Borderline Personality Disorder Research and Treatment

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Borderline personality disorder (BPD), characterized by pervasive instability in moods, interpersonal relationships, self-image and behavior, afflicts approximately 2 percent of the general population and is a leading cause of suicide. Eight to 10 percent of individuals with this disorder take their own lives.

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“A common misapprehension by family, friends and often by clinicians is that patients with borderline personality disorder are not likely to commit suicide since suicidal behavior is seen as a bid for attention, misjudged as not serious. The prevalence is more than 400 times higher than in the general population,” said John Oldham, MD, MS, senior vice president and chief of staff, The Menninger Clinic, and professor of psychiatry and executive vice chair, Menninger Department of Psychiatry & Behavioral Sciences, Baylor College of Medicine.

Despite the prevalence of BPD, its diagnosis by therapists is often impeded by the lack of awareness and frequent co-occurrence with other conditions, such as depression, substance abuse and anxiety. To help therapists diagnose this disorder and build an alliance with their BPD patients, new ways of categorizing and defining BPD are in consideration. Dr. Oldham is one of the consultants on the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V), expected to be published in 2011.

BPD usually manifests itself in late adolescence or early adulthood, according to Dr. Oldham.

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“Patients with borderline personality disorder often have a stormy course, punctuated with episodes of high-risk behavior. The patient’s symptom profile as well as coexisting conditions, such as substance abuse, influence an individual’s course. Due to the disabling nature of the disorder, accompanied by high levels of emotional pain and distress, patients generally seek treatment and if they adhere to treatment and overcome high-risk behavior, they may ultimately do quite well.”

Officially recognized in 1980 by the psychiatric community, borderline personality disorder is at least two decades behind in research treatment options and education compared to other serious mental illnesses. Congressional Resolution, H. Res. 1005, is awaiting final action to designate May as Borderline Personality Disorder Awareness Month. This resolution acknowledges the pressing burden of those afflicted with borderline personality disorder, confirms the widespread prevalence of this disorder and seeks to spread awareness of this under-recognized and often misunderstood mental illness.

This Menninger Continuing Education Conference, offering continuing education credit to health professionals, is co-sponsored by the National Education Alliance for Borderline Personality Disorder (NEA-BPD) and The National Alliance on Mental Illness (NAMI) Metropolitan Houston. Topics and speakers include:

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  • Borderline Personality Disorder: Overview of Recent Research Findings by John M. Oldham, MD, MS
  • Mentalizing in the Treatment of BPD by Jon G. Allen, PhD
  • Evidence-Based Treatment of BPD by Glen O. Gabbard, MD
  • Borderline Personality as a Self-Other Representational Disturbance by Donna S. Bender, PhD
  • New Developments in the Neurobiology of BPD by Larry J. Siever, MD
  • Borderline Personality Disorder in DSM-V by Andrew E. Skodal, MD

For conference information, see http://www.menningerclinic.com/calendar/BorderlineConf.pdf or call Menninger Education at 713-275-5060. The conference schedule and online registration form is also accessible at: MenningerClinic.com, Calendar, Conferences & Forums; NEABPD.org and NAMI.org, NAMI Metropolitan Houston Website.

The Menninger Clinic is an international specialty psychiatric center, providing treatment, research and education. Founded in 1925 in Kansas, Menninger relocated to Houston in 2003 and is affiliated with Baylor College of Medicine and The Methodist Hospital. For 17 consecutive years, Menninger has been named among the leading psychiatric hospitals in U.S.News & World Report‘s annual ranking of America’s Best Hospitals

How much is too much caffeine🕉

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A video of Dr. Ayala discussing caffeine’s impact on the heart is available here:

https://www.wbaltv.com/article/the-woman-s-doctor-how-much-is-too-much-caffeine/30824815

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Tomas H. Ayala, M.D., FACC, is a general cardiologist in Baltimore, Maryland. He sees patients at The Heart Center at Reisterstown, a satellite location of The Heart Center at Mercy. Dr. Ayala provides a range of care to diagnose and treat cardiovascular disease. He has an interest in cardiac imaging, valvular heart disease and geriatric cardiology.

Dr. Tomas Ayala has provided adults of all ages comprehensive cardiology care for more than 15 years. With Fellowship training in Cardiology, Dr. Ayala offers personalized care, concentrating on the best treatment plans to improve patient health and quality of life. He treats patients with congestive heart failure, coronary artery diseasearrhythmiashypertension and valvular heart disease, among other heart conditions.

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He is Board Certified in Cardiovascular Disease, Nuclear Cardiology and Internal Medicine. Dr. Ayala is a Fellow of the American College of Cardiology as well as a member of the American Society of Echocardiography and the American Society of Nuclear Cardiology.

Dr. Tomas Ayala is committed to providing focused care for his patients. He is currently a Testamur of the ASCeXAM in adult Echocardiology, signifying his achievement in passing the Board exam and progressing to the “Board Eligible” stage. Echocardiography Board Certification will place Dr. Ayala among a group of distinguished experts in cardiovascular ultrasound interpretation and enable him to offer enhanced patient care for cardiovascular disease.

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Dr. Ayala works with his patients to help them prevent and manage heart disease and maintain proper heart health. He places emphasis on patient education and understanding of risk factors and medical conditions, encouraging patients to take an active role in their care.

Dr. Tomas Ayala uses comprehensive testing and diagnostic services, including transthoracic echocardiography, transesophageal echocardiogram (TEE) and nuclear myocardial perfusion imaging, to evaluate heart blood flow, pumping function and anatomy in the diagnosis and assessment of cardiac conditions.

The Four Types of Love (Some Are Healthy, Some Are Not)💖

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As Valentine’s Day approaches, think about how you use the word “love” in your life. You love your significant other, your kids, your friends and your siblings in different ways. Dr. Kirtly Parker Jones talks about the research behind these types of affection and why our loved ones make us crazy (in good ways and bad ways).

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Below is a transcript from an interview with Dr. Kirtly Parker Jones, University of Utah Health.

Love. It’s a word that some of us use a lot. “I love that color on you.” “I just love pizza.” “I love, love, love you” to our little grandchildren. Some of us never feel comfortable using the word out loud. Philosophers, Theologians and now neuroscientists and clinicians think a lot about love. We use this word for so many emotions.

Maybe as we approach Valentine’s Day we should think a little bit about the different kinds of love. Some good for you and good for your health and some maybe not so much. The Western tradition from the Greeks distinguishes four types of love and has a Greek word for all of them. There are many sources that define many other kinds of love but four is a pretty manageable number.

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Eros: erotic, passionate love

We might as well get that one out of the way first. Eros is erotic or sexual or passionate love. It’s often all about need and it’s more about the person who’s feeling sexually attractive than it is about the person who is the focus of that love or thing that is the focus of that love. It is addicting. It can cause great joy and great sorrow. It isn’t always good for you. More hearts are broken on Valentine’s Day due to the unfulfillment of erotic love.

Philia: love of friends and equals

It can be the love between lovers when they’ve been together for a long time and are not so hot and bothered anymore. It’s also called brotherly love as in the city of Philadelphia. The city of brotherly love. Of course, it could be sisterly love and it is the accepting love of good friendship. This is the love that is good for your health. The touch of a loved one. The philia touch lowers blood pressure. People in loving relationships feel your love have few doctor visits, shorter hospital visits, have less pain, and have more positive emotions. All of these positive consequences of philia love, loving friendships make us more resilient when hard times come.

Storge: love of parents for children

This kind of love is what mothers know best but isn’t talked about too much when we talk about love. It is the love of parents for children. It is described as the most natural of loves. Natural in that it’s present without corrosion. It’s emoted because we can’t help ourselves and it pays the least attention as to whether the person is worthy of love.

It’s often transient behaviors that wouldn’t be tolerated in philia love. For example, women can continue to love their children despite truly awful behaviors. Behaviors they wouldn’t tolerate in their girlfriends or their spouses. It seems to come unbidden in the care of a newborn and it grows to allow us to love our children despite their behaviors. Thank goodness for that. In many ways it’s probably a genetically programmed and hard wired love compared to the affectionate love, philia, which is maybe not so hot wired.

Agape: love of mankind

The love modeled on the love of the Christian God for men and the love of man for God. It’s the love that is given whether or not it’s returned. It’s the love without any self benefit. In the Buddhist tradition it is the central foundation of loving kindness for all mankind. This kind of love is important in the process of forgiveness. Forgiveness is important to your health, because the inability to forgive is associated with anger and a number of health outcomes that are not very good. It is love that sets a very hard bar but it may be at the foundation for happiness and contentment.

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So, if you are planning something for Valentines Day for the focus of your erotic love, I hope you get it. The good news for your budget is that humans can usually only have erotic love for one person at a time. So it means one card. Good for you.

If you’re planning cards for your philia loves I hope that you have quite a few and they make you smile and that you get a bunch back.

If you’re planning cards for you storge loves your probably just planning on some heart shaped cookies for your kids.

If you planning cards for your agape loves, good luck on that one. You will break the budget and the postal service to send a card to all mankind. But we can take a little moment on Valentine’s Day to send out a little thought message of love and peace to the world.

This interview was originally broadcast by The Scope Radio. The Scope Radio, from University of Utah Health, highlights expert health advice and research you can use for a happier and healthier life.  

Six questions about Coronavirus

A Texas State clinical microbiology expert answers the most common questions he has been fielding from journalists and health officials in the US

As an infectious disease and clinical microbiology expert, Prof. Rodney E. Rohde of the Texas State University College of Health Professions receives daily calls from the media, government and university officials, public health and professional organizations and the public asking him about the emerging novel coronavirus outbreak. Here, he shares some of the most common questions and his responses.

Q: Considering that coronaviruses can technically refer to illnesses ranging from the common cold to something as serious as SARS, what makes this particular coronavirus strain significantly concerning?

