Marijuana Linked to Earlier Onset of Psychosis

Manifesti_LotteriaTripoli_194_mMarijuana (cannabis), thanks to the powerful depressing action of its active ingredient tetrahydrocannabinol (THC), is one of the oldest and most widely used means of self-medication against acute and chronic stress. THC users report experiencing a pleasurable state of relaxation, with heightened sensory experiences of taste, sound and color. In addition to its psychological effects, THC produces alterations in motor behavior, perception, cognition, memory, learning, endocrine function, food intake, and regulation of body temperature. The common perception is that, of all illegal drugs, marijuana may be the safest and least addictive—despite significant evidence that it causes side effects of fatigue, paranoia, memory problems, depersonalization, mood alterations, urinary retention, constipation, decreased motor coordination, lethargy, slurred speech, and dizziness, in addition to increased tolerance and addiction.

Impaired health including lung damage, behavioral changes, and reproductive, cardiovascular and immunological effects have been associated with regular marijuana use. Regular and chronic marijuana smokers may have many of the same respiratory problems that tobacco smokers have (daily cough and phlegm, symptoms of chronic bronchitis), as the amount of tar inhaled and the level of carbon monoxide absorbed by marijuana smokers is 3 to 5 times greater than among tobacco smokers. Smoking marijuana while shooting up cocaine has the potential to cause severe increases in heart rate and blood pressure. – NHTSA Fact Sheet

New research suggests that marijuana use may play a direct causal role in the development of psychotic disorders, including schizophrenia. An extensive meta-analysis of more than 443 studies comparing the age at onset of schizophrenia in individuals who used marijuana with the age at onset of schizophrenia in non–users yielded most sobering results.

Investigators at Prince Wales Hospital and the School of Psychiatry at the University of New South Wales in Sydney, Australia, found that the mean age at illness onset was more than 2.7 years earlier for cannabis users compared with nonusers. The age of onset did not significantly differ between alcohol users and nonusers. These results were published in the February 2011 issue of the Archives of General Psychiatry.

The results support the hypothesis that cannabis use plays a causal role in the development of psychosis… (and) suggest the need for renewed warnings about the potentially harmful effects of cannabis. – Matthew Large

In presenting the findings, lead study author Matthew Large, MBBS, Department of Mental Health Services concluded that the meta-analysis provides strong evidence for a relationship between marijuana use and earlier onset of psychotic illness and of a direct causal role in the development of psychosis in some more vulnerable individuals.

Eat Your Way Out of Stress: Orthomolecularity

NabobPass_EN-US212192238The food most of us consume today is not as rich in nutritional value as it once was due to the significant industrial processing it must undergo to be preserved, packaged and shipped and to the significant effects of pollution in the air, water and soil. Therefore, the human body, especially in heavily industrialized societies, ends up receiving far fewer of the vitamins and minerals that are necessary for optimal health. Moreover, additional energy expenditures and therefore caloric consumption are often required to cope with the stress caused by environmental, situational, and psychological agents.

Thus, the use of nutritional supplements, especially vitamins and herbal extracts, has blossomed into a significant industry and constitutes an increasingly large share of how we obtain these essential nutrients. Generic symptoms such as fatigue, headache, and mood changes are now being treated not only with prescribed or over the counter chemical preparations but also through the consumption of mostly unregulated food supplements.

The Good

As far back as 1968, two-time Nobel Prize winner Linus Pauling pioneered scientific research on the beneficial effects of vitamin supplements and coined the term orthomolecular to describe a nutrition-focused therapy that included large doses of food supplements. His research built on the previous work of two Canadian psychiatrists, Abram Hoffer and Humphrey Osmond, who in 1952 had begun to use very large doses of vitamins, in particular those of the B group, for the treatment of psychiatric disorders. Pauling went one step further by attempting to demonstrate the effectiveness of taking very large doses of vitamins in prevention and in therapy. His studies focused on the antiradical effects of ascorbic acid (vitamin C) and of the liposoluble vitamins A and E in the stimulation of the immune system. Pauling’s view of the benefits of orthomolecularity launched the modern production and distribution of vitamins, minerals, herbs, or products made from plants, animal parts, algae, seafood, or yeasts.

