Saturday, January 2, 2010

BBC News - Late-night teens 'face greater depression risk'

Of 15,500 12 to 18-year-olds studied, those who went to bed after midnight were 24% more likely to have depression than those who went before 2200.

And those who slept fewer than five hours a night had a 71% higher risk of depression than those who slept eight hours, the journal Sleep reports.

It is estimated 80,000 UK children and young people have depression.

The researchers from Columbia University Medical Center in New York looked at data from 15,500 teenagers collected in the 1990s.

One in 15 of those studied were found to have depression.

As well as the higher risk of depression, those who were set a bedtime by their parents of after midnight were 20% more likely to think about suicide than those whose bedtime was 2200 or earlier.

Those who had less than five hours sleep a night were thought to have a 48% higher risk of suicidal thoughts compared with those who had eight hours of sleep.

Teenagers who reported they "usually get enough sleep" were 65% less likely to be depressed.

Depression and suicidal thoughts were also more likely in girls, older teenagers and in those who had a lower self-perception of how much parents care about them.

Most of the parents of the adolescents in the study set a bedtime of 2200 or earlier.

A quarter set a bedtime of 2400 or later.

On average the teenagers were having seven hours and 53 minutes sleep a night - less than the nine hours recommended at that age.

Study leader Dr James Gangwisch said although it it was possible that youngsters with depression struggle to sleep, the fact that parental set bedtimes were linked with depression suggests that a lack of sleep is somehow underpinning the development of the condition.

He said a lack of sleep could affect emotional brain responses and lead to moodiness that hindered the ability to cope with daily stresses.

This moodiness could affect judgment, concentration and impulse control.

"Adequate quality sleep could therefore be a preventative measure against depression and a treatment for depression," he added.

Sarah Brennan, chief executive at the mental health charity YoungMinds, said: "Enough sleep, good food and regular exercise and all essential to stay emotionally healthy.

"Nearly 80,000 children and young people suffer with depression, yet we are still failing to provide our young people with the help and support to cope with it and prevent it.

"Providing parents with information about how to look after your body, for example by getting enough sleep, and how to get help if they are worried about their teenager, will ensure problems are tackled early and prevent serious mental health conditions such as depression."

Friday, January 1, 2010

How to Train the Aging Brain -

I love reading history, and the shelves in my living room are lined with fat, fact-filled books. There's "The Hemingses of Monticello," about the family of Thomas Jefferson's slave mistress; there's "House of Cards," about the fall of Bear Stearns; there's "Titan," about John D. Rockefeller Sr.

The problem is, as much as I've enjoyed these books, I don't really remember reading any of them. Certainly I know the main points. But didn't I, after underlining all those interesting parts, retain anything else? It's maddening and, sorry to say, not all that unusual for a brain at middle age: I don't just forget whole books, but movies I just saw, breakfasts I just ate, and the names, oh, the names are awful. Who are you?

Brains in middle age, which, with increased life spans, now stretches from the 40s to late 60s, also get more easily distracted. Start boiling water for pasta, go answer the doorbell and — whoosh — all thoughts of boiling water disappear. Indeed, aging brains, even in the middle years, fall into what's called the default mode, during which the mind wanders off and begin daydreaming.

Given all this, the question arises, can an old brain learn, and then remember what it learns? Put another way, is this a brain that should be in school?

As it happens, yes. While it's tempting to focus on the flaws in older brains, that inducement overlooks how capable they've become. Over the past several years, scientists have looked deeper into how brains age and confirmed that they continue to develop through and beyond middle age.

Many longheld views, including the one that 40 percent of brain cells are lost, have been overturned. What is stuffed into your head may not have vanished but has simply been squirreled away in the folds of your neurons.

One explanation for how this occurs comes from Deborah M. Burke, a professor of psychology at Pomona College in California. Dr. Burke has done research on "tots," those tip-of-the-tongue times when you know something but can't quite call it to mind. Dr. Burke's research shows that such incidents increase in part because neural connections, which receive, process and transmit information, can weaken with disuse or age.

But she also finds that if you are primed with sounds that are close to those you're trying to remember — say someone talks about cherry pits as you try to recall Brad Pitt's name — suddenly the lost name will pop into mind. The similarity in sounds can jump-start a limp brain connection. (It also sometimes works to silently run through the alphabet until landing on the first letter of the wayward word.)

