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A New Understanding: The Science of Psilocybin (2015)

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Introduction

A New Understanding explores the treatment of end-of-life anxiety in terminally ill cancer patients using psilocybin, a psychoactive compound found in some mushrooms, to facilitate deeply spiritual experiences.

Outline

The documentary explores the confluence of science and spirituality in the first psychedelic research studies since the 1970’s with terminally ill patients.

As a society we devote a great deal of attention to treating cancer, but very little to treating the human being who is dying of cancer. The recent resurgence of psychedelic research is once again revealing the power of compounds like psilocybin to profoundly alter our understanding of both life and death. Through the eyes of patients, their loved ones, therapists, and researchers, A New Understanding examines the use of psilocybin in a controlled setting to reduce psychospiritual anxiety, depression, and physical pain.

The treatment aims to help the patient understand that a ‘good’ death is possible, and to help the patient’s family deal well with the dying process. A New Understanding shows patients and their families coming to terms with dying through the skillful treatment of the whole human being. If we can learn to work more skillfully with dying, we will also learn to take better care of life.

Production & Filming Details

  • Director(s): Roslyn Dauber.
  • Producer(s): Robert J Barnhart, Roslyn Dauber, Brady Dial, Matt Humble, Steve McDonald, Jeff Porter, and Mitch Schultz.
  • Music: Brian Satterwhite.
  • Editor(s): Jason Uson.
  • Studio: Red Phoenix Productions.
  • Production: Golden Teacher Films.
  • Release Date: March 2015 (US).
  • Running Time: 55 minutes.
  • Country: US.
  • Langauge: English.

What Haunts Us (2018)

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Introduction

The 1979 class of Porter Gaud School in Charleston, South Carolina graduated 49 boys. Within the last 35 years, six of them have died by suicide.

Outline

When Paige Goldberg Tolmach gets word that another former student from her beloved high school has killed himself, she decides to take a deep dive into her past in order to uncover the surprising truth and finally release the ghosts that haunt her hometown to this day.

Production & Filming Details

  • Director(s): Paige Tolmach.
  • Producer(s): Sarah Gibson, James Huntsman, Andreas Olavarria, and Told Slater.
  • Music: Nathan Halpern.
  • Cinematography: Adam Dubrowa.
  • Editor(s): Derek Doneen and Allan Duso.
  • Production: Diamond Docs, Matt Tolmach Productions, and The Kennedy/Marshall Company.
  • Distributor(s): Blue Fox Entertainment.
  • Release Date: 24 February 2018 (Boulder International Film Festival) and 11 May 2018 (US, general release).
  • Running Time: 72 minutes.

Should we use tRNS (with the Current Stimulation Parameters) as a Therapeutic Intervention for the Treatment of Depression?

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Research Paper Title

Transcranial random noise stimulation for the acute treatment of depression: a randomised controlled trial.

Background

Transcranial electrical stimulation has broad potential as a treatment for depression.

Transcranial random noise stimulation (tRNS), which delivers randomly fluctuating current intensities, may have greater cortical excitatory effects compared to other forms of transcranial electrical stimulation.

The researchers therefore aimed to investigate the antidepressant efficacy of tRNS.

Methods

Depressed participants were randomly assigned by computer number generator to receive 20 sessions of either active or sham tRNS over four weeks in a double-blinded, parallel group randomised-controlled trial.

tRNS was delivered for 30mins with a direct current offset of 2mA and a random noise range of 2mA. Primary analyses assessed changes in depression severity using the Montgomery-Asperg Depression Rating Scale (MADRS).

Neuroplasticity, neuropsychological, and safety outcomes were analysed as secondary measures.

Results

69 participants were randomised, of which three discontinued treatment early leaving 66 (sham n = 34, active n = 32) for per-protocol analysis.

Depression severity scores reduced in both groups (MADRS reduction in sham = 7.0 [95%CI 5.0-8.9]; and active = 5.2 [95%CI 3.2-7.3]).

However, there were no differences between active and sham groups in the reduction of depressive symptoms, or the number of participants meeting response (sham = 14.7%; active = 3.1%) and remission criteria (sham = 5.9%; active = 0%).

Erythema, paraesthesia, fatigue, and dizziness/light-headedness occurred more frequently in the active tRNS group.

Neuroplasticity, neuropsychological and acute cognitive effects were comparable between groups.

Conclusions

The researchers suggest the results do not support the use of tRNS with the current stimulation parameters as a therapeutic intervention for the treatment of depression.