The Bad and the Ugly

Lately, attention is also being paid to the increasingly worrisome phenomenon of self-medication with unregulated nutritional supplements, such as caffeine-laden energy drinks. A 16-ounce can of an energy drink may contain 13 teaspoons of sugar and the amount of caffeine found in four or more colas. Moreover, this potent mixture of sugars and stimulants is often mixed with alcohol. These products, whose catchy names are Red Bull, Rockstar, Monster and Full Throttle, are increasingly popular among teenagers and young adults, even as young as 10-12 years of age. Unfortunately, these concoctions of uppers and downers have dangerous, even life-threatening, effects on blood pressure, heart rate and brain function, according to a recently released report by the Mayo Clinic’s Foundation for Medical Education and Research.

Hear and Feel Your Stress Drift Away

aavanGogh_1888_ArlesDanceHallCan music reduce stress? Yes, and the evidence is strong. Music can reduce stress, lessen pain, diminish hostility and have a positive effect on emotions and cognition. Beginning with an experimental study by Hatta and Nakamura (1991), researchers have continued to investigate the effects of relaxing music on psychological stress, finding good evidence of its benefits. Rhythmic music may change brain function and treat a range of neurological conditions, including attention deficit disorder and depression, suggested scientists who in 2006 gathered with ethnomusicologists and musicians at Stanford’s Center for Computer Research in Music and Acoustics. The diverse group came together for the symposium, “Brainwave Entrainment to External Rhythmic Stimuli: Interdisciplinary Research and Clinical Perspectives.”

Music with a strong beat stimulates the brain and ultimately causes brainwaves to resonate in time with the rhythm, research has shown. Slow beats encourage the slow brainwaves that are associated with hypnotic or meditative states. Faster beats may encourage more alert and concentrated thinking… Most music combines many different frequencies that cause a complex set of reactions in the brain, but researchers say specific pieces of music could enhance concentration or promote relaxation… Studies of rhythms and the brain have shown that a combination of rhythmic light and sound stimulation has the greatest effect on brainwave frequency, although sound alone can change brain activity. This helps explain the significance of rhythmic sound in religious ceremonies. – Stanford University News Services, 2006

Music therapy is now considered a useful adjunct in the treatment of many illnesses including cancer, stroke, heart disease, headaches, and digestive problems. There are numerous reports that music played before, during or after surgery reduces anxiety, lessens pain, reduces the need for pain medication and reduces recovery time.

In 2010, Wesa, Cassileth & Victorson published evidence in Focus on Alternative and Complementary Therapies Journal that music dramatically decreases distress for women hospitalized in a high-risk obstetrics/gynecology setting.  In 2009, a group of scientists headed by Thaut & Gardiner confirmed that music therapy can improve executive brain functions and contributes to better emotional adjustment in traumatic brain injury rehabilitation. Their study examined the immediate effects of neurologic music therapy (NMT) on cognitive functioning and emotional adjustment with brain-injured persons and a control group. The patients who received the music treatment showed a statistically significant improvement in executive function and overall emotional adjustment, reduced depression, lessened sensation seeking, and lower anxiety. Control participants, who did not receive the music treatment, showed decreases in memory, less positive emotion, and higher anxiety.

An extensive study by Good, Anderson, et al. (2005) tested three non-pharmacological treatments—one of which was music therapy—for pain relief following intestinal surgery in a randomized clinical trial. The 167 patients were randomly assigned to one of three intervention groups or control. The results showed significantly less pain in the intervention groups than in the control group, resulting in 16-40% less pain.