This association often happens automatically, and goes unnoticed. Not long ago I started reading "The Prize," a history of the oil business. When I got to the part about Rockefeller's early days as an oil refinery owner, I realized, hey, I already know this from having read "Titan." The material was still in my head; it just needed a little prodding to emerge.

Recently, researchers have found even more positive news. The brain, as it traverses middle age, gets better at recognizing the central idea, the big picture. If kept in good shape, the brain can continue to build pathways that help its owner recognize patterns and, as a consequence, see significance and even solutions much faster than a young person can.

The trick is finding ways to keep brain connections in good condition and to grow more of them.

"The brain is plastic and continues to change, not in getting bigger but allowing for greater complexity and deeper understanding," says Kathleen Taylor, a professor at St. Mary's College of California, who has studied ways to teach adults effectively. "As adults we may not always learn quite as fast, but we are set up for this next developmental step."

Educators say that, for adults, one way to nudge neurons in the right direction is to challenge the very assumptions they have worked so hard to accumulate while young. With a brain already full of well-connected pathways, adult learners should "jiggle their synapses a bit" by confronting thoughts that are contrary to their own, says Dr. Taylor, who is 66.

Teaching new facts should not be the focus of adult education, she says. Instead, continued brain development and a richer form of learning may require that you "bump up against people and ideas" that are different. In a history class, that might mean reading multiple viewpoints, and then prying open brain networks by reflecting on how what was learned has changed your view of the world.

"There's a place for information," Dr. Taylor says. "We need to know stuff. But we need to move beyond that and challenge our perception of the world. If you always hang around with those you agree with and read things that agree with what you already know, you're not going to wrestle with your established brain connections."

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Thursday, December 31, 2009

Review of ‘The Other Side of Sadness,’ by George A. Bonanno -

Poets ramble on at length about mortality, but it was an anonymous World War I lyricist who probably said it best: "The bells of hell go ting-a-ling-a-ling for you but not for me." We can visualize other people's deaths, but not so much our own ("For me the angels sing-a-ling-a-ling").

Unfortunately, this standard psychic defense routinely backfires. We may aim all our fears outward, but then they boomerang back to fill us with terror. When our loved ones die, how will we manage without them? When the worst possible news hits — and it will — how will we survive?

Orthodox psychology has long emphasized the grim slog in store for those who must live without the people they cannot live without. Freud called it "grief work," a process of painfully severing the emotional ties to the deceased. Elisabeth Kübler-Ross mapped out five morose stages of effective grieving.

But if you actually talk to the bereaved, says George A. Bonanno, you find these classic perspectives are pure — well, Dr. Bonanno doesn't actually say baloney, but so he implies in his fascinating and readable overview of what he calls "the science of bereavement."

Just as meticulous observation and experiment transformed astronomy from a compendium of mythology and wishful thinking into a coherent science, the same tools are changing the psychology of loss.

A professor of clinical psychology at Columbia University, Dr. Bonanno has now interviewed hundreds of bereaved people, following some for years before and after the fact, looking for patterns.

His conclusion: the bereaved are far more resilient than anyone — including Freud, and the bereaved themselves — would ever have imagined.

Dr. Bonanno has not written a self-help book in the ordinary sense, but his message winds up being just about as comforting as if he had. Don't worry, he says. When the worst possible news breaks, you will almost certainly get through it unscathed. Almost everyone does. And if your friends and neighbors mutter that you aren't grieving normally, don't worry; you probably are.

In other cultures, Dr. Bonanno points out, it is the ceremonies of death that are the focus of public attention; the community makes sure they are carried out with precision. In our own navel-inspecting society, it is the emotions of death that well-meaning observers focus on instead. Why isn't that widow shedding at least one little tear? How could the boyfriend be off at the ballgame like that? What is wrong with that bizarrely cheerful orphaned child? Surely they all need therapy.

Not so, Dr. Bonanno maintains. In contrast to the grim slog of Freudian grief work, the natural sadness that actually follows a death is not a thick soup of tears and depression. People can be sad at times, fine at other times. The level of fluctuation is "nothing short of spectacular"; the prevalence of joy is "striking."

Over all, we are hard-wired to move on, helped by innate mechanisms that may seem maladaptive or abnormal but are actually quite common and effective.

One of those tools may well be the ability to smile through the worst of it. Humans are inherently drawn to comfort sad people, but can seldom tolerate more than a few minutes in the presence of the seriously depressed. The fact that the bereaved can shake it off periodically means that people will willingly stay with them, protecting them from a spiral of self-involved solitude.

