Monday, May 1, 2017
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Psychedelic Compound in Ecstasy Moves Closer to Approval to Treat PTSD
Psychologists have occasionally given people psychedelic drugs such as LSD or magic mushrooms to induce altered states, in an attempt to treat mental illness. Today, many of those drugs are illegal, but if clinical trials testing their efficacy yield positive results, a handful could become prescription medicines in the next decade. The furthest along in this process is MDMA—a drug sold illegally as ecstasy or Molly—which is showing promise in the treatment of post-traumatic stress disorder (PTSD).
Last week, at the Psychedelic Science 2017 conference in Oakland, California, researchers presented unpublished results from phase II trials involving a total of 107 people diagnosed with PTSD. The trial treatment involved a combination of psychotherapy and MDMA (3,4-methylenedioxymethamphetamine). The US Food and Drug Administration (FDA) reviewed these data in November, which were not released to the public at the time. The agency recommended that the researchers move forward with phase III trials, the final stage before potential approval of the drug.
At the conference, researchers affiliated with the non-profit organization that is sponsoring the trials, the Multidisciplinary Association for Psychedelic Studies (MAPS) in Santa Cruz, California, presented some of their latest resutls. They used a cinically validated scale that assesses PTSD symptoms such as frequency of nightmares and anxiety levels. More than one year after two or three sessions of MDMA-assisted therapy, about 67% of participants no longer had the illness, according to that scale. About 23% of the control group—who received psychotherapy and a placebo drug—experienced the same benefit.
Researchers leading those trials are now training a cadre of therapists to deliver a form of psychotherapy tailored for use with MDMA, in preparation for the phase III trials. They consider this component essential. “I’ve seen people in my practice who took MDMA at a party and weren’t prepared for the memories that came up, and it was really harmful for them,” says Michael Mithoefer, a psychiatrist in Charleston, South Carolina, and a principle investigator in the MDMA trials.
About 8% of the US population will experience PTSD at some point in their lives. And up to half of participants enrolled in clinical trials to treat PTSD fail to respond to therapies including serotonin-reuptake inhibitors—a class of drugs often used as antidepressants—and cognitive behavioural therapy.
“The results I’ve seen so far with MDMA are so much better than anything I’ve seen so far,” Mithoefer says.
Therapeutic sweet spot
PTSD treatment commonly involves getting a patient to repeatedly recall traumatic events, to extinguish the fear associated with the experience. But that method can fail if patients can't describe the memory because they have walled it off. Other people have such a charged emotional response that the recollection causes harm. “Because of this stress, many patients will drop out of treatment,” explains Daniel Zuj, a research psychologist at the University of Tasmania in Launceston, Australia, who is not involved in the MDMA trials.
In the 1990s, scientists demonstrated in rodents and humans that MDMA was reasonably safe when taken a few times in a controlled setting. The FDA permitted researchers to move forward with clinical trials exploring the drug as a treatment for PTSD.
Studies suggest that MDMA reduces the fear response, and triggers the release of serotonin and other neurotransmitters that induce a feeling of well-being. In this way, individuals may recall events multiple times, in detail, without panicking. “MDMA provides a sweet spot where therapeutic change can happen,” says Mithoefer. “It affects neural networks so that people’s experiences are not hijacked by fear.”
Sustained results
Investigators with MAPS hope to enrol up to 300 people with PTSD to participate in the upcoming phase III trials. The researchers will spend this year training therapists from 14 clinics across North America and Israel to deliver the MDMA-assisted psychotherapy.
They developed their approach by combining modern PTSD therapy with techniques used by LSD researchers in the 1960s. Two therapists supervise the patient while he or she is under the influence of the drug; this lasts five to eight hours for MDMA. It’s essential that people feel they are in a safe, comfortable setting with someone who can oversee the experience, says Alicia Danforth, a clinical psychologist at the Harbor–UCLA Medical Center in Torrance, California, who is involved in MAPS-sponsored trials studying MDMA’s effects on social anxiety in adults with autism.
During his conference presentation, Mithoefer played a video of a former US marine under the influence of MDMA recounting the time his military jeep exploded during a tour in Iraq. The soldier, positioned on a narrow bed between Mithoefer and his wife Annie, a psychiatric nurse, describes the panic that accompanies his memories. But then, he says, an inner-voice assures him that he’ll be all right. “I feel things come up and then blow away like sand,” the marine says. Michael Mithoefer says it’s been five years since the marine’s session. “We are still in touch,” he says, “and that effect has lasted.”
This article is reproduced with permission and was first published on April 28, 2017.