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Rodney Rohde: This is the name for a family of viruses that are mainly characterized by a positive-stranded RNA genome, and are bound in a membranous envelope. In recent history, this virus family has been extensively studied, as this virus family was responsible for the SARS (Severe Acute Respiratory Syndrome) and MERS (Middle East Respiratory Syndrome) outbreaks in 2003 and 2012, respectively. Interestingly, coronaviruses are responsible for about a third of all common cold cases (rhinoviruses, adenoviruses, and others also cause the common cold). This virus, 2019-nCoV, is not similar to the more common coronaviruses, such as those that cause common colds. However, genetic analyses su

ggest this virus emerged from a virus related to SARS. There are ongoing investigations to learn more.

Credit: Texas State University
Dr. Rodney E. Rohde

Novel outbreaks from any microbe should always be of public health concern. The risk from these outbreaks depends on characteristics of the virus, including whether and how well it spreads between people, the severity of resulting illness, and the medical or other measures available to control the impact of the virus (for example, vaccine or treatment medications).

The novel coronavirus is a serious public health threat. The fact that it has caused severe illness and sustained person-to-person spread in China is concerning, but it’s unclear how the situation in other parts of the world will unfold. In the US, authorities will continue to monitor the outbreak and incoming laboratory, healthcare, and public health data to produce the best possible plans and precautions.

The risk of acquiring infection is dependent on exposure. Outside the epidemic region, some people will have an increased risk of infection – for example, healthcare workers caring for 2019-nCoV patients and other close contacts. Likewise, the immunocompromised should be wary of exposure to any novel microbe. However, for most of the general public in the US who are unlikely to be exposed to this virus, the immediate health risk from 2019-nCoV is considered low.

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Q: What do we currently know about the human-to-human transmission of this novel coronavirus? More specifically, once one person is infected, does the coronavirus appear to be significantly contagious in a human-to-human context?

RR: The modes of human-to-human transmission of the virus are still being determined, but given current evidence, it is most likely spread by the following, according to the CDC.

  • Through the air by coughing and sneezing
  • Close personal contact, such as touching or shaking hands
  • Touching an object or surface with the virus on it, then touching your mouth, nose or eyes before washing your hands
  • In rare cases, fecal contamination

With current data available and my professional experience, I do not believe this novel virus is any more contagious than the influenza virus. At this time, both appear to have similar transmission rates and case fatality rates (currently holding steady at about 2 percent). Of course, this could change, and it’s why we must monitor the outbreak closely and rely on “confirmed, and accurate” laboratory test results.

Lastly, it’s important to remember that until recently, all confirmatory laboratory testing (real-time RT-PCR molecular test) was occurring only at the CDC. This week, the US FDA granted emergency-use approval for state public health laboratories to starting testing for coronavirus using kits developed by the CDC. However, testing reagents and supplies could become limited due to rapid and expanding volume of testing.

Q: The number of coronavirus cases in China seems to have increased very quickly in a very short amount of time. In terms of human-to-human transmission of the coronavirus, how concerned should we be (if at all) about the fact that there are more confirmed cases in the US?

RR: As of today (Feb 6, 2020), there are 12 confirmed cases in the US, 76 pending cases, and 206 cases that were suspected but have tested negative. With any novel virus or other microbe, the rapid increase in detected cases is to be expected. The perfect storm of advanced diagnostic laboratory testing coupled with  heightened awareness will certainly cause the daily rates and numbers to continue to climb. We should take typical precautions, much like we would for the influenza virus, such as hand hygiene, avoiding sick individuals, careful travel plans, and staying up to date on our vaccines, including the flu vaccine.

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Globally, it is difficult to know the exact number of cases due to the uncertainty of asymptomatic cases or cases that are not being detected by testing. This map by the Centers for Disease Control and Prevention and this visualization by Johns Hopkins University Center for Systems Science and Engineering show the global spread of the virus.

Q: What are the main symptoms associated with this novel coronavirus?

RR: Symptoms will vary in severity. Current general symptoms include fever, difficulty breathing and cough. All or almost all diagnosed cases have pneumonia; some develop  kidney failure or other organ dysfunction.

Q: How are the symptoms of this novel coronavirus different from those we associate with a typical common cold and seasonal flu?

RR: Both MERS and SARS (earlier coronaviruses) have been known to cause severe illness in people (~35 percent and ~10 percent, respectively). The complete clinical picture with regard to 2019-nCoV is still not fully clear. Reported illnesses have ranged from infected people with little to no symptoms to people being severely ill and dying. CDC believes at this time that symptoms of 2019-nCoV may appear in as few as 2 days or as long as 14 after exposure.

There are ongoing investigations to learn more. This is a rapidly evolving situation and information will be updated as it becomes available.

Q: In terms of screening/testing for the coronavirus and staying generally cognizant of the outbreak as it continues to develop, what do people need to know to protect themselves and avoid getting sick? Put another way: Do we need to do much else outside of our usual cold and flu prevention strategies (regular hand-washing, getting enough rest/fluids, staying home when sick, etc.) to stay safe during this outbreak?

RR: The data at this time tells us to treat this virus outbreak much like we would other respiratory agents like the common cold or flu. Certainly US citizens should pay attention to reputable sources and heed the advice of the government and public health experts. The US Department of State has issued a level 4 “do not travel” advisory for China. Proper perspective is critical. There is no need to panic. We should all do our part in not becoming part of the problem as a “super-spreader” of inaccurate or unchecked information surrounding this virus outbreak.

Remember, each and every year, thousands of American citizens (and many more globally) deal with influenza, common cold, and other respiratory agents. In fact, in any given year, the typical estimate is 36,000 deaths a year in the United States alone, according to CDC reports. Thus, while we must pay attention to this outbreak and be prepared for any rapid changes, we must maintain perspective.

Experimental fingerprint test can distinguish between those who have taken or handled cocaine😌😮

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An experimental fingerprint detection approach can identify traces of cocaine on human skin, even after someone has washed their hands

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An experimental fingerprint detection approach can identify traces of cocaine on human skin, even after someone has washed their hands – and the test is also smart enough to tell whether an individual has actually consumed the class A drug, or simply handled it.

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In a paper published in Nature Publishing Group’s Scientific Reports, a series of experiments by the University of Surrey detail how it is possible to carry out drug testing accurately and painlessly using a single fingerprint sample. For drug testing, it is necessary to be able to distinguish those who have handled cocaine from those who have ingested it because the legal ramifications are different (for example, consider drug driving) – the new research demonstrates that this is possible for the first time using high resolution mass spectrometry techniques.

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A successful, commercially-available fingerprint drug screening system, using lateral flow assay technology and fluorescence-labelled antibodies to selectively detect specific drugs or their metabolites in eccrine sweat collected from fingerprints, is already available for point of care use from Intelligent Fingerprinting – who also offer a fingerprint-based laboratory confirmation service which uses Liquid Chromatography Mass Spectrometry techniques.

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The team, from University of Surrey, Forensic Science Ireland, National Physical Laboratory and Intelligent Fingerprinting, took fingerprints from people seeking treatment at drug rehabilitation clinics who had testified to taking cocaine during the previous 24 hours. Fingerprints were collected from each patient, and the participants were then asked to wash their hands thoroughly with soap and water before giving another set of fingerprints. This same process was used to collect samples from a pool of drug non-users who had touched street cocaine.

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The researchers at Surrey used their world-leading experimental fingerprint drug testing approach (based on rapid, high resolution mass spectrometry) to cross-reference the information from the drug non-users who had touched cocaine with that of volunteers who testified ingesting it. They found that a molecule produced in the body when cocaine is ingested, benzoylecgonine, is essential in distinguishing those who have consumed the class A drug from those who have handled it. Benzoylecgonine was not present in samples from drug non-users, even after touching street cocaine and then washing their hands.

Dr Min Jang said: “A fingerprint is a great way to test for drugs as it is so quick and efficient to collect. Using our methodology, it is possible to analyse a fingerprint sample for drugs in less than 2 minutes”.

Dr Catia Costa from the University of Surrey said: “We are excited about the possibilities for fingerprint drug testing. In addition to illicit drugs, we have found that we can detect pharmaceutical drugs in fingerprints and we are keen to see if we can use this to help patients to check that their medication is being delivered at the right dose.”

Dr Melanie Bailey from the University of Surrey said: We think this research is really significant as our laboratory test using high resolution mass spectrometry can tell the difference between a person who has touched a drug and someone who has actually consumed it – just by taking their fingerprints.

Professor David Russell, Founder and Chief Scientific Officer at Intelligent Fingerprinting, said: “This University of Surrey laboratory study into cocaine testing using experimental high resolution mass spectrometry techniques validates the approach Intelligent Fingerprinting took when originally commercialising our portable fingerprint-based drug screening system for use at the point-of-care. Because our commercially-available test detects both cocaine traces and benzoylecgonine – the major metabolite of cocaine – our customers have been successfully using fingerprint-based drug tests since the Summer of 2017 to determine whether cocaine has actually been taken.”

What's your brand?

A new algorithm analyzes social media data to help brands improve their marketing

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Researchers created an algorithm that successfully predicted consumer purchases. The algorithm made use of data from the consumers’ daily activity on social media. Brands could use this to analyze potential customers. The researchers’ method combines powerful statistical modeling techniques with machine learning-based image recognition.

Associate Professor Toshihiko Yamasaki and his team from the Graduate School of Information Science and Technology at the University of Tokyo explore new and interesting ways to make use of data such as social media data. Some applications they develop are useful for entities like companies to improve their effectiveness in different ways, but in particular in how they reach and influence potential customers.

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“I posed two questions to my team: ‘Is it possible to calculate the similarity between different brands based on the way customers engage with them on social media?’ And, ‘If so, can brands use this information to improve the way they market themselves?'” said Yamasaki. “And with some time, effort and patience, they came back with a simple but confident answer: ‘Yes!'”