Other tools are less convoluted. Almost everyone idealizes the deceased and spends long solitary sessions remembering good qualities, overlooking bad ones. Some talk to the deceased regularly. Some indulge in what Dr. Bonanno calls "ugly coping" — anger at the damn doctors, the damn hospital or the stupid minister's stupid eulogy can make the bereaved feel better about the loss.

And some realize early on that their lives have actually improved. The consuming worry about incurable illness is over. Old dramas end.

Dr. Bonanno uses his own tense relationship with his father to illustrate this last point: the two were mired in a classic "go to college or get out of my house" situation for many years, long after Dr. Bonanno had grown tired of his self-imposed James Dean role. "It felt to me that I had been living my life as if in a stage play," he writes.

"When my father died, it was as if the house lights had come on. To my surprise, I found that the theater was empty. Not only was I the only one left on the stage, but I was the only person in the entire theater. I had been acting out a play by myself. I could have stopped at any point, but I hadn't known it."

His sadness for his father is continuing — the closing chapters of the book find him burning joss paper in ceremonial Chinese mourning for the old man — but "in fact, my life opened up after my father's death." In his view, it is perfectly normal for the two emotions to coexist, with no need to "process" or "resolve" further.

Medical science being what it is, there are undoubtedly rebuttals to Dr. Bonanno's appealing analysis out there somewhere. But it still makes good reading, a sensitive and sensible view of loss (applicable not only to death, one suspects, but also to lost love, lost opportunity, even lost time) to warm the waning days of the year.


How Little Exercise Can You Get Away With? -

Recently researchers trawled through a vast database of survey information about the health and habits of men and women in Scotland, hoping to determine how much exercise is needed to keep the Scots from feeling gloomy (or in technical terms, experiencing "psychological distress"). The answer, according to a study published in this month's British Journal of Sports Medicine: a mere 20 minutes a week of any physical activity, whether sports, walking, gardening or even housecleaning, the last not usually associated with bringing out the sunshine. The researchers found that more activity conferred more mental-health benefits and that "participation in vigorous sports activities" tended to be the "most beneficial for mental health." But their overall conclusion was that being active for as little as 20 minutes a week is sufficient, if your specific goal is mental health.

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Tuesday, December 29, 2009

Shock Waves: an article by Bethany Vaccaro about her brother's brain injury resulting from a blast in Baghdad | The American Scholar

Going to war brings with it the very real possibility of dying. When my brother Robert left for Iraq in September 2006, our family feared that his commitment might demand what is often called the highest price. Before he left, I imagined what it might be like as the sister of a dead soldier to tell everyone that he had laid down his life in such a contentious struggle. I pictured the flag-draped coffin, the article in our local newspaper, the murmuring friends and neighbors filing through to praise the dead hero. Always a realist, I prepared myself for his death as the worst possible outcome. I failed to conceive of any scenario that could rival the bitter finality of his dying.

I soon discovered that giving one's life can come in more than one form. For my brother, his life as he knew it was taken on January 14, 2007, in Baghdad, when an EFP—an explosively formed projectile device—detonated outside his Army Humvee, sending a shock wave through his brain, severely injuring him without leaving a mark on his body. Robert escaped death, but has paid a price almost as high. Today, he is back from war, 25 years old, brain-injured, and disabled. My brother accepted this risk when he signed his military contract in 2002 through the ROTC program at the University of Rhode Island. Although my family didn't sign an agreement or contract, we have discovered that we are as bound to his commitment as he is himself. Before my brother's injury, the phrase traumatic brain injury, or TBI, meant very little to my family. Now it defines our daily existence. The ongoing process of rehabilitation since his injury has tenaciously enmeshed each one of us, altering our plans, our family structure and interactions, our ideas about life and sacrifice, and most resolutely our belief that if he would only make it back home, everything would be okay.

My brother's injury occurred in the early hours of the morning in Baghdad, as his platoon was finishing a 10-hour shift of route clearing. He was a mechanical engineer and a second lieutenant, in charge of 25 men. Their assignment was to find and dismantle or detonate IEDs (improvised explosive devices) and other explosives that litter the roadways in Iraq. His convoy was nearing an Iraqi checkpoint when his vehicle, the third in line, was targeted by an EFP. The explosion catapulted the vehicle into the side of a building. The force of it blew a hole in the side of the armored Humvee, sending a chunk of metal into the driver's head, killing him almost instantly. My brother was in the passenger seat, and it was the force of the explosion rather than metal that penetrated his head.

