Therapeutic Lifestyle Changes Offer Many Mental Health Benefits

By Roger Walsh, PhD, M.D.


Lifestyle changes – such as getting more exercise, time in nature, or helping others – can be as effective as drugs or counseling to treat an array of mental illnesses, according to a new paper published by the American Psychological Association.

Multiple mental health conditions, including depression and anxiety, can be treated with certain lifestyle changes as successfully as diseases such as diabetes and obesity, according to Roger Walsh, M.D., PhD. of the University of California, Irvine’s College of Medicine. Walsh reviewed research on the effects of what he calls “therapeutic lifestyle changes,” or TLCs, including exercise, nutrition and diet, relationships, recreation, relaxation and stress management, religious or spiritual involvement, spending time in nature, and service to others. His paper was published in American Psychologist, APA’s flagship journal.

Walsh reviewed research on TLCs’ effectiveness and advantages, as well as the psychological costs of spending too much time in front of the TV or computer screen, not getting outdoors enough, and becoming socially isolated. He concludes that “Lifestyle changes can offer significant therapeutic advantages for patients, therapists, and societies, yet are insufficiently appreciated, taught or utilized,” The paper describes TLCs as effective, inexpensive and often enjoyable, with fewer side effects and complications than medications. “In the 21st century, therapeutic lifestyles may need to be a central focus of mental, medical and public health,” Walsh said.

According to research reviewed in the paper, the many often unrecognized TLC benefits include:

  • Exercise not only helps people feel better by reducing anxiety and depression. It can help children do better in school, improve cognitive performance in adults, reduce age-related memory loss in the elderly, and increase new neuron formation in the brain.
  • Diets rich in vegetables, fruits and fish may help school performance in children, maintain cognitive functions in adults, as well as reduce symptoms in affective and schizophrenic disorders.
  • Spending time in nature can promote cognitive functions and overall well-being.
  • Good relationships can reduce health risks ranging from the common cold to strokes as well as multiple mental illnesses, and can enhance psychological well-being dramatically.
  • Recreation and fun can reduce defensiveness and foster social skills.
  • Relaxation and stress management can treat a variety of anxiety, insomnia, and panic disorders.
  • Meditation has many benefits. It can improve empathy, sensitivity and emotional stability, reduce stress and burnout, and enhance cognitive function and even brain size.
  • Religious and spiritual involvement that focuses on love and forgiveness can reduce anxiety, depression and substance abuse, and foster well-being.
  • Contribution and service, or altruism, can enhance joy and generosity by producing a “helper’s high.” Altruism also benefits both physical and mental health, and perhaps even extends lifespan. A major exception the paper notes is “caretaker burnout experienced by overwhelmed family members caring for a demented spouse or parent.”

Difficulties associated with using TLCs are the sustained effort they require, and “a passive expectation that healing comes from an outside authority or a pill,” according to Walsh. He also noted that people today must contend with a daily barrage of psychologically sophisticated advertisements promoting unhealthy lifestyle behaviors such as smoking, drinking alcohol, and eating fast food. “You can never get enough of what you don’t really want, but you can certainly ruin your life and health trying” lamented Walsh.

For therapists, the study recommends learning more about the benefits of TLCs, and devoting more time to foster patients’ TLCs.

The paper recognizes that encouraging widespread adoption of therapeutic lifestyles by the public is likely to require wide-scale measures encompassing educational, mental, and public health systems, as well as political leadership.

Source Medical News Today

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Getting Someone to Psychiatric Treatment Can Be Difficult and Inconclusive

By A. G. SULZBERGER and BENEDICT CAREY


That question is as difficult to answer today as it was in the years and months and days leading up to the shooting here that left 6 dead and 13 wounded.

Millions of Americans have wondered about a troubled loved one, friend or co-worker, fearing not so much an act of violence, but — far more likely — self-inflicted harm, landing in the streets, in jail or on suicide watch. But those in a position to help often struggle with how to distinguish ominous behavior from the merely odd, the red flags from the red herrings.

In Mr. Loughner’s case there is no evidence that he ever received a formal diagnosis of mental illness, let alone treatment. Yet many psychiatrists say that the warning sings of a descent into psychosis were there for months, and perhaps far longer.

Moving a person who is resistant into treatment is an emotional, sometimes exhausting process that in the end may not lead to real changes in behavior. Mental health resources are scarce in most states, laws make it difficult to commit an adult involuntarily, and even after receiving treatment, patients frequently stop taking their medication or seeing a therapist, believing that they are no longer ill.

