The first generation of antipsychotic medications, known as the typical antipsychotics, has demonstrated great effectiveness in treating a variety of mental health issues. Schizophrenia is the most frequent cause for the prescription of a typical antipsychotic. These typical antipsychotics also cause a variety of side effects, including sleep disturbances and movement disorders.

Tremors and loss of muscle tone can sometimes become so severe that patients have to discontinue treatment. More recently, the atypical antipsychotics have offered the same clinical results with fewer side effects. However, the side effects that can occur with this class of medications are troubling in their own right.

Although the reasons aren’t clear, atypical antipsychotics can lead to serious metabolic side effects. Prolonged use of these medications can result in obesity and even diabetes. Zyprexa (olanzapine) has the greatest risk of causing harmful metabolic effects. Previous research has indicated that a little-understood relationship between atypical antipsychotics, glucose, and insulin is responsible for weight gain and fat accumulation in those who take atypical antipsychotics.

At Penn State University, researchers conducted a study with live rats to better understand how and why antipsychotic medications lead to changes in human metabolism. One group of rats received daily Zyprexa for several weeks, while another group had a single, acute dose of the drug. The rats given the single dose exhibited an almost immediate drop in their activity levels, without a matching decrease in food intake.

In essence, these rats took in more nutrition than necessary. At the same time, significant changes to insulin meant that the extra calories were converted into fat stores. The acute responses were also observed in the chronically-dosed rats. Surprisingly, the rats did not all gain significant amounts of weight. Still, the body composition of these rats changed in drastic way whether they gained weight or not. Fatty tissue as a proportion of body weight increased steadily for the first three weeks of the study before plateauing. Similar effects have been observed in humans in small studies.

Measurable and significant weight gain is the primary concern when prescribing an atypical antipsychotic. It is arguably the most serious side effect, as increased body mass raises the risk of numerous chronic health problems. However, the rat study at Penn State showed that even without large weight gains, body composition can change in distinctly unhealthy ways. More fatty tissue leads to altered hormone levels and potentially more plaque in the blood stream. This study makes a strong case that patients taking atypical antipsychotics, especially Zyprexa, should have regular blood work to ensure healthy insulin and glucose levels.

References:

1. Albaugh, V.L., Judson, J.G., She, P., Lang, C.H., Maresca, K.P., Joyal, J.L, and Lynch, C.J. (2011). Olanzapine promotes fat accumulation in male rats by decreasing physical activity, repartitioning energy and increasing adipose tissue lipogenesis while impairing lipolysis. Molecular Psychiatry, 16, (5), 569-581.
2. Olanzapine – PubMed Health. (n.d.). National Center for Biotechnology Information. Retrieved from http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0000161/

Some of the symptoms of schizophrenia include delusions, mood fluctuations, and impaired social functioning. One of the reasons social interactions are challenging for people with schizophrenia is the way in which facial expressions are processed. Specifically, it is theorized that schizophrenia deteriorates the recognition processes of individuals and makes it more difficult for them to distinguish between familiar and unfamiliar faces. This can cause significant social struggles because accurately perceiving the facial expressions of others is how people determine their reactions to them. It is also how people decide which faces are threatening and which are safe.

Fabrice Guillaume of the Laboratory of Cognitive Psychology at Aix-Marseille University in France recently led a study that explored facial recognition in individuals with schizophrenia in order to get a better idea of impairments that occurred and why. Guillaume assessed 20 individuals with schizophrenia and 20 without as they evaluated the familiarity of facial expressions. The electrophysiological (ERP) responses of the participants were monitored as a set of faces was presented with expression changes, without expression changes, and then, finally, new faces were presented. Guillaume discovered that when the expressions changed, the participants with schizophrenia did not recognize them as familiar, even though they had seen the faces before.