Reference

Nikolin, S., Alonzo, A., Martin, D., Gálvez, V., Buten, S., Taylor, R., Goldstein, J., Oxley, C., Hadzi-Pavlovic, D. & Loo, C.K. (2020) Transcranial random noise stimulation for the acute treatment of depression: a randomized controlled trial. The International Journal of Neuropsychopharmacology. pii: pyz072. doi: 10.1093/ijnp/pyz072. [Epub ahead of print].

Reviewing Discontinuation Rates of Antidepressant Use by Dutch Soldiers

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Research Paper Title

Discontinuation Rates of Antidepressant Use by Dutch Soldiers.

Background

Soldiers have a higher risk for developing psychiatric disorders that require treatment; often with antidepressants.

However, antidepressants as well as the psychiatric disorder, may influence military readiness in several ways.

In the general population, early discontinuation of antidepressant treatment is often seen. It is yet unknown whether this occurs to a similar extent in soldiers.

The objective of this study was to evaluate discontinuation of antidepressant use by Dutch soldiers in the first 12 months after start and determinants thereof.

Methods

Data were obtained from the military pharmacy. All Dutch soldiers who started using an antidepressant between 2000 and 2014 were included.

Kaplan-Meier curves were constructed to estimate the discontinuation rate over time and the influence of each determinant on discontinuation rate was estimated using Cox regression.

Results

About 25.9% of de 2479 starters had discontinued their antidepressant use after 1 month; after 3 and 6 months this number increased to 52.7% and 70.3%, respectively.

Early discontinuation was higher in soldiers who received their first prescription from a neurologist or rehabilitation specialist (HR 1.85, 95% CI 1.55-2.21, HR 2.66 95% CI 1.97-3.58) compared to soldiers with a first prescription from a general practitioner.

In addition, early discontinuation was lower in soldiers who were prescribed serotonin reuptake inhibitors and other antidepressants (HR 0.57, 95% CI 0.51-0.60, HR 0.63, 95% CI 0.55-0.73) and in soldiers between 40 and 50 years of age (HR 0.79, 95% CI 0.70-0.89).

Conclusions

More than half of the soldiers discontinued their prescribed antidepressant within 3 months and after 6 months, only 30% were still on antidepressants.

Reference

Janssen, D.G.A., Vermetten, E., Egberts, T.C.G. & Heerdink, E.R. (2019) Discontinuation Rates of Antidepressant Use by Dutch Soldiers. Military Medicine. 184(11-12), pp.868-874. doi: 10.1093/milmed/usz060.

What is the Association with Several Physical, Mental, & Cognitive Health Outcomes with Gait Speed in Older Adults?

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Research Paper Title

Clinical and Ambulatory Gait Speed in Older Adults: Associations With Several Physical, Mental, and Cognitive Health Outcomes.

Background

Although clinical gait speed may indicate health and wellbeing in older adults, there is a lack of studies comparing clinical tests with ambulatory gait speed with regard to several health outcomes.

The objective of this study was to examine the associations of clinical gait speed, measured by the 2.44 meter walk test and the ambulatory gait speed with several physical, mental, and cognitive health outcomes in older adults.

A cross-sectional design was used.

Methods

The study population comprised 432 high-functioning community-dwelling older adults (287 women) aged between 65 and 92.

Clinical and ambulatory gait speeds were measured using the 2.44 m walk test and a portable gait analysis device, respectively.

Multiple linear regressions were used to examine the association of clinical and ambulatory gait speeds with several health outcomes (BMI, waist circumference, systolic and diastolic blood pressure, chronic conditions, self-rated health, exhaustion, upper and lower body strength, physical and mental health status, cognitive status and self-rated cognitive status).

Results

The results showed that the average gait speed for clinical and ambulatory measures cannot be directly compared.

Clinical gait speed was associated with 7 health outcomes, while the ambulatory gait speed was associated with 6 health outcomes.

The significant associations between measures of gait speed and the health outcomes converged in 5 of the 13 health outcomes studied, however, the strength of associations were singly different between measures.

The short monitoring time, the inability to distinguish between the ambulatory gait speed inside the home and outdoor gait speed, and the under-representative sample are limitations of the study.

Conclusions

The results indicated differences in the number and strength of associations between clinical and ambulatory gait speed.

Both measures have construct validity because they have been associated with physical and health outcomes, however, they may have different predictive validity.

Further research should be done to compare their predictive validity in longitudinal designs.