The Virginia Tech gunman was committed involuntarily before killing 32 people in a 2007 rampage.

With Mr. Loughner, dozens of people apparently saw warning signs: the classmates who listened as his dogmatic language grew more detached from reality. The police officers who nervously advised that he could not return to college without a medical note stating that he was not dangerous. His father, who chased him into the desert hours before the attack as Mr. Loughner carried a black bag full of ammunition.

“This isn’t an isolated incident,” said Daniel J. Ranieri, president of La Frontera Center, a nonprofit group that provides mental health services. “There are lots of people who are operating on the fringes who I would describe as pretty combustible. And most of them aren’t known to the mental health system.”

Dr. Jack McClellan, an adult and child psychiatrist at the University of Washington, said he advises people who are worried that someone is struggling with a mental disorder to watch for three things — a sudden change in personality, in thought processes, or in daily living. “This is not about whether someone is acting bizarrely; many people, especially young people, experiment with all sorts of strange beliefs and counterculture ideas,” Dr. McLellan said. “We’re talking about a real change. Is this the same person you knew three months ago?”

Those who have watched the mental unraveling of a loved one say that recognizing the signs is only the first step in an emotional, often confusing, process. About half of people with mental illnesses do not receive treatment, experts estimate, in part because many of them do not recognize that they even have an illness.

Pushing such a person into treatment is legally difficult in most states, especially when he or she is an adult — and the attempt itself can shatter the trust between a troubled soul and the one who is most desperate to help. Others, though, later express gratitude.

“If the reason is love, don’t worry if they’ll be mad at you,” said Robbie Alvarez, 28, who received a diagnosis of schizophrenia after being involuntarily committed when his increasingly erratic behavior led to a suicide attempt. At the time, he said, he was living in Phoenix with his parents, who he was convinced were trying to kill him. In Arizona it is easier to obtain an involuntary commitment than in many states because anyone can request an evaluation if they observe behavior that suggests a person may present a danger or is severely disabled (often state laws require some evidence of imminent danger to self or others).

But there are also questions about whether the system can accommodate an influx of new patients. Arizona’s mental health system has been badly strained by recent budget cuts that left those without Medicaid stripped of most of their services, including counseling and residential treatment, though eligibility remains for emergency services like involuntary commitment. And the state is trying to change eligibility requirements for Medicaid, which would potentially reduce financing further and leave more with limited services.

Still, people who have been through the experience argue that it is better to act sooner rather than later. “It’s not easy to know when we could or should intervene but I would rather err on the side of safety than not,” said H. Clarke Romans, executive director of the local chapter of the National Alliance on Mental Illness, an advocacy group, who had a son with schizophrenia.

The collective failure to move Mr. Loughner into treatment, either voluntarily or not, will never be fully understood, because those who knew the young man presumably wrestled separately and privately about whether to take action. But the inaction has certainly provoked second-guessing. Sheriff Clarence Dupnik of Pima County told CNN last Wednesday that Mr. Loughner’s parents were as shocked as everyone else. “It’s been very, very devastating for them,” he said. “They had absolutely no way to predict this kind of behavior.”

Linda Rosenberg, president of the National Council for Community Behavioral Healthcare, said, “The failure here is that we ignored someone for a long time who was clearly in tremendous distress.” Ms. Rosenberg, whose group is a nonprofit agency leading a campaign to teach people how to recognize and respond to signs of mental illness, added, “He wasn’t someone who could ask for help because his thinking was affected, and as a community no one said, let’s stop and make sure he gets help.”

At the University of Arizona, where a nursing student killed three instructors on campus eight years ago before killing himself, feelings of sadness and anger initially mixed with some guilt as the university examined the missed warning signs.

The overhauled process for addressing concerns is now more responsive, even if there are sometimes false alarms, said Melissa M. Vito, vice president for student affairs. “I guess I’d rather explain why I called someone’s parents than why I didn’t do something,” she said.

Many others feel the same way.

Four years ago Susan Junck watched her 18-year-old son return from community college to their Phoenix home one afternoon and, after preparing a snack, repeatedly call the police to accuse his mother of poisoning him. She assumed it was an isolated outburst, maybe connected to his marijuana use. In the coming months, though, her son’s behavior grew more alarming, culminating in an arrest for assaulting his girlfriend, who was at the center of a number of his conspiracy theories.