The participants with schizophrenia also had a hard time distinguishing between familiar faces with new expressions and unfamiliar faces. “This result suggests that patients with schizophrenia are more sensitive to the expression change and appears to be inconsistent with studies showing spared familiarity in schizophrenia,” Guillaume said. The findings could be interpreted to indicate a broader, more global perception of faces occurs in schizophrenia, and that individuals with schizophrenia have an impaired ability to retrieve the global perception when perceptual nuances, such as expressions, occur. In sum, the results of this study reveal that people with schizophrenia can experience facial recognition deficits, which can have a dramatic impact on social interactions, even when they try to identify faces familiar to them.

Reference:
Guillaume, Fabrice, Francois Guillem, Guy Tiberghien, and Emmanuel Stip. Mismatched expressions decrease face recognition and corresponding ERP old/new effects in schizophrenia. Neuropsychology 26.5 (2012): 568-77. Print.

If you don’t get the right nutrients, your body won’t function to the best of its ability. Some general health conditions can be linked to nutritional deficiency, but it’s up for debate whether the same applies to specific mental health conditions. Some nutrition experts do claim that unique cases of social anxiety can actually be caused by a nutritional deficiency. In the condition several experts refer to as pyroluria, once the nutritional deficiency is taken care of, the social anxiety is relieved. Other experts are quick to dismiss the validity of this diagnosis.

Trudy Scott, a food-and-mood expert who said in an email that she has suffered from pyroluria, is a certified nutritionist, immediate past president of the National Association of Nutrition Professionals, and author of The Antianxiety Food Solution: How the Foods You Eat Can Help You Calm Your Anxious Mind, Improve Your Mood and End Cravings.

“The person experiences shyness, inner tension, and social anxiety,” Scott said in regard to symptoms of pyroluria. “Symptoms usually start in childhood and are made worse under stressful situations. The wonderful thing is that the symptoms can be completely alleviated with taking these supplements: zinc, vitamin B6, and evening primrose oil. People typically start to feel less anxious, less shy, and more social within a week. The important thing is that if you do have pyroluria, you do need to take the supplements always.”

Generally only zinc and Vitamin B6 are recommended for pyroluria, but “gamma-linolenic acid (GLA), found in evening primrose oil and borage oil, is also beneficial for those with pyroluria because its levels are often low, and supplementing with GLA improves zinc absorption,” she added. In her book about anxiety, mood, and food, she wrote a whole chapter about pyroluria.

“I am … very passionate about the subject because I have pyroluria myself and used to suffer terribly from social phobia and shyness, anxiety, unexplained fears, waking with a sense of doom and even panic attacks,” Scott said. “I have used the amazing healing powers of foods and nutrients to completely heal. I now help women find natural solutions for anxiety and other mood disorders.”

She has posted a questionnaire on her website for pyroluria. It includes a long list of symptoms, and if 15 or more items are checked on the list, it is likely a person has pyroluria: http://www.everywomanover29.com/blog/pyroluria-questionnaire-from-the-antianxiety-food-solution/

She said that in research studies, pyroluria is also called “the mauve factor.” “Much of what we know about pyroluria is based on the work of Humphrey Osmond, Abram Hoffer, and Carl Pfeiffer,” Scott said. “Much of the original work was done with schizophrenic patients in psychiatric hospital settings. Although pyroluria was first identified in the 1960s, the medical and mental health communities have been slow to recognize it, and many mental health practitioners and physicians remain unfamiliar with this condition.”

She said she learned about the condition mainly from reading the following books:
The Mood Cure by Julia Ross
Depression-Free Naturally by Joan Mathews-Larson
Nutrition and Mental Illness (1988) by Carl Pfeiffer

Her own book goes into the specific details and biological/chemical/genetic aspects of pyroluria. In her book, she cites research prevalence rates from Joan Mathews-Larson, the author of Depression-Free Naturally. Pyroluria is thought to exist in “11 percent of the healthy population” and “40 percent of adults with psychiatric disorders,” according to Scott’s book. For people with alcohol addiction, pyroluria is thought to have a 40% prevalence rate. However, the prevalence rates do depend on the source. In her own experience as a nutritionist, Scott said about 80% of her clients who have moderate to severe anxiety have symptoms associated with pyroluria.