Finally, a just published German study offers case-study evidence that music therapy has positive effects on basic vital signs, the reduction of pain and on neurological development in newborn babies with health problems. At the other end of life’s spectrum, a very recent study of patients suffering from dementia of the Alzheimer’s type who exhibited disruptive behaviors showed that weekly session of live music therapy- and occupational therapy-based structured activities over 8 weeks resulted in a significant improvement in disruptive behaviors and depressive symptoms.

Sigmund Freud: What a Funny Guy!

freud-of-the-pampas_357025Sigmund Freud lived and worked in the Austrian capital, Vienna until the Nazi Anschluss of 1938 placed him and his family in great peril. Freud was allowed to leave Austria with his family through the intercession of his patients Princess Marie Bonaparte and William Bullitt, and diplomatic pressure by the United States. One condition imposed by the Germans for his safe conduit was that Freud state that he had been treated with due respect. In response, Freud is reported to have declared, ‘‘I can heartily recommend the Gestapo to anyone.”

Freud viewed humor as an outlet for discharging psychic energy and reducing the emotional impact of negative events. He regarded humor as one of the most adaptive defense mechanisms.

The essence of humor is that one spares oneself the affects to which the situation would naturally give rise and overrides with a jest the possibility of such an emotional display. Freud, S. (1916)

In his groundbreaking study of humor, Jokes and Their Relation to the Unconscious, Freud hypothesized that jokes and dreams serve to satisfy our unconscious desires. Jokes provide their unique pleasure by allowing a temporary release of inhibitions and permitting the safe expression of sexual, aggressive, playful, or cynical instincts that would otherwise remain hidden and inexpressible. Laughter is the release of defensive tension that has been aroused by the circumstances that precede it. Tension can be elicited by behaviors, feelings or thoughts associated with anger and sexuality—in situations where their expression would be inappropriate. When ego defenses that inhibit their expression become unnecessary, as when the joke’s punch line is revealed, the energy that would be normally suppressed can be released in laughter.

There are two ways in which the process at work in humor may take place. Either one person may himself adopt a humorous attitude, while a second person acts as spectator, and derives enjoyment from the attitude of the first; or there may be two people concerned, one of whom does not himself take any active share in producing the humorous effect, but is regarded by the other in a humorous light. To take a very crude example: when the criminal who is being led to the gallows on a Monday observes, ‘Well, this is a good beginning to the week’, he himself is creating the humor; the process works itself out in relation to himself and evidently it affords him a certain satisfaction. Freud, S. (1928)

Freud also wrote “Humor” (1928), a brief paper in which humor is distinguished from wit and comicality, whereby humor represents an internalized form of forgiveness that changes one’s perspective and provides some relief from emotions associated with disappointments and failures. Likewise, humor permits the reinterpretation of failures as being of lesser importance or seriousness than initially believed, thereby transforming such failures, said Freud, into “mere child’s play.”

The Ineffable Madness of War

guernica-picasso
Over 2.2 million American service members have served in Iraq or Afghanistan since September 11, 2001.

Detailed statistics have been recently released that reveal the enormous cost in lives and health of these two ongoing American wars:

  • The US Veteran’s Administration (VA) has diagnosed 167,000 new cases of post-traumatic stress disorder (PTSD), 195,000 cases of depressive conditions and affective psychoses, and 103,000 cases of anxiety disorders among these troops.
  • The suicide rate in the Army and Marine Corps has, for the first time, equaled that of the US civilian population.
  • An estimated 18 US veterans are dying by suicide each day, according to the VA.
  • In 2009 throughout the Army, 160 soldiers died by suicide, at the same time as 160 soldiers died while serving in Iraq, i.e. one suicide for each combat casualty.
  • In 2009 worldwide another 146 Army soldiers died from unintentional drug overdoses, murders, or from other causes that the Army labels as risky behaviors.
  • The Army reported over 1700 known suicide attempts in 2009.
  • The suicide rate in 2009 for the US Marines was 24 suicides per 100,000 marines, which was even higher than the 22 suicides per 100,000 rate of the US Army.