“I knew something was wrong but I literally just did not understand what,” Ms. Junck, 49, said in a recent interview. “It probably took a year before I realized my son has a mental illness. This isn’t drug related, this isn’t bad behavior, this isn’t teenage stuff. This is a serious mental illness.”

Fearful and desperate, she brought her son to an urgent psychiatric center and — after a five-hour wait — agreed to sign paperwork to have him involuntarily committed as a danger to himself or others. Her son screamed for her help as he was carried off. He was diagnosed with paranoid schizophrenia and remains in a residential treatment facility.

This week Erin Adams Goldman, a suicide prevention specialist with a mental health nonprofit organization in Tucson, is teaching the first local installment of a course that is being promoted around the country called mental health first aid, which instructs participants how to recognize and respond to the signs of mental illness.

A central tenet is that if a person has suspicions about mental illness it is better to open the conversation, either by approaching the individual directly, someone else who knows the person well or by asking for a professional evaluation.

“There is so much fear and mystery around mental illness that people are not even aware of how to recognize it and what to do about it,” Ms. Goldman said. “But we get a feeling when something is not right. And what we teach is to follow your gut and take some action.”

Web Source: http://www.nytimes.com/2011/01/19/us/19mental.html?pagewanted=1&_r=1&partner=rss&emc=rss

Universities Miss Chance to Identify Depressed Students, Study Finds

ScienceDaily


One out of every four or five students who visits a university health center for a routine cold or sore throat turns out to be depressed, but most centers miss the opportunity to identify these students because they don’t screen for depression, according to new Northwestern Medicine research.

About 2 to 3 percent of these depressed students have had suicidal thoughts or are considering suicide, the study found.

“Depression screening is easy to do, we know it works, and it can save lives,” said Michael Fleming, professor of family and community medicine at Northwestern University Feinberg School of Medicine. “It should be done for every student who walks into a health center.”

The consequences of not finding and treating these students can be can be serious and even deadly. “These kids might drop out of school because they are so sad or hurt or kill themselves by drinking too much or taking drugs,” Fleming said.

“Things continually happen to students — a low grade or problems with a boyfriend or girlfriend — that can trigger depression,” Fleming said. “If you don’t take the opportunity to screen at every visit, you are going to miss these kids.”

Fleming, who joined Feinberg in the fall of 2010, is lead author of a paper on the findings in the January issue of the American Journal of Orthopsychiatry. He conducted the research when he was a faculty member at the University of Wisconsin.

The study is the first to screen for depression in a large population of students who are coming to campus health centers for routine care. Prior depression studies have been conducted by surveying general college samples or students in counseling centers. The frequency of depression and suicidal thoughts among campus health clinic users was nearly twice as high as rates reported in general college samples.

Depressed students need treatment, which may include counseling and medication. These students are more likely to drink, smoke and be involved in intimate partner violence, the study found.

With new technology, screening students is simple, Fleming noted. While waiting for an appointment at the health center, the student could answer seven simple questions — a depression screening tool that that could be immediately entered into his electronic health record. “They can answer those seven questions in a minute,” Fleming said.

When the doctor or nurse sees the student, she then could address the student’s sadness or depression.

Universities typically separate mental health treatment from primary care treatment. If a student comes to a campus health center and complains about depression, he is referred to a counseling center.

“But students don’t necessarily get there unless they are pretty depressed,” Fleming said. “If we screen, we can try to find every student that is depressed.”

Historical perceptions and biases against preventive screenings are that kids who need treatment the most don’t go to campus health centers, and they won’t tell the truth about their depression.

That’s wrong. “Students will tell you the truth,” Fleming said. “If they are sad and depressed, they will tell you that. And, kids who are drinking too much or who are suicidal do go to the campus health centers.”

The study also found that students who exercise frequently are not as depressed. “That’s the one thing that seemed to be protective,” Fleming said.

The study surveyed 1,622 college students at college campuses including the University of Wisconsin, the University of Washington and the University of British Columbia.

 

Web Source: http://www.sciencedaily.com/releases/2011/01/110110154647.htm

Story Source:

The above story is reprinted (with editorial adaptations by ScienceDaily staff) from materials provided by Northwestern University, via EurekAlert!, a service of AAAS.