But the way their team deduced this was anything but simple. The computational analysis of social media data is often called mining, as the term suggests it is a monumental and laborious task. For this reason, researchers in this field make use of various computational tools to analyze social media in ways that human beings cannot.

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“In the past, many companies improved their marketing strategies with the use of customer surveys and projections based on their sales data,” explained lead researcher Yiwei Zhang. “However, these are time-consuming and imprecise. Now we have access to and expertise in tools such as machine learning and complex statistical analysis.”

The team began its work by gathering publicly available social media data from followers of selected brands. They used proven image recognition and machine-learning methods to analyze and categorize photos and hashtags relating to the brands’ followers. This revealed patterns of behavior of consumers towards different brands. These patterns meant the researchers could calculate the similarity between different or even unrelated brands.

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“We evaluated our proposed algorithm against purchase history and questionnaires, which are still useful to provide context to purchase information,” continued Zhang. “The experimental results show that credit card or point card companies could predict customers’ past purchasing behavior well. Our algorithm could accurately predict customers’ willingness to try new brands.”

This research could be extremely useful for new promotions of brands that make use of social media networks. It could also be used by shopping centers and malls to plan which stores they include or for stores themselves to choose which brands to stock. And the research could even help match brands with suitable social media influencers to help better advertise their products.

“To visualize what has not been visible before is always very interesting,” concluded Yamasaki. “People might say that professionals already ‘see’ these kinds of patterns, but being able to show the similarity between brands numerically and objectively is a new innovation. Our algorithm is demonstrably more effective than judging these things based on intuition alone.”

PTSD is not just for veterans

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That individuals who suffer with post-traumatic stress disorder, better known as PTSD, have experienced severe trauma at some point in their lives. The trauma could come in the form of sexual assault, a natural disaster, a car accident or anything that would prompt someone to have a harrowing reaction.

However, many believe that PTSD is a mental health condition that affects only those who have come back home from war, but this is not the case.

“We must see PTSD, and other trauma-related disorders, as mental health issues that face many survivors of human rights violations,” said Tina Kempin Reuter, associate professor in the University of Alabama at Birmingham’s College of Arts and Sciences and director for UAB Institute for Human Rights. “Whether they’re survivors of genocide, ethnic cleansing, racial or ethnic persecution, and other forms of direct and indirect violence, many of these individuals continue to battle their traumas across their lifetime.”

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PTSD affects 3.5 percent of the U.S. adult population, according to the National Alliance on Mental Illness, or approximately 8 million Americans who live with the condition. Approximately 37 percent of people diagnosed with PTSD display serious symptoms.

The root cause of PTSD is a traumatic event, but the symptoms are what overwhelm people to the point where it is diagnosable. People with PTSD often have recurring, distressing and upsetting memories of the trauma, and continually have upsetting memories that are hard to stop.

Symptoms can include flashbacks, night sweats, insomnia, panic attacks, and isolating themselves from friends and family.

U.S. National Library of Medicine research indicates that, when people experience trauma firsthand, it changes the brain. Several areas of the brain are involved. A stress response includes the amygdala, hippocampus and the prefrontal cortex. PTSD and trauma can cause lasting changes in those areas of the brain.

There are other disorders and mental health conditions that can appear along with PTSD, including generalized anxiety disorder, obsessive compulsive disorder, depression, borderline personality disorder and substance abuse.

Many who experience PTSD also may struggle with suicidal ideation and may attempt to take their life.

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Causes of PTSD:

  • A stressful experience
  • Trauma
  • Mental illness
  • Predisposition to mental illness or family history of mental illness

Risk factors for PTSD:

  • Long-lasting trauma
  • Childhood sexual abuse
  • Other childhood trauma
  • A job where you’re exposed to trauma, such as a military position
  • Lack of a sound support system
  • Seeing someone get hurt
  • A history of substance abuse
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How to cope with trauma

PTSD is not necessarily preventable because individuals cannot control when trauma happens. However, they can be equipped to cope with the trauma afterward.

Reuter says it is vital to seek mental health treatment in the form of therapy and, if needed, a psychiatrist, after someone experiences a traumatic event.

“Significant barriers can prevent many individuals living with PTSD and other trauma-related disorders from seeking the treatment they need,” Reuter said. “These barriers include lack of access or knowledge about mental health resources, lack of insurance to pay mental health providers, physical disability or other disability preventing individuals to access care, discrimination, and the stigma often associated with seeing a counselor.”

Reuter says that, in recent years, the global mental health community has worked to address these and other barriers by promoting “e-counseling” — that is, communicating with therapists and mental health professionals over the phone or computer. 

“Programs like BetterHelp can assist people living with PTSD to find and utilize the counseling they need,” Reuter said. “We hope that, as more individuals living with PTSD take advantage of these services, they are able to live fuller and healthier lives.”

Reuter notes that PTSD is a treatable mental illness, and many experiencing it are not alone. Seeking help from a mental health professional is a first step, whether that is working with someone in their local area or finding the help of an online counselor, like one at UAB partner BetterHelp, which provides treatment plans for those suffering with PTSD.

Healing from trauma can be difficult, but it is possible. If you are experiencing PTSD, seek help from available resources. And if you know someone who is experiencing PTSD, encourage them to do the same. The Substance Abuse and Mental Health Services Administration national helpline is 1-800-662-HELP (4357).

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About UAB
Known for its innovative and interdisciplinary approach to education at both the graduate and undergraduate levels, the University of Alabama at Birmingham is an internationally renowned research university and academic medical center, as well as Alabama’s largest employer, with some 23,000 employees, and has an annual economic impact exceeding $7 billion on the state. The five pillars of UAB’s mission include education, research, patient care, community service and economic development. UAB is a two-time recipient of the prestigious Center for Translational Science Award. Learn more at www.uab.edu. UAB: Powered by will.

Nine Truths about Weight and Eating Disorders

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The Academy for Eating Disorders (AED) has released a new document titled Nine Truths about Weight and Eating Disorders in order to increase awareness of eating disorders in people along the full spectrum of body sizes. Despite the stereotype of patients being extremely underweight, eating disorders can occur at any weight. A companion to the “Nine Truths about Eating Disorders,” this document aims to eradicate the stereotypes and educate both medical professionals and the public about these deadly disorders.

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Eating disorders have one of the highest mortality rates among psychiatric illnesses, second only to opioid addiction. Although doctors previously believed that only patients at very low weights were at risk for fatal medical complications, recent research has shown that the risk extends the range of body weights.1 Cardiac issues due to caloric restriction, use of diet pills and laxatives, and self-induced vomiting are a leading cause of death in eating disorders, regardless of weight.2-3 Early intervention is an important factor in lowering rates of death and medical complications, but diagnosis in higher weight patients is often delayed. Instead, these patients are often given recommendations to lose weight, which can exacerbate their behavioral symptoms.

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Weight-based discrimination and bullying are prevalent in healthcare, employment, and educational settings. This stigma has been shown to affect both mental and physical health, including greater levels of depression and lowered self-esteem, with higher risk for diabetes and disordered eating behaviors.4 Individuals who have experienced weight bias from medical professionals are more likely to avoid routine healthcare, which can lead to delayed diagnoses of other medical issues.

“Weight stigma is pervasive, pernicious, and cuts to the core of our mission by both increasing the risk of eating disorders and making sustained recovery so much more difficult,” said Dr. Bryn Austin, President of the Academy for Eating Disorders. “The more a person takes the ubiquitous demeaning and dismissive messages in media and in society about fat bodies to heart, the likelier they are to develop an eating disorder and the more they will struggle with recovery, regardless of how much that person weighs. In addition, frank discrimination in healthcare against people living in larger bodies takes a direct and sometimes devastating toll on health and well-being regardless of whether or not a person believes the stigmatizing messages. With our new Nine Truths about Weight and Eating Disorders, we hope to offer our fellow health professionals — whether pediatricians or geriatricians, social workers or cardiologists – new insights on these topics, new ways of understanding patients’ and families’ experiences and, hopefully, more compassion to the care they provide.”

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Creation of the Nine Truths about Weight and Eating Disorders was led by Dasha Nicholls, MBBS, MD and Phillippa Diedrichs, PhD. Dr. Nicholls is on the Faculty of Medicine, Department of Brain Sciences at the Imperial College, London, UK. She is past president of the Academy for Eating Disorders and past chair of the Eating Disorders Faculty at the Royal College of Psychiatrists. Dr. Diedrichs is Professor of Psychology at the Centre for Appearance Research, University of the West of England in Bristol, UK. She has served as an advisor to the British Government, including the Equalities Office, the Minister for Women and Equalities, the All Party Parliamentary Group on Body Image, and the Mayor of London. Both are Fellows of the Academy for Eating Disorders.

References:

  1. Garber, A. K., Cheng, J., Accurso, E. C., Adams, S. H., Buckelew, S. M., Kapphahn, C. J., . . . Golden, N. H. (2019). Weight loss and illness severity in adolescents with atypical anorexia nervosa. Pediatrics, 144(5), e20192339.
  2. Jáuregui-Garrido, B. & Jáuregui Lobera, I. (2012). Sudden death in eating disorders. Vascular Health and Risk Management, 8, 91-98.
  3. Crow, S. J., Peterson, C. B., Swanson, S. A., Raymond, N. C., Specker, S., Eckert, E. D., & Mitchell, J. E. (2009). Increased mortality in bulimia nervosa and other eating disorders. American Journal of Psychiatry, 166(12), 1342-1346.
  4. Wu, Y.-K. & Berry, D. C. (2018). Impact of weight stigma on physiological and psychological health outcomes for overweight and obese adults: a systematic review. Journal of Advanced Nursing, 74(5), 1030-1042.
  5. DiGiacinto, D., Gildon, B., Stamile, E., & Aubrey, J. (2015). Weight-biased health professionals and the effects on overweight patients. Journal of Diagnostic Medical Sonography, 31(2), 132-135.