She added that stress can be a major factor for what age pyroluria develops and that it is a genetic condition that seems to affect more women than men. In addition, people who have pyroluria tend to also have gluten sensitivity, especially if they also are dealing with other issues like depression, anxiety, autism, alcoholism, bipolar disorder, and schizophrenia, according to the book. People with pyroluria may also have digestive problems, and they need to make sure to balance out an increased Vitamin B intake with a higher intake of magnesium.

In the book The Mood Cure by Julia Ross, the author includes a discussion of the prevalence, testing, and treatment of pyroluria, as well as a checklist similar to that offered by Trudy Scott. Ross states that the questionnaire was developed by Dr. Carl Pfeiffer, a clinician and researcher. He wrote the book Nutrition and Mental Illness: An Orthomolecular Approach to Balancing Body Chemistry in 1988.

Ross states in her book that pyroluria is fairly uncommon in the general public, but in certain groups of people (like those who have experienced alcohol addiction), it is more common. “I am just getting familiar with this condition, but I can see that it is an important one for certain people, affecting stress levels and mood generally and preventing full response to nutrient therapy until it is addressed,” Ross wrote in her book.

There are a plethora of articles dedicated to nutrition, diet, and mental health in general, as well as multiple research studies suggesting that certain mental health issues can be improved through natural supplements and a healthy overall diet. “Notably, essential vitamins, minerals, and omega-3 fatty acids are often deficient in the general population in America and other developed countries and are exceptionally deficient in patients suffering from mental disorders,” according to an abstract from a research study in Nutrition Journal. “Studies have shown that daily supplements of vital nutrients often effectively reduce patients’ symptoms.”

Another abstract from a research article in the journal Alternative Therapies in Health and Medicine concludes the following: “Many patients will benefit from the use of specific dietary supplements, such as a multivitamin-mineral high in B vitamins and omega-3 fatty acid,” according to the abstract. “And no matter what the underlying cause of the mood disorder, patients should be counseled about the relationship between food and mood, for the evidence now substantiates what laypeople and medical professionals have long known intuitively: the way we eat affects the way we feel.”

The research, authored by Tieraona Low Dog, director of the fellowship at Arizona Center for Integrative Medicine at University of Arizona, added in the research abstract that the healthiest diet for improving mental health is a “low-glycemic, modified Mediterranean diet rich in fruits, vegetables, whole grains, and seafood (if not vegetarian) and low in processed, refined foods.”

Other experts remain unaware of the condition and are skeptical of its legitimacy. Scott Carroll, a psychiatrist with dual board certifications in adult and child and adolescent psychiatry, said in an email that he is not accustomed to pyroluria and had to look it up on Google to find out what it was.

“Once I saw that it is connected to orthomolecular psychiatry, which I have heard of, I knew it was in the pseudoscience realm,” said Carroll, who is also an assistant professor at the University of New Mexico School of Medicine. “Not surprisingly, it claims to be the cause of a number of unrelated psychiatric disorders, which is typical of pseudoscience disorders. Like so many ‘cure-alls,’ it sounds plausible, but there is no scientific basis to it, and it allows dubious practitioners to prey on desperate, suffering people.”

He said there are certain cases where nutrition can play a part in mood and mental disorders. “Inadequate amounts of Omega 3 fatty acids, especially from fish or krill oil, have been shown to affect mood and anxiety in a broad way of which social anxiety can be a part,” Carroll said. “Also, low folate, low Vitamin D, and low B12 have all been associated with negative effects on mood and anxiety.”