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May 1, 2017 at 02:02AM
Autism May Be Tied to Maternal Grandmother’s Smoking While Pregnant
Girls whose grandmothers smoked while their mothers were in utero are 67 percent more likely to display certain traits linked to autism, such as poor social communication skills and repetitive behaviors, according to a new study by researchers at the University of Bristol in the U.K.
In addition, boys and girls whose grandmothers smoked while their mothers were in utero are 53 percent more likely to be diagnosed with an autism spectrum disorder (ASD).
The findings overwhelmingly suggest that if a female is exposed to cigarette smoke while she is still in the womb, it could affect her developing eggs, resulting in changes that may eventually affect the development of her own children.
“We already know that protecting a baby from tobacco smoke is one of the best things a woman can do to give her child a healthy start in life. Now we’ve found that not smoking during pregnancy could also give their future grandchildren a better start too,” said the noted British epidemiologist and researcher Professor Jean Golding.
For the study, the researchers combed through the data of 14,500 participants enrolled in the Children of the 90s study, the birth cohort study developed by Golding that produced a detailed data set of children born in the area in 1991 and 1992.
Unlike the analysis of autistic traits, which was based on over 7,000 participants, the 177 diagnosed with ASD were too few to analyze grandsons and granddaughters separately.
By using detailed information collected over many years on multiple factors that may affect children’s health and development, the researchers were able to rule out other potential explanations for their results.
More research is needed to discover what the exact mechanisms are behind these molecular changes and to see whether the same associations are present in other groups of people.
Previous studies of maternal smoking during pregnancy and ASD in children have been inconclusive. Going back a generation has revealed an intergenerational effect, which surprisingly is most clear-cut when the mother herself did not smoke in pregnancy. The reasons for this are not entirely clear.
“In terms of mechanisms, there are two broad possibilities,” said researcher Professor Marcus Pembrey. “There is DNA damage that is transmitted to the grandchildren or there is some adaptive response to the smoking that leaves the grandchild more vulnerable to ASD.
“We have no explanation for the sex difference, although we have previously found that grand-maternal smoking is associated with different growth patterns in grandsons and granddaughters,” he said.
“More specifically, we know smoking can damage the DNA of mitochondria, the numerous ‘power-packs’ contained in every cell, and mitochondria are only transmitted to the next generation via the mother’s egg. The initial mitochondrial DNA mutations often have no overt effect in the mother herself, but the impact can increase when transmitted to her own children.”
The prevalence of ASD has increased in recent years, and while some of this increase is probably due to improved diagnosis, changes in environment or lifestyle are also likely to play a role. The researchers also stress that many different factors, including genetic variation, are believed to affect an individual’s chances of developing ASD.
The findings are published in the journal Scientific Reports.
Source: University of Bristol
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May 1, 2017 at 01:08AM
Tips to Reduce Anxiety for Autistic Adults During Physician Visit
Primary care medical visits can pose complex and challenging experiences for adults with autism spectrum disorders, and a new study from the University of Southern California provides suggestions on ways in which both an individual and a provider can better prepare for the encounters.
Researchers offered the following example to describe what often happens:
- During his first visit to the doctor’s office, Bobby fled from the waiting room, ran outside the building and hid in the parking lot.
- During his second visit, the 22-year-old’s anxiety was just as palpable.
- Bobby began jumping in place, repeating dialogue from his favorite TV show and complaining that the office’s bright, buzzing fluorescent lights hurt his eyes and ears.
- Because he refused to allow any care providers to touch his body, his initial physical examination again had to be postponed.
“Adults with autism spectrum disorder face unique challenges to receiving optimal medical care due to a number of factors,” said Dr. Leah Stein Duker, assistant professor of research at the USC Chan Division of Occupational Science and Occupational Therapy.
These factors include difficulties with communication, challenges making health care decisions, overstimulation within the clinic environment and a lack of ASD-specific training for providers, she said.
Some physicians interviewed in a 2013 survey, for example, erroneously considered autism as only a childhood disorder.
“There is limited research detailing the specific needs of adults with ASD during primary care health encounters, and even fewer evidence-based strategies to facilitate these experiences,” Duker said.
“They are often fraught with serious difficulties for the patients, their caregivers and their practitioners — this means that the quality of their medical care is not what it could be or what it should be.”
Unfortunately, there are no professional standards or agreed-upon best practices for primary care encounters with autistic adults.
Researchers explain that this is a population that will only continue growing as the wave of children who were diagnosed with autism beginning in the early 1990s — and which grew exponentially throughout the ’90s and ’00s — comes of age.
Duker hopes to change that with a new research grant she recently received from the American Occupational Therapy Foundation.
The grant will fund a study in which she and her team will conduct interviews with adults with ASD, their caregivers and their providers to better understand the types of problems they face during primary care.