Stress and the Female Brain Advantage

drlouannbrizendineIn 1994, Louann Brizendine, a neuropsychiatrist at the University of California, established the Women’s Mood and Hormone Clinic in San Francisco—one of very few such institutions in the world—and focused her attention on the etiology and functioning of the female nervous system.

In 2007, she published The Female Brain as the culmination of her 20 years of research and a compendium of the latest findings from a range of disciplines. It is a fascinating and, in some ways, startling revelation of the most noteworthy particularities that characterize the human female brain.

Size Does Matter… and So Does Density

Women and men have very nearly the same number of brain cells, even though the female brain is about 9% smaller than men’s. This fact had been known for some time and had been, more or less jokingly, interpreted as meaning that women were not as smart. Dr. Brizendine reveals a much simpler explanation: women’s brain cells are more tightly packed into the skull.

To further dispel any notion of masculine brain superiority, she says, women have 11% more language and hearing neurons than men and a larger hippocampus, the area of the brain that is most closely associated with memory. Much more developed in female brains than male’s is also the circuitry for observing emotion on other people’s faces. Dr. Brizendine concludes that, when it comes to speech, emotional intelligence, and the ability to store richer and more detailed memories, women appear to possess a richer brain endowment and thus a natural advantage.

The amygdala in males, on the other hand, has far more processors than in females, which could explain men’s greater intensity in perceiving danger and their higher proneness to aggression. The male body is much quicker to mobilize to anger and take violent action in reaction to an immediate physical danger.

Are women not as capable of reacting to danger? Dr. Brizendine says that a woman’s brain is as capable to perceive danger or deal with life-threatening situations, but that it mobilizes the body’s resources in quite a different way. The female brain appears to be wired to perceive greater stress over the same event than a man’s. This greater arousal and more forceful stress reaction appears to be a natural way to ensure adequate protection against all possible risks to her children or family unit. Brizendine suggests that this ancestral reason may account for the way a modern woman may view unpaid bills as catastrophic and naturally perceive them more intensely threating to the family’s very survival.

[amtap book:isbn=0767920104]

MRI scans have pushed knowledge much higher by allowing the observation of the workings of the brain in real time. The brain lights up in different places depending on whether it is stimulated by love, looking at faces, solving a problem, speaking, or experiencing anxiety. What lights up, where and when, is different between men’s and women’s brains. Women use different parts of the brain and different circuits to accomplish the same tasks, including solving problems, processing language, and generally experiencing the world.

This is a fascinating book for the scientist and the novice alike, well worth reading. It is the Stresshacker Recommended selection for this month.

The History of Stress In Very Small Bites: 6

HansSelyeBy far the most important figure in the history of the concept of stress as applied to human behavior is Hans H. B. Selye (1907-1982), who is credited with starting modern research into the concept itself and its physiopsychological manifestations. In 1950, in addressing the American Psychological Association convention, Selye introduced his theory of stress reaction, which has since become the standard model of stress. In 1956, he published The Stress of Life, in which he elaborated his stress theory and perfected its definition of physiopsychological stress as “the nonspecific response of the body to any demand made upon it,” which could be a real or perceived threat, challenge, danger or change that requires the body and the mind to adapt.

Selye’s research made important contributions to psychology, biology and medicine. He had begun his work in 1926 when, as a second year medical student, Selye noticed many similarities among patients who, in spite of suffering from very disparate diseases, all seemed to have many symptoms in common. He would later describe this constellation of common symptoms as a syndrome, ‘‘the syndrome of just being sick.” 