“However, in people with low folate, it is more often a case of a genetic inability to transport the folate molecule into the brain rather than a low blood level,” he added. “In those cases, which often present with chronic depression and anxiety that has never responded to antidepressants, there are folate precursors that are more lipophilic and can diffuse into the brain without use of a transport mechanism.”

Nerina Garcia-Arcement, a licensed clinical psychologist and clinical assistant professor at the NYU School of Medicine, said in an email that she didn’t study pyroluria in school and hasn’t read about it in any research studies after graduating from her doctorate program.

“Based on current knowledge it does not appear to be a legitimate health condition,” Garcia-Arcement said. “Further research is required to further explore and understand whether social anxiety or any other mental health condition could be related to improper synthesis in the blood.  Although this theory seems appealing, being able to ‘cure’ a mental disorder with vitamins or supplements … is unlikely.”

“Causes of social anxiety that have been substantiated by research include chemical imbalances in the brain (i.e., serotonin, a neurotransmitter), inherited traits (genetic and through observing anxious family members), negative life events or experiences, and an overactive amygdala (a part of the brain that controls emotions, including fear response),” she added.

She said that good nutrition is important for overall health, but it’s not necessarily linked to mental disorders. “In my experience, the social anxiety could be traced to other causes, not nutritional deficiencies,” Garcia-Arcement said. “Having a healthy and balanced diet is overall beneficial, but it won’t cure social anxiety or a mood disorder. I am more likely to recommend my clients get enough sun exposure to improve their moods (seasonal affective disorder) than recommend diet changes.”

Related articles:
Social Anxiety Can Be a Hidden Problem in College
Breathing Lessons
The Birth of Anxiety

People in their 20s seem to have it all: youth, energy, health, and looks. But they are also still figuring themselves out, and this time of change can bring certain mental health concerns as well. Experts have information on these issues that tend to impact people in their 20s, and provide some solutions for addressing and coping with these problems.

Clinical psychologist Dean Haddock, a marriage, family, and child counselor and the executive director and founder of Community Counseling and Psychological Services, points to a fairly common activity of 20-somethings that can lead to mental health issues if it’s not checked: alcohol and drug use.

“The first problem that leads to many others is alcohol and chemical abuse, which often leads to dependency,” Haddock said in an email. “The mental disorders that follow are often depression, anxiety, and brain injury. Of course, self-esteem and body-image problems often lead to eating disorders.”

Haddock gives three tips to help people in their 20s prevent and get through some common mental health concerns:

1. Know your genetic history of mental disorders. Knowing is half the battle to avoid those disorders in yourself.
2. Be choosey about your friends, as they will influence your decisions. Healthy friends lead to healthier decisions.
3. Self-esteem is often the result of the people who matter to you. If they do not esteem you, then you will not esteem yourself.

Nerina Garcia-Arcement, a clinical psychologist and clinical assistant professor at NYU School of Medicine, suggests that the many life changes people experience in their 20s can cause mental health issues at times.

“Your 20s are filled with life transitions that can be stressful,” Garcia-Arcement said. “This is a time when young adults are solidifying their personalities, developing their independence from family, starting or finishing college, beginning new jobs, developing a career, forming romantic relationships, and learning to manage their existing family relationships and friendships within these context.”

“Individuals in their 20s don’t have a lifetime of experience to draw on when managing multiple life transitions at once,” she added. “When someone experiences these transitions, anxiety and depressive disorders can occur.”

Here are six of Garcia-Arcement’s tips to help people in their 20s cope with mental health issues more common to that age group:

1. Seek out and form strong support networks.
2. Seek out others who are going through similar experiences and share your feelings, whether you are feeling worried, nervous, scared, sad, confused, or excited.
3. Know that you are not alone in your confusion about your career and relationships.
4. Seek out mentors who have achieved their goals, and ask for advice.
5. If you are feeling stress, sadness, or anxiety, engage in activities that will help you manage those feelings such as yoga, meditation, exercise, hobbies, social activities, relaxation exercises, and deep breathing.
6. If you feel you are not getting the necessary support and feel overwhelmed or depressed, seek out mental health professionals who can help you manage the feelings related to your life transitions.