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ABOUT

The Academy for Eating Disorders (AED) is an international professional association committed to the leadership in eating disorders research, education, treatment, and prevention. The goal of the AED is to provide global access to knowledge, research, and best treatment practice for eating disorders. For additional information, please contact Elissa Myers at (703) 626-9087 and visit the AED website at www.aedweb.org.

Saving the Planet, One Drop at a Time

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Scientists at the Johns Hopkins Applied Physics Laboratory (APL), in Laurel, Maryland, have identified highly absorbent materials that can extract drinkable water out of thin air — which could potentially lead to technologies that supply potable water in the driest areas on the planet.

For many of the world’s poor, one of the greatest environmental threats to health remains lack of access to safe water. Scientists at the Johns Hopkins University Applied Physics Laboratory (APL), in Laurel, Maryland, have identified highly absorbent materials that can extract drinkable water out of thin air – which could potentially lead to technologies that supply potable water in the driest areas on the planet.

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The researchers – a team from APL’s Research and Exploratory Development Department led by Zhiyong Xia, Matthew Logan and Spencer Langevin – describe their discovery in the Jan. 30 issue of Scientific Reports, a journal of the Nature Research family. 

Their research leverages metal-organic frameworks (MOFs), an amazing next-generation material that has the largest known surface areas per gram – a single gram of the MOF can soak up a football field’s worth of material, if the material were laid in a single layer across the field. The sponge-like crystals can be used to capture, store and release chemical compounds – like water – and the large surface area offers more space for chemical reactions and adsorption of molecules.

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MOFs have shown promise for water harvesting, but little research has been done to determine the best properties for fast and efficient production of water.

“Initial experiments have proved that the concept can work,” says Xia. “But the problem has been capacity. Other research teams have been able to produce as much as about  1.3 liters of water per day per kilogram of sorbent  under arid conditions – enough only for one person. To create an optimal water harvesting device requires a better understanding of the structure property relationship controlling absorption and delivery.”

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Xia and his team studied a series of MOFs – unraveling the fundamental material properties that govern the kinetics of water sequestration in this class of materials as well as investigating how much water they can absorb. They also explored the potential impact of temperature, humidity and powder bed thickness on the adsorption-desorption process to see which one achieved optimal operational parameters.

“We identified a MOF that could produce 8.66 liters of water per day per kilogram of MOF under ideal conditions, an extraordinary finding.” Xia said. “This will help us deepen our understanding of these materials and guide the discovery of next-generation water harvesting methods.”

Xia and his team are now exploring other MOFs with low relative humidity influx points, high surface areas, and polar functional properties to see how they perform in very dry environments. They are also exploring different configurations of MOFs to determine which allow for optimal absorption.

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The researchers drew on APL’s ongoing efforts in water purification methods. APL has developed a novel way to remove highly toxic perfluoroalkyl substances — an ever-expanding group of manufactured chemicals that are widely used to make various types of everyday products — from drinking water. A separate effort yielded a cost-effective method to remove toxic heavy metal ions from drinking water.

“Our scientists’ and engineers’ collective strengths and expertise in materials and chemistry have positioned APL to make extraordinary impact and invent the future of clean drinking water for deployed warfighters, as well as for citizens around the world,” said Ally Bissing-Gibson, APL’s Biological and Chemical Sciences program manager. “We look forward to saving the planet, one drop at a time.”

Want to change your personality?

Most people have an aspect of their personality they’d like to change, but without help it may be difficult to do so, according to a study led by a University of Arizona researcher and published in the Journal of Research in Personality.

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Contrary to the once-popular idea that people’s personalities are more or less set in stone, research has proven that personalities do change throughout the lifespan, often in line with major life events. For example, there is evidence that people tend to be more agreeable and conscientious in college, less extroverted after they get married and more agreeable in their retirement years.

While it’s well-established that personalities can change in response to life circumstances, researcher Erica Baranski wondered if people can actively and intentionally change aspects of their personalities at any given point simply because they desire to do so.

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She and her colleagues studied two groups of people: approximately 500 members of the general population who ranged in age from 19 to 82 and participated in the research online; and approximately 360 college students.

Both groups completed the 44-item “Big Five Inventory,” which measures five key personality traits: extroversion, conscientiousness, agreeableness, openness to experience and neuroticism, also referred to as emotional stability. The participants were then asked whether they desired to change any aspect of their personality. If they answered yes, they were asked to write an open-ended description of what they wanted to change.

Across both groups, most people said they desired to increase extroversion, conscientiousness and emotional stability.

The college students were surveyed again six months later, and the general population group was surveyed again a year later. Neither group had achieved the personality goals they set for themselves at the beginning of the study, and, in fact, some saw change in the opposite direction.

“In both samples, the desire to change at ‘time one’ did not predict actual change in the desired direction at all at ‘time two,'” said Baranski, a postdoctoral psychology researcher in the University of Arizona Institute on Place, Wellbeing & Performance. “In the general population sample, we didn’t find that personality change goals predicted any change in any direction.”

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College Students Saw More Change

While the general population group exhibited no change in personality traits between the first and second rounds of data collection, the college student group did show some changes; however, they were either in the opposite direction than desired or were for different personality traits than the one the person intended to change.

Specifically, college students who expressed the strongest desires to be more conscientious actually exhibited less conscientiousness six months later. That could be because those individuals exhibited low levels of conscientiousness to begin with, putting them at a disadvantage from the outset, Baranski said.

In addition, students who said they wanted to be more extroverted showed increases in agreeableness and emotionally stability rather than extroversion in the follow-up. Baranski said that perhaps as part of their effort to become more social and extroverted, they actually focused on being friendlier and less socially anxious – behaviors more directly related to agreeability and emotionally stability, respectively.

Baranski said college students may have exhibited more change than the general population because they are in such a transformational period in their lives. Still, the changes they experienced didn’t align with the goals they set for themselves.

“College students are thrown into this new environment, and they may be unhappy and may look within selves to become happier and change some aspect of their personality,” Baranski said. “But, meanwhile, there is a bombardment of other things that they’re told they need to achieve, like doing well in a class or choosing a major or getting an internship, and those goals might take precedence. Even though they know more sustained and introspective change might be better, the short-term effort is more attractive and more necessary in the moment.”

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Overall, Baranski’s findings illustrate how difficult it can be for people to change aspects of their personality based on desire alone. That doesn’t mean people can’t make the changes they want. They just might need outside help doing so – from a professional, a friend or maybe even a mobile app reminding them of their goals, Baranski said.

Baranski intentionally did not interact with study participants between the first and second rounds of data collection. That approach differs from that of another researcher, Southern Methodist University’s Nathan Hudson, who in several other separate studies assessed personality change goals over a 16-week period but followed up with participants along the way. In that research, which Baranski cites, experimenters assessed participants’ personality traits and progress toward their goals every few weeks. With that kind of interaction, participants were more successful in making changes.

“There is evidence in clinical psychology that therapeutic coaching leads to change in personality and behavior, and there is recent evidence that suggests that when there’s a lot of regular interaction with an experimenter, personality change is possible,” Baranski said. “But when individuals are left to their own devices, change may not be as likely.”

Future research, Baranski said, should look at how much intervention is needed to help people achieve their personality goals, and which types of strategies work best for different traits.

“Across all the studies that have been done on this topic over the last several years, it’s clear that most people want to change an aspect of their personality,” Baranski said. “If left unattended, those goals aren’t achieved, so it would be helpful for people who have those goals to know what is necessary for them to accomplish them.”

Borderline Personality Disorder Potentially at Higher Risk for Heart Attacks

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Mental health professionals should recommend screening patients for cardiovascular risks

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Middle-aged adults who show symptoms of borderline personality disorder may be at greater risk for a heart attack, as they show physical signs of worsening cardiovascular health more than other adults, according to research published by the American Psychological Association.

“Although borderline personality disorder is well studied for its relationship to psychological and social impairments, recent research has suggested it may also contribute to physical health risks,” said Whitney Ringwald MSW, MS, of the University of Pittsburgh and lead author of the study. “Our study suggests that the effects of this disorder on heart health are large enough that clinicians treating patients should recommend monitoring their cardiovascular health.”

The study was published in Personality Disorders: Theory, Research, and Treatment.

Borderline personality disorder is characterized by intense mood swings, impulsive behaviors, and extreme emotional reactions. Their inability to manage emotions often makes it hard for people with borderline personality disorder to finish school, keep a job, or maintain stable, healthy relationships. According to the National Institute of Mental Health, 1.4% of adults have BPD, but that number does not include those with less severe symptoms, who nevertheless may experience clinically significant impairments, said Aidan Wright, PhD, of the University of Pittsburgh and another author of the study.

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“It can be challenging to treat BPD because you are seeking to change a person’s longstanding patterns of thinking, feeling and behaving that are very well ingrained,” he said. “There are several evidence-based treatment options that can be helpful, so there are many reasons to be optimistic, but treatment may take a long time.”

The researchers analyzed health data from 1,295 participants in the University of Pittsburgh Adult Health and Behavior Project. This is a registry of behavioral and biological measurements from non-Hispanic white and African American adults, 30 to 50 years old, recruited between 2001 and 2005 in southwestern Pennsylvania. The researchers looked at self-reported basic personality traits, as well as those reported by up to two of the participants’ friends or family members, and self-reported symptoms of depression. By combining several physical health measurements, including blood pressure, body mass index and the levels of insulin, glucose, cholesterol and other compounds in the blood after a 12-hour fast, the researchers established a relative cardiovascular risk score for each participant.

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They found a significant association between borderline personality traits and increased cardiovascular risk. The researchers also looked at the potential role of depression, as people with BPD are also often depressed. While borderline personality traits and depression were both significantly associated with cardiovascular risk the effect of borderline traits was independent of depression symptoms.

“We were surprised by the strength of the effect and we found it particularly interesting that our measure of borderline personality pathology had a larger effect, and a unique effect, above and beyond depression in predicting heart disease.” said Wright.  “There is a large focus on depression in physical health, and these findings suggest there should be an increased focus on personality traits, too.”