His discovery of the stress response was a byproduct of his research on the effect of hormone injections in rats. Noticing that many of the rats became sick after receiving the injections and that the same sickness struck a control group of rats injected only with a neutral solution containing no hormones, he had the intuition that the rats could be having a reaction to the trauma of being injected rather than to the hormones. Selye surmised that being handled and injected caused high levels of sympathetic nervous system arousal in the rats, which eventually developed health problems such as ulcers. Selye coined the term "stressor" to label the traumatic stimulus that acted psychologically on the mind while at the same time producing a physical effect.

In refining his theory of the stress reaction, which he dubbed the General Adaptation Syndrome, Selye identified three distinct stages. The alarm reaction is the first stage, which occurs when the organism first becomes aware of the stressor. In the second stage of recovery or resistance, the organism mounts a response to the stressor, by mobilizing resources, using energy and repairing itself. The third stage of exhaustion occurs if the organism is unable to put an end to the stressor. This third stage also signals the onset of chronic stress.

With remarkable insight, Selye sliced the concept of stress into four variants. These he called eustress (the good stress caused by positive and exciting stressors), distress (the harmful stress caused by unpleasant or negative stressors), hyperstress (caused by stressors so overwhelming that they overcome all abilities of the body to adapt), and hypostress (the mildest stressors that barely cause a physical and psychological reaction, while still being noticeable).

Stress Like an Egyptian

hosni-mubarakPower stresses. Absolute power stresses absolutely. This easy paraphrase of a famous saying about the corruptive effect of political power can perhaps convey the enormous stress that tyrannical political power can cause at the micro and macro levels of a nation-state. The classic fight-flight-freeze stress reaction is magnified by the stark reality of the actual physical danger, and enormous emotional cost, that comes with ruling a country with an iron fist. An absolute ruler is nearly always unloved, feared, and only forcibly respected by his immediate entourage and of course even more so by his countrymen at large. This must be Mr. Hosni Mubarak’s plight right now, as his country of Egypt is in the throes of a more or less peaceful, and some say long overdue, revolution to overthrow his 40-year-old quasi-dictatorship. How is he coping?

The 82-year-old Mr. Mubarak is nothing if not a survivor of trauma. A seemingly perennial victim of acute traumatic stressors, he has survived three wars, an Islamic uprising and multiple assassination attempts. His beloved 12-year-old grandson, Muhammad, died suddenly of a brain aneurism. He came to power on October 7, 1981 when the president of Egypt, Mr. Anwar el-Sadat was assassinated not three feet away from then-vice president Mr. Mubarak in a hail of gunfire and grenades. It is possible that, since that day, Mr. Mubarak may suffer from posttraumatic stress disorder (PTSD).

This seminal traumatic event, and the others that followed, may have engendered in Mr. Mubarak a strong desire for safety and stability above all else. In the current circumstances, he has reacted to the calls for his resignation in true-to-character fashion with a staunch change-resistant response, which one Arab official has called, “his reflex adherence to the status quo.”

It is perhaps not coincidental that President Obama told reporters he believes that Mr. Mubarak’s decision not to seek reelection may represent an important “psychological break” that could transition the Egyptian president out of power. The decision must not have come easily for Mr. Mubarak, and must have required a significant departure from his usual modus operandi of maintaining the safety of the status quo.

Mr. Mubarak appears to have rationalized his deep-seated aversion to change and his need to ensure survival and safety for himself, his family and the country he rules, with a near-absolute belief that he is the only person who can guarantee Egypt’s political, economic and social stability. It is nothing short of a psychological drama that he is now the focus and the very symbol of Egyptian crisis, the very instigator of chaos on the streets and political and economic turmoil.

For 40 years, Mr. Mubarak has lived in splendid isolation from danger in the presidential palace in Cairo or at his private residence in the seaside community of Sharm el Sheik, both heavily guarded by a corps of bodyguards. His acquaintances describe him as a man who does not show emotion, who can be forceful and aggressive in pursuing his views, but maintains a near-absolute control over the privacy of his feelings. As if the world around him was just too dangerous to risk betraying the slightest hint of weakness.