Stephanie Sarkis, a licensed mental health counselor, said in an email that anxiety and depression are some of the main mental health issues 20-somethings face.

“We have seen an increase in these issues due to the lagging economy and difficulties finding employment,” Sarkis said. “Many people in their 20s have moved back in with their parents, which can trigger feelings of failure and frustration.”

Dr. Maiysha Clairborne, a family physician and wellness and stress management coach, added in an email that eating disorders associated with body dysmorphic disorder and body-image issues are also common for people in their 20s. She has three overall tips for people in this age group:

1. Talk to someone. The worst thing that a person can do when they are feeling depressed, anxious, or alone is to isolate more. Many times when we talk with someone we trust about what’s going on, we come to realize that we are not the only ones experiencing it and then we can get support.
2. Get active. Staying physically active not only helps to keep the body fit but also helps release endorphins and serotonin in the brain, which help keep the mood elevated. Physical activity is also a good release for stress and anxiety.
3. Minimize sugar and junk food. Sugar and processed junk foods can worsen the emotions of stress, anxiety, and depression because they cause erratic changes in your body’s blood sugars. This can disrupt the normal release of hormones in the brain that keep your moods stable.

Scott Carroll, a psychiatrist with dual board certifications in adult and child and adolescent psychiatry, said there are many issues specific to people in their 20s, including problems associated with medication use.

“Many people were on stimulants/meds for their ADHD when they were younger, but they thought it was okay to stop their meds when they were done with school,” Carroll said. “Now they are struggling at work and don’t know why. I’ve also seen young adults stop all kinds of meds like their thyroid meds because they didn’t know why they were even on it, and then they have all kinds of problems.”

Bad habits involving drug and alcohol use can start to become a major substance abuse issue when people are in their 20s, and other mental health issues start coming to the forefront at this time in peoples’ lives. Examples include bipolar disorder and schizophrenia. Also, panic attacks can start for people who have a genetic predisposition and who have higher amounts of stress associated with newfound adulthood.

“The 20s are an important time of social/emotional development,” Carroll said. “Unlike previous generations, identity formation often takes the entire 20s due to the complexity of modern society. It could be said that adolescence lasts until the early 30s in today’s society due to [prolonged] periods of education (grad school, law school, med school, etc.), lack of stable job options, and delays in getting married and starting families.”

Carroll, who is also an assistant professor at the University of New Mexico School of Medicine, suggests that when it comes to serious relationships and marriage, people in their 20s should consider how their choices could eventually affect their mental health and how their brain plays a part in their decision.

“Many 20-somethings are tempted to get married, but it is generally a bad idea because the brain in not done developing until about 25 [years old] … which leaves young adults vulnerable to having their rational mind be overwhelmed by their feelings or stress,” Carroll said. “Relationship choices often dramatically change from the early 20s to the late 20s, so many people find that the person that was perfect at 22 is a disaster at 27.  This can be an incredibly hard transition, to have to break up with your former soul mate that you thought you’d love for life because you’ve changed so much over the last several years.”

Related articles:
Do I Have a Healthy Relationship With Food and My Body?
Social Anxiety Can Be a Hidden Problem in College
How Schools Could Prevent Depression

There are a number of different experiences that can cause a child to develop maladaptive coping tendencies. Children who are emotionally or physically abused, neglected, or raised in extremely stressful environments may internalize their emotions. Likewise, children who have experienced sexual abuse may dissociate as a way of defending themselves from the psychological harm that results from sexual abuse. Trauma suffered in childhood increases the risk for dissociative behaviors. Auditory hallucinations are one form of dissociation and are evident in individuals with mental illnesses such as schizophrenia. To better understand how childhood trauma, dissociation, and hallucinations are related, F. Varese of the School of Psychology at Bangor University in the United Kingdom recently led a study comparing the dissociative behaviors, childhood traumas, and cognitive discrimination of 45 individuals with schizophrenia and 20 participants with no prior hallucination history.