Reference

De la Cámara, M.Á., Higueras-Fresnillo, S., Sadarangani, K.P., Esteban-Cornejo, I., Martinez-Gomez, D. & Veiga, Ó.L. (2020) Clinical and Ambulatory Gait Speed in Older Adults: Associations With Several Physical, Mental, and Cognitive Health Outcomes. Physical Therapy. pii: pzz186. doi: 10.1093/ptj/pzz186. [Epub ahead of print].

Trying to Understand the Link between Socioeconomic Deprivation, Blood Lipids, Pyschosis, & Cardiovascular Risk

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Research Paper Title

Socioeconomic deprivation and blood lipids in first-episode psychosis patients with minimal antipsychotic exposure: Implications for cardiovascular risk.

Background

The influence of socioeconomic deprivation on the cardiovascular health of patients with psychosis-spectrum disorders (PSD) has not been investigated despite the growing recognition of social factors as determinants of health, and the disproportionate rates of cardiovascular mortality observed in PSD.

Discordant results have been documented when studying dyslipidemia -a core cardiovascular risk factor- in first-episode psychosis (FEP), before chronic exposure to antipsychotic medications.

The objective of the present study is to determine the extent to which socioeconomic deprivation affects blood lipids in patients with FEP, and examine its implications for cardiovascular risk in PSD.

Methods

Linear regression models, controlling for age, sex, exposure to pharmacotherapy, and physical anergia, were used to test the association between area-based measures of material and social deprivation and blood lipid levels in a sample of FEP patients (n = 208).

Results

Social, but not material deprivation, was associated with lower levels of total and HDL cholesterol.

This effect was statistically significant in patients with affective psychoses, but not in schizophrenia-spectrum disorders.

Conclusions

Contrary to other reports from the literature, the relationship between socioeconomic disadvantage and blood lipid levels was contingent on the social rather than the material aspects of deprivation.

Furthermore, this association also depended on the main diagnostic category of psychosis, suggesting a complex interaction between the environment, psychopathology, and physical health.

Future studies exploring health issues in psychosis might benefit from taking these associations into consideration.

A better understanding of the biology of blood lipids in this context is necessary.

Reference

Veru-Lesmes, F., Rho, A., Joober, R., Iyer, S. & Malla, A. (2020) Socioeconomic deprivation and blood lipids in first-episode psychosis patients with minimal antipsychotic exposure: Implications for cardiovascular risk. Schizophrenia Research. pii: S0920-9964(19)30589-4. doi: 10.1016/j.schres.2019.12.019. [Epub ahead of print].

Is there an Association between Firearm Ownership & Capability for Suicide in Post-Deployment National Guard Service Members?

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Research Paper Title

Firearm Ownership and Capability for Suicide in Post-Deployment National Guard Service Members.

Background

National Guard service members demonstrate increased suicide risk relative to the civilian population.

One potential mechanism for this increased risk may be familiarity with and access to firearms following deployment.

This study examined the association between firearm ownership, reasons for ownership, and firearm familiarity with a widely studied suicide risk factor-capability for suicide-among National Guard service members.

Methods

Data were drawn from a cross-sectional survey of National Guard service members conducted immediately post-deployment in 2010. Service members (n = 2,292) completed measures of firearm ownership, firearm familiarity, and capability for suicide.

Results

Firearm ownership and increased firearm familiarity were associated with capability for suicide (d = 0.47 and r = .25, for firearm ownership and familiarity, respectively).

When examined separately based on reason for ownership, owning a firearm for self-protection (d = 0.33) or owning a military weapon (d = 0.27) remained significantly associated with capability for suicide.

In contrast, owning a firearm for hobby purposes did not (d = -0.07).

Conclusions

Our findings support theories emphasising practical aspects of suicide (e.g., three-step theory) and suggest that owning firearms, in particular for self-protection, along with familiarity using firearms may be associated with greater capability for suicide.

Reference

Goldberg, S.B., Tucker, R.P., Abbas, M., Schultz, M.E., Hiserodt, M., Thomas, K.A., Anestis, M.D. & Wyman, M.F. (2019) Firearm Ownership and Capability for Suicide in Post-Deployment National Guard Service Members. Suicide & Life-Threatening Behavior. 49(6), pp.1668-1679. doi: 10.1111/sltb.12551. Epub 2019 Apr 19.

Depression: Obstetric Mental Health Clinics & Outpatient Psychiatric Services

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Research Paper Title

Depression Outcomes From a Fully Integrated Obstetric Mental Health Clinic: A 10-Year Examination.

