regardless, this information gives just a few more reasons why it is important to keep getting the recommended amount of exercise (30 minutes a day at least five days a week) to maintain optimal health throughout life.



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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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