Healthsifter by mary desmond pinkowish, since 2003

How the OCD Brain Might Work, or Not Work, Actually

A small portion of the brain called the orbitofrontal cortex may be underactive in people with obsessive-compulsive disorder (OCD), according a report in ScienceNow Daily News. Here's a summary of the findings. The full article appears in the current issue of the journal Science.

"[The scientists] monitored 14 OCD patients, 12 unaffected relatives, and 15 people without a family history of the disorder as they engaged in a task intended to stimulate the orbitofrontal cortex. As a functional magnetic resonance imaging machine measured blood flow to various parts of their brains, the participants viewed two superimposed images--a face over a house, for example--on a screen and had to figure out through trial and error which images were "correct" and which ones were "incorrect," as determined by the researchers. Once the subjects caught on to which image was the right choice, the researchers switched it up and made the other image the correct choice. That forced the participants to change their newly acquired habit, something previously shown to activate the orbitofrontal cortex. But although normal subjects exhibited the expected activity in this region, those with OCD and their relatives showed reduced activity, even though their performance on the task was normal."

Laugh Along with Hypochondria, aka Somatoform Disorder

One (or more) of my nearest and dearest suffer periodically from hypochondria, so I know how difficult this problem can be. Still, it's OK to have a chuckle about it too, as hypochondriac Jennifer Traig does today at Slate. She points out that unfortunately, a person with hypochondria (called somatoform disorder by psychaitrists) has a 5% chance of full recovery. These are worse odds than leukemia, heart failure, or necrotizing fasciitis (aka flesh-eating strep). She also points out that...oh well, never mind. I don't want to feed your hypochondria. You'll have to read her article, where you'll also find out that your doctor is never happy to see you if you're a hypochondriac.

"Even doctors hate us. Most doctors would rather see a patient with suppurating genitals than a hypochondriac, and with good reason. Hypochondriacs are difficult, doubting backseat doctors who continually second-guess their physicians. Convinced that something is fundamentally, fatally wrong, they are the patients who are angry when the path report comes back benign. They are also outrageously expensive. It's estimated that they cost healthcare providers billions of dollars in unnecessary tests, care, and procedures."

(Illustration from iStockphoto.com)

Do Infections Cause Mental Illness?

Scientific American online discusses the evidence surrounding the links between some infectious disease and mental illness.

The most notable is the association between influenza in pregnant women and schizophrenia in their offspring many years later. Also interesting: the intersection of OCD and strep infections.

D-Cycloserine: A Miracle Drug for Anxiety Problems?

Excuse the hyperbole, but D-cycloserine really does sound almost like it could revolutionize the treatment of anxiety disorders, and maybe a few other related illnesses. David Kohn, writing in the Baltimore Sun, describes how this really old, humble antibiotic, now used mainly to treat TB, may turn out to be a superstar in the treatment of anxiety disorders.

Among its many talents, D-cycloserine binds to NMDA (N-methyl-D-aspartate) receptors in the amygdala region of the brain, where fears and phobias may originate. When combined with conventional exposure therapy, D-cycloserine works after just a few doses. The scientists involved with these studies say that the drug speeds up the exposure therapy process, which can be scary and demands lots of courage and determination on the part of the patient. D-cycloserine is a "learning aid," say the researchers. It's interesting that nothing happens if the drug is taken without the thearpy.

D-cycloserine is available now, but a company called Tikvah Therapeutics is trying to get a formulation approved by the FDA for use in people with anxiety disorders.  The doses typically used for anxiety are lower than those used for TB.

D-cycloserine is also being tested as a treatment for obsessive compulsive disorder (OCD) and smoking cessation. It may also be effective in people with chronic pain syndromes.

Mental Health Parity

The House just passed a bill that would prevent health insurers from providing less coverage for mental health problems than physical ones. Quoting from an aticle in the New York Times this week:

"The bill would ban insurance companies from setting lower limits on treatment for mental health problems than on treatment for physical problems, including doctor visits and hospital stays. It would also disallow higher co-payments. The insurance industry is up in arms, as are others who envision sharply higher premiums and a free-for-all over claims for coverage of things like jet lag and caffeine addiction."

There's a good discussion of the issues here. Free registration required. Don't let that stop you. The Senate bill on the same topic gives insurers more discretion about what they'll pay for. Read more about mental health parity from the US Dept of Health and Human Services,the Milbank Memorial Fund,  the AMA, the Health Blog at WSJ.com, and the National Alliance on Mental Illness (NAMI).

Are People with Borderline Disorder Stigmatized by Psychiatric Professionals?

I don't know a lot about borderline personality disorder, so I was interested to read this article posted at Psych Central.

The Genetic Basis of Post-Traumatic Stress Disorder (PTSD)

Certain genes may predispose people to PTSD, according a study published in JAMA and reported in the Seattle Times, the Wall Street Journal, and other news outlets. The new study, which included about 900 subjects, suggests that people who have a predisposing gene and who also suffer child abuse do not recover from traumatic events as adults and are at increased risk for PTSD. The worse the abuse in childhood, the higher the risk of stress- and trauma-related problems in adulthood.

This study dovetails with another that appears in the March 15th edition of Biological Psychiatry, which suggests that high levels of stress may cause physical damage to an area of the brain responsible for emotional responses (the gray matter in the pregenual anterior cingulate cortex). Read more about that study at Psych Central and Science Daily.

A better way to diagnose mental illness

Link: Mind Over Manual - New York Times.
So much common sense here from Dr. Sally Satel. Her idea about using a diagnostic continuum approach to illnesses like depression and bipolar seems like a logical, helpful way to proceed.