Journal Reference:

  1. Sara Mackenzie, Jennifer R. Wiegel, Marlon Mundt, David Brown, Elizabeth Saewyc, Eric Heiligenstein, Brian Harahan, Michael Fleming. Depression and Suicide Ideation Among Students Accessing Campus Health Care. American Journal of Orthopsychiatry, 2011; 81 (1): 101 DOI: 10.1111/j.1939-0025.2010.01077.x

LOW VITAMIN D LINKED TO SCHIZOPHRENIA

There may be a link between sunlight, vitamin D and children’s brain development.
Content provided by Timothy McDonald, ABC Science

THE GIST

  • Babies born with low vitamin D levels are shown to be twice as likely to develop schizophrenia.
  • The finding may mean there could be a way to prevent cases of the disease.
  • Scientists caution more research needs to be done to confirm the link.

Babies born with low vitamin D levels are twice as likely to develop schizophrenia later in life, researchers from the Queensland Brain Institute have found.

But the researchers say the good news from the study is that it suggests it may be possible to prevent schizophrenia.

John McGrath from the Queensland Brain Institute says there have been suggestions for some time that there may be a link between sunlight, vitamin D and brain development. He says it is increasingly clear children with low vitamin D levels are more likely to develop schizophrenia.

“For the babies who had very low vitamin D, their risk was about twice as high as those babies who had optimal vitamin D,” said McGrath.

“But the amazing thing was that the study that was based in Denmark, where low vitamin D is quite common, we found that if vitamin D is linked to schizophrenia our statistics suggest that it could explain about 40 percent of all schizophrenias. That’s a much bigger effect than we’re used to seeing in schizophrenia research.”

While the simplest way to get enough vitamin D is to spend more time in the sun, it remains unclear whether there are fewer cases of schizophrenia in a country like Australia which sees a lot more sunlight.

“We don’t have high-quality data on that, but some statistics suggest we do have slightly lower incidences and prevalence of schizophrenia,” said McGrath.

“Like many other diseases, like multiple sclerosis, schizophrenia tends to be more common in places further away from the equator. And if you’re born in winter and spring you tend to have a slightly increased risk of schizophrenia also, and that was one of the original pieces of the jigsaw puzzle that led us to wonder maybe vitamin D could be implicated.”

Ian Hickie from the Brain and Mind Research Institute in Sydney says he is not surprised by the results, however he says more research is needed.

“So the real acid test is going to be trying to lift vitamin D levels in pregnant women and newborns and see whether there’s an effect on later schizophrenia,” said Hickie. “Or even in fact, looking at providing higher levels of vitamin D by vitamin D supplementation in other ways later in life and particularly childhood and the teenage years, to see whether you might reduce the risk of onset of schizophrenia.”

Vitamin D supplements may prove an effective way to prevent schizophrenia. But McGrath agrees there is only a statistical link at the moment and that does not prove vitamin D deficiencies are to blame for schizophrenia.

“Because the treatment and the outcome can be separated by about 20, 30 years, we need to treat pregnant women and then wait for their offspring to develop schizophrenia,” he said. “It will be a very challenging study to do.”

It could be decades before scientists know for sure.

“But medical research tends to move at a steady pace. I think the other thing is that there are many other studies suggesting that vitamin D is good for baby’s bone health,” McGrath said.

“So it may well be that recommendations will be made to women to increase their vitamin D status for more obvious outcomes, like baby’s rickets for example. If that happened then it may well be that schizophrenia would start to fall in decades to come.”

But Hickie warns against spending too much time in the sun to get more vitamin D because that could increase the risk of skin cancer.

“Rates of melanoma and skin cancer are obviously very high in our country and directly related to sun exposure, particularly in childhood,” he said.

“So on the one hand we need to be careful about over exposure to sunlight, on the other hand it may well be that in some places, or in some individuals, low levels of vitamin D may constitute a risk factor, particularly in pregnancy and therefore affecting the rates of vitamin D in newborn children.”

“So this is one of the issues that we’re going to need to look at clearly. I don’t think it means that everyone should be rushing out into the sun and necessarily putting themselves at risk of other sun-related cancers.”

Even if vitamin D does make a difference, there are several other factors that may play a part.

A predisposition to the illness can run in families, chemical imbalances in the brain may be responsible and stressful events are often thought to play a role in the onset of the schizophrenia.

This article was originally posted at Discovery.com: http://news.discovery.com/human/vitamin-d-schizophrenia.html#mkcpgn=hknws1