After he was wounded, Robert's brain began to swell and the pressure inside his skull skyrocketed. He was taken into surgery as quickly as possible, where a large part of the skull on the right side of his head was removed to allow his brain to expand unencumbered. The pressure continued to rise, and a second surgery to remove even more of the skull was necessary before he left Iraq. It was almost a week before he was stable enough to be moved to the Landstuhl Regional Medical Center in Germany. During this time, my family did little besides sit together and pace around the house, waiting for the phone to ring with an update on his condition. We didn't fully grasp the severity of his injury. We weren't told at the time that he was awarded his Purple Heart in the middle of the night after he was wounded, because doctors feared he wouldn't live until the next day.

Once Robert was in Germany, the Army flew my father out to be with him. It was only then that we understood the gravity of the situation. As his body began to awaken, my brother was kept in an induced coma, allowing his brain to rest. When they finally tried to bring him out of it, he would not wake up.

I am one of five children spanning 14 years. Robert, the eldest, and I were lumped together for much of our childhood, being the closest in age to each other. Although he is 18 months older, I have always acted like the eldest. My mother says he didn't talk until I did. I distinctly remember explaining to him how to pronounce "Hallelujah." Because we were homeschooled, much of our schoolwork was done together. We did our English and history lessons as a pair, as well as all of our science projects—I dictated the steps of the scientific method while he scribbled ferociously into a notebook that would later prove indecipherable. We didn't stay particularly close. He moved into his own sphere when he joined ROTC in college, while I studied philosophy and kept to myself. I could tell he relished being in the traditionally masculine world of the military, where he could perform and deliver, unlike at our university, where he struggled to get through his required courses. Occasionally, he would let me go out with him and his ROTC buddies. I would sit back with my pint of beer and listen to their rapid banter, chuckling where I thought it was appropriate, as they fired movie quotes at each other. I liked watching him laugh and gesticulate. Like our father, Robert would laugh until his eyes watered—with an exuberance that seemed a long time coming after the hesitations of his childhood.

My parents have organized their lives around their children, creating a force field that continually draws us home even as we have grown up. The night we learned of Robert's injury, the rest of us were at our house in Kingston, Rhode Island, where we had spent most of our lives. We were sitting on the floor of the kitchen tie-dyeing T-shirts when the phone rang. A crackly voice told us he had been in an explosion and was going into surgery for head trauma. They would call again in two hours to let us know how it had gone. We gathered in our living room, stunned and unsure of what to do with ourselves. My father stood in the center of the room, slowly rocking back and forth on his feet. When he moved, the imprint of his shoes was chiseled into the carpet as clearly as if he had been standing on clay. He finally sat down, dragging an armchair tight into the circle of chairs and couches. It was not a time for sitting on the other side of the room. I knew my parents were praying, clinging to their lifelong faith, but I only waited for events to unfold and eventually sat at the kitchen table coloring fairies and dragons with my siblings to pass the hours. Every instant seemed like it could be the magical moment—surely now he is gone, or now all is well.

The phrase head trauma meant very little to me that night. I wondered to myself if my brother had perhaps lost an ear or an eye. The possibility of cognitive changes never crossed my mind. I was only vaguely aware of traumatic brain injury as the so-called "signature" wound of the Iraq war, something that is largely due to the increasing sophistication of the explosive devices used by the insurgency. I learned later that the Defense and Veterans Brain Injury Center, which operates out of Walter Reed Army Medical Center, had treated 1,803 cases of TBI stemming from the Afghanistan and Iraq conflicts as of November 2008, while cumulatively their sites had recorded 9,100 cases of this injury. I was completely unaware of the large advocacy and support networks, such as the Wounded Warrior Project, that exist to rally for the treatment of severely injured service men and women, the influx of whom our government has proven sadly unequipped to handle. I didn't know that it is still an uphill battle for many families to receive the kind of care that this incredibly complex injury needs in order to maximize recovery. This was the world we were about to enter that night, although we couldn't have been more ignorant of its existence.

As soon as my brother was moved to Bethesda Naval Hospital in Maryland, my parents began the arduous task of attending to him. I never saw a hint of hesitation in them, even through the long months of care, as everything else in their lives took a distant second place. They were unflinchingly proud of Robert, as they had been when he joined the Army, decided to volunteer for deployment, and ultimately left for Iraq. My parents saw his wartime role in crisp black and white. They were not angry, like I was. Any political context for his actions and what had happened to him collapsed into the overarching fact that he is their son and was in need.