The interviews will form the basis for a preliminary intervention plan that will likely include target strategies such as physician education, caregiver training, tips for promoting patient–provider communication and decision-making strategies for patients and caregivers.
“My objective is to improve health care services for adults with ASD, which can ultimately enhance both short- and long-term outcomes for this vulnerable and underserved population,” Duker said.
At a presentation during last month’s annual conference of the American Occupational Therapy Association, Duker and her colleague Beth Pfeiffer, associate professor at Temple University’s College of Public Health, highlighted Bobby’s case to demonstrate how occupational therapy successfully helped Bobby’s primary care providers improve his overall care access and experience.
His occupational therapist and the medical office nursing staff developed a verbal and visual “picture schedule” for each phase of subsequent office visits in order to help Bobby know what to expect.
To reduce his anxiety, Bobby’s family reviewed the picture schedule and did role-playing with him during the week prior to each visit.
The occupational therapist worked with office staff to section off a “quiet area” of the waiting room with dimmed lighting, a sound machine to muffle office noises and walls painted a soothing light blue color.
In-service training was given to the physicians and staff about strategies to support successful visits, including the value of visual cues and alternative methods of communication.
The office also established a scheduling policy to ensure that patients with developmental and sensory needs like Bobby can book appointments when the clinic is not as busy, giving him extra time to complete exams and work with families and caregivers.
Source: USC
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May 1, 2017 at 01:01AM
Childhood Routines, Self-Regulation Reduce Weight Problems in Kids
New research finds that family structure including regular bedtimes, mealtimes and limited screen time appear to be linked to better emotional health in preschoolers. Moreover, strong emotional health is believed to lower the chances of obesity later in life.
Ohio State researchers say the study is the first to look at the connections between early childhood routines and self-regulation and their potential association with weight problems in the pre-teen years.
“This study provides more evidence that routines for preschool-aged children are associated with their healthy development and could reduce the likelihood that these children will be obese,” said lead author Sarah Anderson, Ph.D.
The study appears in the International Journal of Obesity.
Researchers evaluated three household routines when children were 3 years old: regular bedtime, regular mealtime and whether or not parents limited television and video watching to an hour or less daily. Then they compared those to parents’ reports of two aspects of children’s self-regulation at that same age.
Lastly, they investigated how the routines and self-regulation worked together to impact obesity at age 11, defined based on international criteria. (The U.S. criteria for childhood obesity is set lower and would have included more children.)
The research included 10,955 children who are part of the Millennium Cohort Study, a long-term study of a diverse population of children born in the United Kingdom from September of 2000 to January of 2002.
At age 3, 41 percent of children always had a regular bedtime, 47 percent always had a regular mealtime and 23 percent were limited to an hour or less daily of TV and videos. At age 11, about 6 percent were obese.
All three household routines were associated with better emotional self-regulation – a measure based on parents’ responses to questions such as how easily the child becomes frustrated or over-excited. Those children with greater emotional dysregulation were more likely to be obese later.
“We saw that children who had the most difficulties with emotion regulation at age 3 also were more likely to be obese at age 11,” said Anderson, an associate professor in Ohio State’s College of Public Health.
Anderson and her colleagues also found that the absence of a regular preschool bedtime was an independent predictor of obesity at 11. Obesity risk increased even when children “usually” had a regular bedtime, as opposed to “always.” The risk was greatest for those who had the least amount of consistency in their bedtimes.
How persistent and independent children were at age 3 – another aspect of self-regulation – was not related to obesity risk, nor were routines associated with these aspects of self-regulation.
The new findings build on previous research by Anderson and her colleagues showing an association between earlier preschool bedtimes and decreased odds of obesity later. The 2010 US national sample showed that obesity prevalence was lowest for children who got enough sleep, had limits on screen time and ate meals with their families.
“This research allows us to better understand how young children’s routines around sleep, meals, and screen time relate to their regulation of emotion and behavior,” Anderson said. “The large, population-based, UK Millennium Cohort Study afforded the opportunity to examine these aspects of children’s lives and how they impact future risk for obesity.”
This research should prompt future work looking at the role of emotional self-regulation in weight gain in children and how bedtime routines can support healthy development, Anderson said.
“Sleep is so important and it’s important for children in particular. Although there is much that remains unknown about how sleep impacts metabolism, research is increasingly finding connections between obesity and poor sleep,” she said.
While it’s impossible from this work to prove that routines will prevent obesity, “Recommending regular bedtime routines is unlikely to cause harm, and may help children in other ways, such as through emotion regulation,” Anderson said.
But competing family pressures including parents’ work schedules don’t always allow for consistency, Anderson pointed out.
“As a society, we should consider what we can do to make it easier for parents to interact with their children in ways that support their own and their children’s health.”
Source: Ohio State
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May 1, 2017 at 12:19AM