The researchers said their findings have important implications for primary care doctors and mental health professionals who treat patients with BPD.

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“Mental health practitioners may want to screen for cardiovascular risk in their patients with BPD, ” said Wright. “When discussing the implications of a personality disorder diagnosis with patients, practitioners may want to emphasize the link with negative health outcomes and possibly suggest exercise and lifestyle changes if indicated. Primary care physicians should attend to personality as a risk factor when monitoring patients for long-term health as well.”

Article: “Borderline Personality Disorder Traits Associate with Midlife Cardiometabolic Risk,” by Whitney R. Ringwald, MSW, MS, Aidan G.C. Wright, PhD,  Stephen B. Manuck, PhD, University of Pittsburgh; and Taylor A. Barber, BS, Philadelphia College of Osteopathic Medicine. Personality Disorders: Theory, Research, and Treatment, published online Oct. 28, 2019.

Help with Heavy Menstrual Bleeding

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In women with uterine fibroids, the drug elagolix suppresses ovarian hormone production and prevents heavy menstrual bleeding

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About 50 % of women with uterine fibroids—non-cancerous muscle tumors that grow in the uterus—experience heavy menstrual bleeding and other symptoms.  Surgery is commonly recommended when these symptoms are severe enough to prompt a woman to seek treatment.  The most common surgery used to treat fibroids is removal of the uterus (hysterectomy), though in some cases, removal of the fibroids and repair of the uterus (myomectomy) are performed.  Surgery is usually extensive in both cases.  Long-acting hormone injections can reduce symptoms such as heavy bleeding in women with fibroids, but side effects can be significant and it can take months for the effects of the medications to wear off.

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In a study published in the New England Journal of Medicine on January 23, 2020, researchers reported on the effectiveness of a new, rapidly reversible oral pill that was used to reduce heavy menstrual bleeding in women with uterine fibroids. The study, which included a large group of researchers from across the country, was led by Dr. William Schlaff, Chair of the Department of Obstetrics and Gynecology at the Sidney Kimmel Medical College at Thomas Jefferson University.

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A total of 790 women, ages 18-51, with heavy bleeding due to fibroids, were enrolled into one of three study arms. One group received the oral pill, elagolix, which reduces the production of the hormones estrogen and progesterone normally produced by a woman’s ovaries.  When these hormones are suppressed, fibroids usually get smaller and bleeding is reduced.  A second group received elagolix plus a low dose of estrogen and progestin (“add-back” therapy) with the hope that the additional hormones would produce the same benefit but reduce the side effects of elagolix used alone (like hot flushes and bone loss).  A third group received identical placebo pills that did not contain elagolix or the “add back” hormones.  All of the women enrolled in the two identical trials reported by these researchers were confirmed to have uterine fibroids by ultrasound and heavy menstrual bleeding (more than 80mLs of blood loss per cycle) for at least two cycles. 

The results showed that 80.4% of the women treated with elagolix alone had a reduction of menstrual bleeding of 50% or more compared to 9.6% of the women in the placebo group.  Of those women treated with elagolix plus “add back” therapy, 72% had a reduction of 50% or more.  Women treated with elagolix alone had significantly more loss of bone mineral as compared with the women treated with placebo, a known and clinically significant side effect of this class of medications.  However, there was no difference between the loss of bone mineral in the group treated with elagolix and “add-back” as compared to those in the placebo group. 

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For many women with fibroids, severe symptoms like bleeding have a major impact on the quality of life.  Surgery and long-acting injectable medications are acceptable treatments for many, but certainly not all women in this situation. 

“The potential value of an oral, easily reversible medication that can be combined with low-dose hormonal “add back” to reduce heavy menstrual bleeding while avoiding problematic symptoms and side effects could be a major step forward,” says Dr. Schlaff.

AbbVie Inc. funded these studies and participated in the study design, research, analysis, data collection, interpretation of data, reviewing and approval of the publication. Consult article reference for complete list of disclosures.

Article reference: William Schlaff et al., “Elagolix Therapy for Heavy Menstrual Bleeding in Women with Uterine Fibroids,” New England Journal of Medicine, DOI: 10.1056/NEJMoa1904351, 2019.

Why eating yogurt may help lessen the risk of breast cancer

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One of the causes of breast cancer may be inflammation triggered by harmful bacteria say researchers.

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Scientists say their idea- as yet unproven – is supported by the available evidence, which is that bacterial induced inflammation is linked to cancer.

The paper in the journal Medical Hypotheses is by Lancaster University medical student Auday Marwaha, Professor Jim Morris from the University Hospitals of Morecambe Bay NHS Trust and Dr Rachael Rigby from Lancaster University’s Faculty of Health and Medicine.

The researchers say that: “There is a simple, inexpensive potential preventive remedy; which is for women to consume natural yoghurt on a daily basis.”

Yoghurt contains beneficial lactose fermenting bacteria commonly found in milk, similar to the bacteria – or microflora- found in the breasts of mothers who have breastfed.

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Dr Rigby said: “We now know that breast milk is not sterile and that lactation alters the microflora of the breast.

“Lactose fermenting bacteria are commonly found in milk and are likely to occupy the breast ducts of women during lactation and for an unknown period after lactation.”

Their suggestion is that this lactose fermenting bacteria in the breast is protective because each year of breast feeding reduces the risk of breast cancer by 4.3%.

Several other studies have shown that the consumption of yoghurt is associated with a reduction in the risk of breast cancer, which the researchers suggest may be due to the displacement of harmful bacteria by beneficial bacteria.

There are approximately 10 billion bacterial cells in the human body and while most are harmless, some bacteria create toxins which trigger inflammation in the body.

Chronic inflammation destroys the harmful germs but it also damages the body. One of the most common inflammatory conditions is gum disease or periodontitis which has already been linked to oral, oesophageal, colonic, pancreatic, prostatic and breast cancer.

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The researchers conclude that: “The stem cells which divide to replenish the lining of the breast ducts are influenced by the microflora, and certain components of the microflora have been shown in other organs, such as the colon and stomach, to increase the risk of cancer development.

“Therefore a similar scenario is likely to be occurring in the breast, whereby resident microflora impact on stem cell division and influence cancer risk.”

Talks With Kris Godinez

Covert Narcissists/Hermit BPD/ Passive Aggressiveness

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Few Effective Treatments

Photo by Emiliano Vittoriosi

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No single treatment stands out as especially effective for borderline personality disorder, a mental illness that can involve self-harm and suicide attempts, according to two new reviews of recent studies.

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BPD does appear to respond more strongly to certain kinds of psychological “talk” therapies, British researchers found. However, the psychological treatments that showed the most promise were relatively new and supported by “too few data for confidence,” the authors write.

Because both are complex, intensive therapies that require long-term staff training, “we believe that such treatments will only be available to a select few patients,” said co-author Mark Fenton.

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The team, led by Conor Duggan of the University of Nottingham and Clive Adams of the University of Leeds, conducted separate reviews on psychological and drug therapies for BPD.

The reviews appear in the current issue of The Cochrane Library, a publication of The Cochrane Collaboration, an international organization that evaluates medical research. Systematic reviews draw evidence-based conclusions about medical practice after considering both the content and quality of existing medical trials on a topic.

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The team analyzed findings from seven studies on structured talking therapies, comprising 262 adult outpatients with either a formal diagnosis of BPD or at least three criteria for the illness.

People undergoing a treatment called dialectical behavior therapy appeared to have fewer suicide attempts or thoughts of suicide at six months compared to those in usual care. Introduced in 1991, the treatment involves individual psychotherapy sessions, telephone coaching, lengthy group therapy sessions and cognitive modification.

Treating patients in a day hospital unit geared to psychoanalytic treatment also seemed to “decrease admission and use of prescribed medication and increase social improvement and social adjustment,” the reviewers found.

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Although both treatments are “difficult to apply to everyday care,” the researchers say that results so far suggest that “the problems of people with borderline personality disorder may be amenable to treatment.”

BPD is characterized by “an internal sense of emptiness and an inability to regulate emotion, going from high to low levels of emotion very quickly,” according to Scott Haltzman, M.D, a professor at Brown University. “These people tend to respond to the world with swings from rage to glee.”

Two percent of the general population and 20 percent of psychiatric inpatients have borderline personality disorder. Borderline patients are overwhelmingly female (75 percent).

“This group of people is often a challenge to health service providers,” said Fenton, who is also editor of the U.K.-based “Database of Uncertainties About the Effects of Treatments. He said that people with BPD have difficulty engaging in relationships, including relationships with therapists.

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Unlike some other psychiatric conditions, there is no widely accepted drug regimen for borderline personality disorder.

“If offered medication, people with BPD should know that this is not based on good evidence,” the reviewers concluded.

The second review pooled results from ten small, short-term randomized studies on drug therapies for BPD. These studies involved 554 patients, both inpatients and outpatients

Studies of the various drugs used “show that antidepressants offered the best chance of improvement, but even here, results were not robust,” according to Fenton. “For ratings of anger, fluoxetine (Prozac) may offer some improvement over placebo,” the researchers say.

Although the antipsychotic drug haloperidol showed some improvement in symptoms of hostility, “the numbers are so small it is likely to be a false positive,” said Fenton. The reviewers do not recommend the use of antipsychotic drugs for borderline personality disorder outside of clinical trials.

Although the drug data were not encouraging, “that does not mean (medication) may not do considerable good, and there is no indication of significant harm,” the reviewers wrote. “People with BPD or their carers are in a position to lobby for and facilitate good research in this area.”

Binks CA et al. Psychological therapies for people with borderline personality disorder, The Cochrane Database of Systematic Reviews 2006, Issue 1.

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Binks CA, et al. Pharmacological interventions for people with borderline personality disorder. The Cochrane Database of Systematic Reviews 2006, Issue 1.