How to Get a Larger Brain

aaMonet_WaterLiliesHow do you increase the volume of gray matter in your brain? Mindfulness-Based Stress Reduction (MBSR), one of the most widely used mindfulness training programs, may be the answer. MBSR is receiving increasing attention for the significant morphological changes that it appears to produce on brain structures. The most recent results come from a controlled longitudinal study completed at Massachusetts General Hospital and published in the January 2011 edition of Psychiatry Research. Researchers at MGH investigated pre–post changes in brain gray matter concentration in individuals who participated in an 8-week MBSR program. Changes in gray matter concentration, measured using voxel-based morphometry, showed increases in gray matter concentration within the left hippocampus, as compared with a control group of individuals who did not meditate and showed no such increase. Whole brain analysis also confirmed gray matter increases in the MBSR group only, which were located in regions of the brain involved in learning and memory processes, emotion regulation, self-referential processing, and perspective taking, such as the posterior cingulate cortex, the temporo-parietal junction, and the cerebellum.

Earlier studies conducted in the last five years at Yale and Harvard have shown that mindfulness meditation increases the thickness of gray matter between .004 and .008  inches (in proportion to the frequency of meditation) in parts of the brain that are responsible for attention and processing of sensory input. It also appears to slow down the brain deterioration which is a part of the natural aging process.

Yoga and tantric meditation, mantra or transcendental meditation, and mindfulness meditation are increasingly popular forms of stress management. The therapeutic value of meditation in producing positive effects on psychological well-being and ameliorating symptoms of a number of disorders has become widely accepted. Research on the neural mechanisms that underlie these beneficial effects and actual morphological changes produced by these practices offers encouraging new avenues of study that further validate their effectiveness.

Abuse in Childhood May Mean Shorter Life

aavanGogh_1885_AutumnLandscapeAccording to an analysis by the Centers for Disease Control and Prevention (CDC), the experience of verbal, physical, sexual abuse, or severe family dysfunction, such as an incarcerated, mentally ill, or substance-abusing family member, domestic violence, or absence of a parent because of divorce or separation, is directly linked to serious problems in adulthood, which may include substance abuse, depression, cardiovascular disease, diabetes, cancer, and premature death.

The combination of risky behaviors such as substance abuse, the effects of severe depression on variables such as suicide, and the incidence of deadly diseases such as diabetes and cancer contribute to an elevated risk of early death in adults who experienced abuse and dysfunctional family environments. More specific studies have confirmed that individuals with six or more adverse childhood experiences were almost twice as likely (1.7  times) to die before age 75 and 2.4 times more likely to die before age 65 years, i.e. below to well below normal life expectancies.

The CDC analyzed information from 26,229 adults in five US states (Arkansas, Louisiana, New Mexico, Tennessee, and Washington) using the 2009 ACE (Adverse Childhood Experience) module of the Behavioral Risk Factor Surveillance System (BRFSS), which is operated by state health departments in cooperation with the CDC. The results of the analysis show that 59.4% of the interviewed reported having at least one adverse childhood experience, and 8.7% reported five or more.

The prevalence of each adverse childhood experience ranged from a high of 29.1% for household substance abuse to a low of 7.2% for having an incarcerated family member. Over one quarter (25.9%) of respondents reported having experienced verbal abuse, 14.8% reported physical abuse, and 12.2% reported sexual abuse. In measures of severe family dysfunction, 26.6% reported separated or divorced parents, 19.4% reported that they had lived with someone who was depressed, mentally ill, or suicidal, and 16.3% reported witnessing domestic violence.

The analysis reiterates the risk for long-term impact on health and mortality of childhood abuse, stress and trauma. Numerous studies (Sansone & Poole, Ozer, Best, et al., Heim, Newport, et al., Bremner et al., to cite only a few of the most recent) have confirmed the positive and significant correlations between childhood physical abuse, emotional abuse, and witnessing violence and the number of psychophysiological and pain disorders in adulthood.