The day my mother prepared to leave for Bethesda, she told us she might stay the whole week. She was sure we could mind each other (two of my brothers were still being homeschooled), the house, and our grandmother for that amount of time. It would be hardest on my nine-year-old brother, who had never been separated from both his parents at once. But we were all eager to rally and pitch in, snapping into an automatic mode that propelled us through our daily routines. My mother was gone for the better part of four months, my father for six months. They would rotate, depending on my father's university work schedule, and were often not home for more than three days at a time. But even when they were home, my parents were present in Rhode Island only in body. Their minds and all their energies were concentrated on a single hospital bed hundreds of miles away.

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Sunday, December 27, 2009

Months to Live - Hard Choice for a Comfortable Death -

In almost every room people were sleeping, but not like babies. This was not the carefree sleep that would restore them to rise and shine for another day. It was the sleep before — and sometimes until — death.

In some of the rooms in the hospice unit at Franklin Hospital, in Valley Stream on Long Island, the patients were sleeping because their organs were shutting down, the natural process of death by disease. But at least one patient had been rendered unconscious by strong drugs.

The patient, Leo Oltzik, an 88-year-old man with dementiacongestive heart failure and kidney problems, was brought from home by his wife and son, who were distressed to see him agitated, jumping out of bed and ripping off his clothes. Now he was sleeping soundly with his mouth wide open.

"Obviously, he's much different than he was when he came in," Dr. Edward Halbridge, the hospice medical director, told Mr. Oltzik's wife. "He's calm, he's quiet."

Mr. Oltzik's life would end not with a bang, but with the drip, drip, drip of an IV drug that put him into a slumber from which he would never awaken. That drug, lorazepam, is a strong sedative. Mr. Oltzik was also receiving morphine, to kill pain. This combination can slow breathing and heart rate, and may make it impossible for the patient to eat or drink. In so doing, it can hasten death.

Mr. Oltzik received what some doctors call palliative sedation and others less euphemistically call terminal sedation. While the national health coverage debate has been roiled by questions of whether the government should be paying for end-of-life counseling, physicians like Dr. Halbridge, in consultations with patients or their families, are routinely making tough decisions about the best way to die.

Among those choices is terminal sedation, a treatment that is already widely used, even as it vexes families and a profession whose paramount rule is to do no harm.

Doctors who perform it say it is based on carefully thought-out ethical principles in which the goal is never to end someone's life, but only to make the patient more comfortable.

But the possibility that the process might speed death has some experts contending that the practice is, in the words of one much-debated paper, a form of "slow euthanasia," and that doctors who say otherwise are fooling themselves and their patients.

There is little information about how many patients are terminally sedated, and under what circumstances — estimates have ranged from 2 percent of terminal patients to more than 50 percent. (Doctors are often reluctant to discuss particular cases out of fear that their intentions will be misunderstood.)

While there are universally accepted protocols for treating conditions like flu and diabetes, this is not as true for the management of people's last weeks, days and hours. Indeed, a review of a decade of medical literature on terminal sedation and interviews with palliative care doctors suggest that there is less than unanimity on which drugs are appropriate to use or even on the precise definition of terminal sedation.

Discussions between doctors and dying patients' families can be spare, even cryptic. In half a dozen end-of-life consultations attended by a reporter over the last year, even the most forthright doctors and nurses did little more than hint at what the drugs could do. Afterward, some families said they were surprised their loved ones died so quickly, and wondered if the drugs had played a role.

Whether the patients would have lived a few days longer is one of the more prickly unknowns in palliative medicine. Still, most families felt they and the doctors had done the right thing.

Mr. Oltzik died after eight days at the hospice. Asked whether the sedation that rendered Mr. Oltzik unconscious could have accelerated his death, Dr. Halbridge said, "I don't know."

"He could have just been ready at that moment," he said.

With their families' permission, Dr. Halbridge agreed to talk about patients, including Mr. Oltzik and Frank Foster, a 60-year-old security guard dying of cancer. He said he had come to terms with the moral issues surrounding sedation.

"Do I consider myself a Dr. Death who is bumping people off on a regular basis?" he asked. "I don't think so. In my own head I've sort of come to the realization that these people deserve to pass comfortably."

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