The Cochrane Collaboration is an international nonprofit, independent organization that produces and disseminates systematic reviews of health care interventions and promotes the search for evidence in the form of clinical trials and other studies of interventions. Visit http://www.cochrane.org for more information.

INTERVIEWS Contact Mark Fenton at 0044 (0)1865 517622 or at mfenton@cochrane-sz.org

No Empathy!

Research Links Borderline Personality Traits with Lowered Empathy

Photo by Abigail Keenan

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Those with borderline personality disorder, or BPD, a mental illness marked by unstable moods, often experience trouble maintaining interpersonal relationships. New research from the University of Georgia indicates that this may have to do with lowered brain activity in regions important for empathy in individuals with borderline personality traits.

The findings were recently published in the journal Personality Disorders: Theory, Research and Treatment.

“Our results showed that people with BPD traits had reduced activity in brain regions that support empathy,” said the study’s lead author Brian Haas, an assistant professor in the Franklin College of Arts and Sciences psychology department. “This reduced activation may suggest that people with more BPD traits have a more difficult time understanding and/or predicting how others feel, at least compared to individuals with fewer BPD traits.”

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Credit: University of Georgia
Brian Haas is an assistant professor in the University of Georgia’s psychology department.

For the study, Haas recruited over 80 participants and asked them to take a questionnaire, called the Five Factor Borderline Inventory, to determine the degree to which they had various traits associated with borderline personality disorder. The researchers then used functional magnetic resonance imaging to measure brain activity in each of the participants. During the fMRI, participants were asked to do an empathetic processing task, which tapped into their ability to think about the emotional states of other people, while the fMRI measured their simultaneous brain activity.

In the empathetic processing task, participants would match the emotion of faces to a situation’s context. As a control, Haas and study co-author Joshua Miller also included shapes, like squares and circles, that participants would have to match from emotion of the faces to the situation.

“We found that for those with more BPD traits, these empathetic processes aren’t as easily activated,” said Miller, a psychology professor and director of the Clinical Training Program.

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Haas chose to look at those who scored high on the Five Factor Borderline Inventory, instead of simply working with those previously diagnosed with the disorder. By using the inventory, Haas was able to obtain a more comprehensive understanding of the relationship between empathic processing, BPD traits and high levels of neuroticism and openness, as well as lower levels of agreeableness and conscientiousness.

“Oftentimes, borderline personality disorder is considered a binary phenomenon. Either you have it or you don’t,” said Haas, who runs the Gene-Brain-Social Behavioral Lab. “But for our study, we conceptualized and measured it in a more continuous way such that individuals can vary along a continuum of no traits to very many BPD traits.”

Haas found a link between those with high borderline personality traits and a decreased use of neural activity in two parts of the brain: the temporoparietal junction and the superior temporal sulcus, two brain regions implicated to be critically important during empathic processing.

The research provides new insight into individuals susceptible to experiencing the disorder and how they process emotions.

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“Borderline personality disorder is considered one of the most severe and troubling personality disorders,” Miller said. “BPD can make it difficult to have successful friendships and romantic relationships. These findings could help explain why that is.”

In the future, Haas would like to study BPD traits in a more naturalistic setting.

“In this study, we looked at participants who had a relatively high amount of BPD traits. I think it’d be great to study this situation in a real life scenario, such as having people with BPD traits read the emotional states of their partners,” he said.

An abstract of the study, “Borderline Personality Traits and Brain Activity During Emotional Perspective Taking,” is available at http://www.ncbi.nlm.nih.gov/pubmed/26168407.

Borderline Personality Disorder—as Scientific Understanding Increases, Improved Clinical Management Needed

Even as researchers gain new insights into the neurobiology of borderline personality disorder (BPD), there’s a pressing need to improve diagnosis and management of this devastating psychiatric condition.

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The special issue comprises seven papers, contributed by experts in the field, providing an integrated overview of research and clinical management of BPD. “We hope these articles will help clinicians understand their BPD patients, encourage more optimism about their treatability, and help set a stage from which the next generation of mental health professionals will be more willing to address the clinical and public health challenges they present,” according to a guest editorial by Drs. Lois Choi-Kain and John Gunderson of the Adult Borderline Center and Training Institute at McLean Hospital, Belmont, Mass.

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Borderline Personality Disorder—Research Advances, Emerging Clinical ApproachesAlthough the diagnostic criteria for BPD are well-accepted, it continues to be a misunderstood and sometimes neglected condition; many psychiatrists actively avoid making the diagnosis. Borderline personality disorder accounts for nearly 20 percent of psychiatric hospitalizations and outpatient clinic admissions, but only three percent of the research budget of the National Institute of Mental Health. (The NIMH provides information about BPD online at www.nimh.nih.gov/health/topics/borderline-personality-disorder)

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The Guest Editors hope their special issue will contribute to overcoming the disparity between BPD’s public health importance and the attention received by psychiatry. Highlights include:• A research update on the neurobiology of BPD. Evidence suggests that chronic stress exposure may lead to changes in brain metabolism and structure, thus affecting the processing and integration of emotion and thought. This line of research might inform new approaches managing BPD—possibly including early intervention to curb the neurobiological responses to chronic stress.• The urgent need for earlier intervention. A review highlights the risk factors, precursors, and early symptoms of BPD and mood disorders in adolescence and young adulthood. While the diagnosis of BPD may be difficult to make during this critical period, evaluation and services are urgently needed.• The emergence of evidence-based approaches for BPD. While these approaches have raised hopes for providing better patient outcomes, they require a high degree of specialization and treatment resources. A stepped-care approach to treatment is proposed, using generalist approaches to milder and initial cases of BPD symptoms, progressing to more intensive, specialized care based on clinical needs.• The critical issue of BPD in the psychiatric emergency department. This is a common and challenging situation in which care may be inconsistent or even harmful. A clinical vignette provides mental health professionals with knowledge and insights they can use as part of a “caring, informed, and practical” approach to helping BPD patients in crisis.

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The special issue also addresses the critical issue of resident training—preparing the next generation of mental health professionals to integrate research evidence into more effective management for patients and families affected by BPD. Drs. Choi-Kain and Gunderson add, “For clinicians, educators, and researchers, we hope this issue clarifies an emerging basis for earlier intervention, generalist approaches to care for the widest population, and a more organized approach to allocating care for individuals with BPD.”

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About the Harvard Review of PsychiatryThe Harvard Review of Psychiatry is the authoritative source for scholarly reviews and perspectives on a diverse range of important topics in psychiatry. Founded by the Harvard Medical School Department of Psychiatry, the journal is peer-reviewed and not industry sponsored. It is the property of Harvard University and is affiliated with all of the Departments of Psychiatry at the Harvard teaching hospitals. Articles encompass all major issues in contemporary psychiatry, including (but not limited to) neuroscience, psychopharmacology, psychotherapy, history of psychiatry, and ethics.

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About Wolters KluwerWolters Kluwer is a global leader in professional information services. Professionals in the areas of legal, business, tax, accounting, finance, audit, risk, compliance and healthcare rely on Wolters Kluwer’s market leading information-enabled tools and software solutions to manage their business efficiently, deliver results to their clients, and succeed in an ever more dynamic world.

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Wolters Kluwer reported 2015 annual revenues of €4.2 billion. The group serves customers in over 180 countries, and employs over 19,000 people worldwide. The company is headquartered in Alphen aan den Rijn, the Netherlands. Wolters Kluwer shares are listed on Euronext Amsterdam (WKL) and are included in the AEX and Euronext 100 indices. Wolters Kluwer has a sponsored Level 1 American Depositary Receipt program. The ADRs are traded on the over-the-counter market in the U.S. (WTKWY). Wolters Kluwer Health is a leading global provider of information and point of care solutions for the healthcare industry. For more information about our products and organization, visit www.wolterskluwer.com, follow @WKHealth or @Wolters_Kluwer on Twitter, like us on Facebook, follow us on LinkedIn, or follow WoltersKluwerComms on YouTube.

Letter to my best friend

I am so proud of you

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By Giusi Nigro

I know you since you were a child, I saw you getting bigger and I noticed the sadness in your look, the tearing eyes of who remembers things you would want to forget. They pulled your hair and they forced, you to do something that you, incredulous, struggled to understand, in that dark corner, where traces of blood, cleared by the rain, are no longer there even if you still see them and that rip you inside when you re-think about the scene.

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During the night, you do not dream anymore to be grabbed with force and troughed on the ground, and being dominated by two monsters, you dream now to be strong and combatant: one night you shoot, armed with shot gun, the following night you cut them with a kitchen knife and yet you stab or you tie them with a rope. During the night, in your loneliness, you are strong, not impotent like that evening, you announce victory, then you wake up in tears and the reality vehemently slams just in front of you impudently. Another shower delete, like to wash from your body that smell, those dirty hands which infiltrate between the underwear, and you leave the water running on the stolen innocence.  

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Many years of “why me?”, and why you? You will never find an answer, you will never understand, there is no why, it was your turn, everything just to dominate, like the savage instinct of somebody without breaks in front of the weak, like the temporary victory which gives you the title of a champion for a moment, like the forever losers which try to get even and act in group to recharge, to feel better, those sick in their head collecting trophies, fake trophies, imaginary, earned only due to the physics’ strength against a fragile person, and weaker. You were not the target but your skirt. The suffered humiliation, and the silence, have been like a boulder for you, carrying it on your shoulders for many years. The judgement of people who did not know.

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Those severe accusations which yet resound: “she was easy!” told by who was not there but wanted to believe to the story of the trophy. The popular judgement of the small town there to protect the predators and strike the victim. You were young and innocent, afraid, defenseless, you could not know you were going to regret the silence, that if you had a guide, you could have sent them to prison. You believed the treats: “if you speak, you are dead! “and you were dead anyway.   Living without existing, feeling invisible and less than nothing, believing to be wrong, abandoning yourself to cheap thoughts, cowardly take the blame: “I deserve it, I trusted the wrong people”, I do not deserve anything good, I choose always the wrong because I am wrong, refusing the good things. No, you are not wrong, you needed that therapist to make you understand. You or somebody else did not make difference to them.