Background

A fully integrated Obstetric Mental Health Clinic (OBMHC) was established in 2007 in the rural northwest United States to address perinatal depression.

The purpose of this mixed methods study was to examine depression outcomes in women receiving outpatient psychiatric services between 2007 and 2017 at a fully integrated OBMHC and to explore patient and obstetric team perceptions of OBMHC experiences.

Methods

A retrospective database study was employed; depression was measured at baseline and follow-up visits using the Edinburgh Postnatal Depression Scale.

Descriptive statistics, regression models, and trend analysis were employed to determine effectiveness.

A subset of patients participated in telephone interviews; the obstetric team was surveyed regarding perceptions of the service.

Results

The sample included 192 women (195 pregnancies). Approximately 72% experienced less depression by the first follow-up visit.

Patients taking three or more psychiatric medications attended more OBMHC visits.

Trend analysis indicated that women with the highest levels of depression had the best response to the intervention.

Three qualitative themes emerged:

  • Safe Place;
  • Mental/Emotional Stability; and
  • Integrated Personalised Approach.

Obstetric team members (n = 11) perceived the clinic to be helpful and noted improved access to mental health care.

Conclusions

OBMHCs can be effective when psychiatric nurses are embedded within an outpatient obstetric service.

Improved access, timely services, and patient reassurance can lead to an improved pregnancy experience and reduced depressive symptoms.

The longevity of this clinic’s experience serves as a role model for other centres to replicate this successful integrated model of care.

Reference

Goedde, D., Zidack, A., Li, Y.H., Arkava, D., Mullette, E., Mullowney, Y. & Brant, J.M. (2020) Depression Outcomes From a Fully Integrated Obstetric Mental Health Clinic: A 10-Year Examination. Journal of the American Psychiatric Nurses Association. doi: 10.1177/1078390319897311. [Epub ahead of print].

College Students & Substance Use: Do They Require different Strategies for Prevention & Intervention?

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Research Paper Title

Cumulative Risk of Substance Use in Community College Students.

Background

Substance use in community college students has been explored in only a handful of studies.

Differences in population characteristics and substance use between 2- and 4-year students suggest that different factors may promote and thwart this behaviour.

Cumulative risk is a parsimonious methodology that provides better model stability and more statistical power, yet it has only been recently used in substance use research.

The aim of this study is to investigate multiple aspects of substance use risk in a population in need of substance use prevention and intervention services.

Methods

The researchers conducted a cross-sectional study of community college students (N = 288; 75% female) examining the relative contributions of different domains of cumulative risk (eg, life stressors, academic stressors, and mental health diagnoses) to develop different profiles of risk across substance use classes (ie, alcohol, cigarette, marijuana, and hard drug use).

Results

Cumulative risk analyses indicated that alcohol and tobacco use were associated with the domains of life stressors and peer/family substance use, marijuana use with peer/family substance use and stressful childhood experiences, and hard drug use with peer/family substance use, lack of social support, low access to care, and stressful childhood experiences.

Conclusions

Different strategies for prevention and intervention may be necessary to effectively address different forms of substance use in this population.

Scientific Significance

The risk domain profiles related to specific drugs may lead to targeted interventions to reduce substance use in community college students.

Reference

Salgado García, F., Bursac, Z. & Derefinko, K.J. (2020) Cumulative Risk of Substance Use in Community College Students. The American Journal on Addictions. 29(2), pp.97-104. doi: 10.1111/ajad.12983. Epub 2020 Jan 3.

What is Sickness Behaviour?

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Sickness Behaviour is a type of short-term depression:

“Remember the last time you had a stomach bug and just wanted to crawl into bed and pull up the covers? That is called “sickness behaviour” and it is a kind of short-term depression.

The bacteria infecting you aren’t just making you feel nauseous, they are controlling your mood too. It sounds absurd: they are in your gut and your feelings are generated in your brain.

In fact, this is just an inkling of the power that microbes have over our emotions. In recent years, such organisms in the gut have been implicated in a range of conditions that affect mood, especially depression and anxiety.

The good news is that bacteria don’t just make you feel low; the right ones can also improve your mood. That has an intriguing implication: one day we may be able to manipulate the microbes living within our gut to change our mood and feelings.” (Anderson, 2019, p.34).

Reference

Anderson, S. (2019) The Psychobiotic Revolution. New Scientist. 07 September 2019.