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Do not be ashamed, do not let them win, they have to be ashamed of their committed crime, those fouls ex-cons. You did not report them, not to be an accomplice, but for fear, for irresponsibility, because nobody teaches to a young girl in her early teens how to deal with these cases. We are thought to be ashamed, to the mocking of the truth, in a small town where it is possible to perpetrate violence and they all will be from the side of the strong, even if the strong is not in the right side.   You cannot erase the past, I know it, and it will be your burden forever, but you can make this weight you carry around, as a good luck holder. Look at your inner side, you are not like them, you are a lot of more, you are sensitive, deep, and you are what they would like to be, you know how to dance, to dance under the rain, to look at the stars and shine with them, you know how to look at the horizon and create more joint lines, you can inspire. Look at them and ask yourself: “What are they good at? Who do they hang with?”.

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You are the living success that you can heal from the pain. Look at your eyes now, shining, look at them inside, they are the reflection of a balance you asked from so long, they scream loud that the past is behind and need to move forward, they sum the price you paid, overpaid, but paid off. Now it is your turn to live, do it, do not hesitate, stand up to change everything you do not like it, stay far from pointless people, laugh! Remember when you were laughing to void to cry? My dear friend, it will not be the same anymore, I see the light in your eyes, the strength of a healed after a terminal disease, the grit of a fighter winning against a bear. Their witch laugh which still echoed in your ears, is now your smile of happiness, calm, quiet, understanding that the torment is not a drug to be addicted of, but it is a victory against the pain, it is strength, it is putting the soul. The rest do not matter. He who laughs last laughs best!  

Your friend,

Giusi Nigro

Why We Make (and Break) New Year’s Resolutions?

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By Dr. Charles Herrick, Chair of Psychiatry, Nuvance Health

Summary:

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  • Research shows that as many as 50 percent of adults in the United States make New Year’s resolutions, but fewer than 10 percent keep them for more than a few months.
  • Giving up on New Year’s resolutions is often related to three issues: difficulty breaking old habits, focusing on specific outcomes, and problems with purpose.
  • You can increase your chances of achieving your New Year’s resolutions by setting realistic and achievable process goals that will help you form new habits, as well as following other steps for success.
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Do you feel excited about making a New Year’s resolution on January 1 each year, but find yourself losing enthusiasm as the weeks go by — only to give up entirely by late February or March? If so, you’re not alone.

Research shows that as many as 50 percent of adults in the United States make New Year’s resolutions, but fewer than 10 percent actually keep them for more than a few months. But why?

Whether your goal is to lose weight, get more exercise, quit smoking, save money, or something else entirely, the truth is that there are some common psychology-based reasons why New Year’s resolutions fall flat. But before you put your goals on the shelf until next year, here’s what you need to know about why we make and break New Year’s resolutions — as well as a tips you can use to give yourself the best chance of making your resolution stick.

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Why do people make New Year’s resolutions?

It’s human nature to set goals at the start of something new, making the start of the New Year a popular time to set new goals and expectations for the year ahead.

Why do I break my New Year’s resolutions?

There are many reasons why people may not keep New Year’s resolutions, but instances of New Year’s resolution burnout can be narrowed down to three psychology-related issues: difficulty breaking old habits, focusing on specific outcomes, and problems with purpose.

Difficulty breaking old habits

Meeting new goals usually requires creating new habits and breaking old ones — and old habits are hard to break. For example, quitting smoking will require you to eliminate smoking from your daily activities, and losing weight will require you to change your diet and exercise routine.

Our habits are ingrained and embedded in our implicit memory, which is also called our automatic memory or unconscious memory. Implicit memory uses our past experiences to help us remember things without actively thinking about them, making it easy for us to stick to similar routines and challenging for us to make changes.

Habits are also multi-faceted, meaning that many elements reinforce our habits and make them more challenging to break. For example, a smoking habit may be influenced by your lifestyle, the places you go, the people you interact with when you smoke, physical sensations associated with smoking, and other rituals. Your feelings, thoughts, and emotions related to smoking can also contribute to making the habit satisfying even before you actually smoke.

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Focusing on specific outcomes

Another reason people have trouble keeping New Year’s resolutions is that they focus on a specific outcome, such as reaching a certain body weight. Focusing on a specific outcome can be defeating if you don’t achieve your goal quickly. In most cases, it takes time to achieve a specific outcome, and many people become frustrated and eventually give up before reaching their goal.

Problems with purpose

If you’re like most people, you’re busy — and you probably don’t have a lot of time left over at the end of the day to devote to accomplishing things that aren’t interesting or important to you. If you don’t feel connected to your resolution, it isn’t meaningful to you, or you aren’t motivated to make the changes required to achieve your goals, you will be more likely to give up.

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How can I keep my New Year’s resolution?

Developing a new habit as part of your New Year’s resolution means that you will need to consciously think about the changes you need to make, at least until the new habit becomes embedded in your implicit memory. The process of developing a new habit uses a lot of declarative, or episodic, memory and working memory — and requires a lot more mental effort.

To make it easier to keep your New Year’s resolution, you need to take a multi-faceted approach. Here are a few tips that may help:

1: Find your purpose, but avoid focusing on a specific outcome 

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If you want to lose weight, for example, avoid focusing on achieving a specific weight. Instead, ask yourself why you want to lose weight and use that as the basis for your goal. Asking “why” will help you find your real purpose, which will help to improve your motivation. Setting a goal of achieving better health so you can have more energy for your hobbies, for example, takes the focus off of a specific outcome, such as getting to 150 pounds.

Also, it’s important to remember that early success will motivate you to do more, and better health and an increase in energy is an outcome you will likely be able to achieve quickly by being more active or eating a healthier diet.

By focusing on being healthier rather than achieving a specific weight, you will also be more likely to maintain your healthy habits. If you set a goal of getting to 150 pounds and achieve it, you may be more likely to eventually fall back into old habits and not sustain long-term weight loss.

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2: Break your goal into components, and set realistic and achievable process goals 

If your goal is to achieve better health, you need to figure out exactly what you need to change to make it happen. For example, you might identify two components that will help you achieve your goal: more exercise and a healthier diet.

Identifying the components is just the first step. You must also set realistic and achievable process goals for each component that make you feel excited and motivated. The more excited you are about your process goals, the more likely you will be to find the time to focus on achieving them. Some examples of process goals include:

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  • “I intend to exercise for 30 minutes, four days a week, to achieve better health.”
  • “I intend to eat three plant-based dinners each week to achieve better health.”
  • “I intend to eat one-half of my normal portion of dessert after dinner every night to achieve better health.”

These goals shouldn’t require a huge sacrifice, and they shouldn’t make you feel deprived. However, they should require some effort — you want to feel good when you achieve them, after all.

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3: Make a public commitment 

Human beings are inherently social, and we want to connect with and feel accepted by others. We also want to avoid experiencing feelings of shame and embarrassment that can sometimes be associated with letting people down.

Making a public commitment to achieving your goal can help you hold yourself accountable and ultimately follow through. Many people find that their desire to avoid letting people down — and thereby avoid feelings of shame and embarrassment — is a powerful motivator to help them deliver on their commitment.

Examples of making a public commitment include telling family or friends about your goal, signing up for a weight loss program, or joining a fitness program with a group of co-workers.

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4: Engage with likeminded people

People tend to be more successful at achieving their goals when they connect with other likeminded people. Also, we tend to model the behavior of the people we like and admire, so it’s important to surround yourself with people who reinforce habits that will help you achieve your goals.

Finding a group of likeminded people who you admire will help you stay motivated — especially during the cold, dark months of January, February, and March, when New Year’s resolutions often hit the skids. Some people may find success and accountability by being part of a larger group, while others may prefer to pair up or join a smaller group. Whatever size group you choose and whether it’s in-person or online, engaging with others will keep you connected to your goals and make you more likely to be successful.

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The bottom line: Finding your purpose, changing your focus, setting the right goals, making a public commitment, and engaging with likeminded people can help you achieve your New Year’s resolutions.

Dr. Charles Herrick is a board certified psychiatrist, and the chair of psychiatry at Nuvance Health’s Danbury Hospital and Norwalk Hospital.

New dog, old tricks?

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A new study shows that untrained stray dogs respond to gestures from people, suggesting that understanding between humans and dogs transcends training

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If you have a dog, hopefully you’re lucky enough to know that they are highly attuned to their owners and can readily understand a wide range of commands and gestures. But are these abilities innate or are they exclusively learned through training?

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To find out, a new study in Frontiers in Psychology investigated whether untrained stray dogs could understand human pointing gestures.

The study revealed that about 80% of participating dogs successfully followed pointing gestures to a specific location despite having never received prior training. The results suggest that dogs can understand complex gestures by simply watching humans and this could have implications in reducing conflict between stray dogs and humans.

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Dogs were domesticated 10,000-15,000 years ago, likely making them the oldest domesticated animals on the planet. Humans then bred dogs with the most desirable and useful traits so that they could function as companions and workers, leading to domesticated dogs that are highly receptive to human commands and gestures.

However, it was not clear whether dogs understand us through training alone, or whether this was innate. Can dogs interpret a signal, such as a gesture, without specific training, or even without having met the signaling person previously? One way to find out is to see whether untrained, stray dogs can interpret and react to human gestures.

Stray dogs are a common feature in cities around the world and particularly in many developing countries. While they may observe and occasionally interact with people, such dogs have never been trained, and are behaviorally “wild”. Conflicts between stray dogs and humans are a problem and understanding how humans shape stray dog behavior may help alleviate this.

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To investigate, Dr. Anindita Bhadra of the Indian Institute of Science Education and Research Kolkata, India, and colleagues studied stray dogs across several Indian cities. The researchers approached solitary stray dogs and placed two covered bowls on the ground near them. A researcher then pointed to one of the two bowls, either momentarily or repeatedly, and recorded whether the dog approached the indicated bowl. They also recorded the perceived emotional state of the dogs during the experiment.

Approximately half of the dogs did not approach either bowl. However, the researchers noticed that these dogs were anxious and may have had bad experiences with humans before. The dogs who approached the bowls were noted as friendlier and less anxious, and approximately 80% correctly followed the pointing signals to one of the bowls, regardless of whether the pointing was momentary or repeated. This suggests that the dogs could indeed decipher complex gestures.

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“We thought it was quite amazing that the dogs could follow a gesture as abstract as momentary pointing,” explained Bhadra. “This means that they closely observe the human, whom they are meeting for the first time, and they use their understanding of humans to make a decision. This shows their intelligence and adaptability.”

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The results suggest that dogs may have an innate ability to understand certain human gestures which transcends training. However, it should be noted that the shyer, more anxious animals tended not to participate, so future studies are needed to determine more precisely how an individual dog’s personality affects their ability to understand human cues.

Overall, dogs may be more perceptive than we realize. “We need to understand that dogs are intelligent animals that can co-exist with us,” said Bhadra “They are quite capable of understanding our body language and we need to give them their space. A little empathy and respect for another species can reduce a lot of conflict.”

It’s 2020: Time to Teach Teens ‘Safe’ Sexting

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Credit: Getty Images/Florida Atlantic University
Youth who sext open themselves up to possible significant and long-term consequences, such as humiliation, extortion, victimization, school sanction, reputational damage, and even criminal charges.

Preaching sexual abstinence to youth was popular for a number of decades, but research repeatedly found that such educational messages fell short in their intended goals. Simply telling youth not to have sex failed to delay the initiation of sex, prevent pregnancies, or stop the spread of sexually-transmitted diseases. Since the advent of photo- and video-sharing via phones, children have received similar fear-based messages to discourage sexting – the sending or receiving of sexually explicit or sexually suggestive images (photos or video) usually via mobile devices. Unfortunately, messages of sexting abstinence don’t seem to be reducing the prevalence of adolescents sharing nudes. 

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Consequently, in a new paper published in the Journal of Adolescent Health, researchers from Florida Atlantic University and the University of Wisconsin-Eau Claire, say that it is time to teach youth “safe” sexting.

“The truth is that adolescents have always experimented with their sexuality, and some are now doing so via sexting,” said Sameer Hinduja, Ph.D., co-author and a professor in the School of Criminology and Criminal Justice within FAU’s College for Design and Social Inquiry, and co-director of the Cyberbullying Research Center. “We need to move beyond abstinence-only, fear-based sexting education or, worse yet, no education at all. Instead, we should give students the knowledge they need to make informed decisions when being intimate with others, something even they acknowledge is needed.”

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Hinduja and co-author Justin Patchin, Ph.D., a professor of criminal justice at the University of Wisconsin-Eau Claire and co-director of the Cyberbullying Research Center, acknowledge that although participating in sexting is never 100 percent “safe” (just like engaging in sex), empowering youth with strategies to reduce possible resultant harm seems prudent.

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Hinduja and Patchin collected (unpublished) data in April 2019 from a national sample of nearly 5,000 youth between the ages of 12 and 17, and found that 14 percent had sent and 23 percent had received sexually explicit images. These figures represent an increase of 13 percent for sending and 22 percent for receiving from what they previously found in 2016. 

The authors do want youth to understand that those who sext open themselves up to possible significant and long-term consequences, such as humiliation, extortion, victimization, school sanction, reputational damage, and even criminal charges. But they also want youth who are going to do it anyway to exercise wisdom and discretion to prevent avoidable fallout.

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“This is not about encouraging sexting behaviors, any more than sex education is about encouraging teens to have sex,” said Hinduja. “It simply recognizes the reality that young people are sexually curious, and some will experiment with various behaviors with or without informed guidance, and sexting is no exception.”

Hinduja and Patchin provide suggested themes encapsulated in 10 specific, actionable messages that adults can share with adolescents in certain formal or informal contexts after weighing their developmental and sexual maturity.

  1. If someone sends you a sext, do not send it to — or show — anyone else. This could be considered nonconsensual sharing of pornography, and there are laws prohibiting it and which outline serious penalties (especially if the image portrays a minor).  
  2. If you send someone a sext, make sure you know and fully trust them. “Catfishing”— where someone sets up a fictitious profile or pretends to be someone else to lure you into a fraudulent romantic relationship (and, often, to send sexts) — happens more often than you think. You can, of course, never really know if they will share it with others or post it online, but do not send photos or video to people you do not know well.  
  3. Do not send images to someone who you are not certain would like to see it (make sure you receive textual consent that they are interested). Sending unsolicited explicit images to others could also lead to criminal charges.  
  4. Consider boudoir pictures. Boudoir is a genre of photography that involves suggestion rather than explicitness. Instead of nudes, send photos that strategically cover the most private of private parts. They can still be intimate and flirty but lack the obvious nudity that could get you in trouble.  
  5. Never include your face. Of course, this is so that images are not immediately identifiable as yours but also because certain social media sites have sophisticated facial recognition algorithms that automatically tag you in any pictures you would want to stay private.  
  6. Make sure the images do not include tattoos, birthmarks, scars, or other features that could connect them to you. In addition, remove all jewelry before sharing. Also, consider your surroundings. Bedroom pictures could, for example, include wall art or furniture that others recognize.  
  7. Turn your device’s location services off for all of your social media apps, make sure your photos are not automatically tagged with your location or username, and delete any meta-data digitally attached to the image.  
  8. If you are being pressured or threatened to send nude photos, collect evidence when possible. Having digital evidence (such as screenshots of text messages) of any maliciousness or threats of sextortion will help law enforcement in their investigation and prosecution (if necessary) and social media sites in their flagging and deletion of accounts.  
  9. Use apps that provide the capability for sent images to be automatically and securely deleted after a certain amount of time. You can never guarantee that a screenshot was not taken, nor that another device was not used to capture the image without you being notified, but using specialized apps can decrease the chance of distribution.  
  10. Be sure to promptly delete any explicit photos or videos from your device. This applies to images you take of yourself and images received from someone else. Having images stored on your device increases the likelihood that someone — a parent, the police, a hacker — will find them. Possessing nude images of minors may have criminal implications. In 2015, for example, a North Carolina teen was charged with possessing child pornography, although the image on his phone was of himself. 
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– FAU –

About Florida Atlantic University: Florida Atlantic University, established in 1961, officially opened its doors in 1964 as the fifth public university in Florida. Today, the University, with an annual economic impact of $6.3 billion, serves more than 30,000 undergraduate and graduate students at sites throughout its six-county service region in southeast Florida. FAU’s world-class teaching and research faculty serves students through 10 colleges: the Dorothy F. Schmidt College of Arts and Letters, the College of Business, the College for Design and Social Inquiry, the College of Education, the College of Engineering and Computer Science, the Graduate College, the Harriet L. Wilkes Honors College, the Charles E. Schmidt College of Medicine, the Christine E. Lynn College of Nursing and the Charles E. Schmidt College of Science. FAU is ranked as a High Research Activity institution by the Carnegie Foundation for the Advancement of Teaching. The University is placing special focus on the rapid development of critical areas that form the basis of its strategic plan: Healthy aging, biotech, coastal and marine issues, neuroscience, regenerative medicine, informatics, lifespan and the environment. These areas provide opportunities for faculty and students to build upon FAU’s existing strengths in research and scholarship. For more information, visit fau.edu.

Rethinking interactions with mental health patients

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Credit: Pixabay
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New research overturns the belief that people with severe mental illness are incapable of effective communication with their psychiatrist, and are able to work together with them to achieve better outcomes for themselves.

“Interviews are a critical part of assessing people suffering from thought disorder (TD), and deciding what the best therapy is for them,” says Professor Cherrie Galletly from the Adelaide Medical School, University of Adelaide.

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“Clinical interactions with people suffering with severe mental illness can be challenging, especially if the patient has disordered communication.”

Published in the journal Australian Psychiatry the study analysed 24 routine clinical interviews between psychiatrists and inpatients, with a mean age of just under 30 years, who were suffering from TD.

“The study, the first of its kind, examined the expertise with which psychiatrists conducted clinical interviews of people suffering from TD, and the shared goals that were accomplished,” says Professor Galletly.

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“When interviewing people with TD psychiatrists need to adopt a mindset that the information the patient provides in that particular moment is, for them, meaningful, truthful, relevant and clear.

“They have to piece together snippets of information in order to create and interpret meaning and build respectful relationships by inviting patients to share their perspectives no matter how disordered or delusional their responses appear.”

Thought disorder is common in psychotic disorders. The thoughts and conversation of people suffering from TD appear illogical and lacking in sequence and may be delusional or bizarre in content.

In 2010, 0.3% of Australians aged 18-64 years, had a psychotic illness with men aged 25-34 experiencing the highest rates (0.5%) of illness.

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“Patients are positioned as active participants by psychiatrists who adopt a non-confrontational, non-judgemental approach, conveying support and safety, and ask open ended questions which allows the patient to engage, feel listened to, and work with the psychiatrist to achieve a shared understanding,” says Professor Galletly.

“Findings from this study of sample interviews between psychiatrists and their patients highlight the need to rethink the notion that patients experiencing TD are incapable of communicating productively with the people trying to help them.

“Psychiatrists use transactional, relational and interactional techniques when they are talking to patients with thought disorder, which go beyond techniques normally employed in clinical interviews.

“Experienced psychiatrists undertake meaningful interviews with these patients, who in turn respond in ways that belie the notion that effective communication is not possible.

“The findings from this research can be used to develop training resources for clinicians who work with people with psychotic disorders.”