Because dissociation is recognized as a pathway for hallucinations and an outcome of childhoodtrauma, Varese sought to determine if the frequency and type of trauma influenced hallucinations and the capacity to determine real and imagined events in the participants. Using a signal detection performance task (SDT), Varese found that the participants with a history of childhood sexual abuse were the most likely to experience dissociative behaviors that resulted in hallucinations. The frequency of abuse was directly related to the level of dissociation, with the most severely abused participants exhibiting the highest levels of hallucinations. The findings also showed that the participants with infrequent hallucinations had lower levels of abuse and dissociation than those who experienced more hallucinations. Varese believes that further research is needed to determine if adult stress and trauma rather than childhood trauma contributed to the intermittent hallucinations in the participants with sporadic dissociative behaviors. In sum, these results suggest that a better comprehension of the type of abuse suffered may be the key to developing effective treatment strategies for individuals who experience hallucinations. Varese added, “Future research should examine whether other cognitive processes associated with both dissociative states and hallucinations (e.g., deficits in cognitive inhibition) may explain the relationship between dissociation and hallucinatory experiences.”

Reference:
Varese, F., Barkus, E., Bentall, R. P. (2012). Dissociation mediates the relationship between childhood trauma and hallucination-proneness. Psychological Medicine, 42.5, 1025-1036.

Probation officers assume a large level of responsibility for the offenders in their care and the community at large. They are responsible for monitoring criminal offenders and assessing what level of risk they pose to the general public. When offenders commit an infraction, such as a technical violation of not meeting the conditions of their probation, it is up to the probation officer to manage that infraction and ultimately decide the consequence. Individuals who struggle with mental health issues such as depression, schizophrenia, and bipolar account for a large percentage of offenders. Unlike offenders with substance abuse problems, the main cause of reincarceration for mentally ill offenders is a technical violation, not a new criminal offense. Research has shown that in fact, mentally ill offenders are just as unlikely to commit a new offense as are offenders with no history of mental illness or drug abuse. But unfortunately, mentally ill offenders are monitored more closely and assessed more harshly than substance abusing offenders.

Jennifer Eno Louden of the Department of Psychology at the University of Texas recently conducted a study to better evaluate the conditions by which probation officers assess and manage mentally ill offenders. Her goal was to determine whether these offenders were being unfairly assessed, resulting in increased rates of reincarceration. Louden enlisted 234 probation officers and presented them with probation violation scenarios committed by a mentally ill offender, an offender with substance use issues, an offender with both problems, and an offender with neither. She evaluated their risk assessments and management recommendations and found that even though statistics show substance users as more likely to engage in violent acts, the officers rated the mentally ill offenders as being 13% more likely to commit acts of violence.

The primary risk management strategy recommended by the officers was forced psychological treatment, usually in the form of medication. Although mental health treatment is not a negative recommendation, forcing the treatment is seen as a cause for concern. For these individuals, many of whom have schizophrenia, the negative side effects of medication can cause more harm than good. The goal of treatment was not helping the offenders address their mental health problems but rather managing their behavior; however, it did not help them decrease their chance of reoffending. Louden believes this study demonstrates the need for further training and education for probation officers who work with mentally ill offenders. She said, “By targeting interventions away from a sole focus on mental disorder toward robust predictors of recidivism, real improvements can be made in the criminal justice outcomes for offenders with mental disorders.”

Reference:
Eno Louden, J., Skeem, J. L. (2012). How do probation officers assess and manage recidivism and violence risk for probationers with mental disorder? An experimental investigation. Law and Human Behavior. Advance online publication. doi: 10.1037/h0093991

Any caregiver is likely to be vulnerable to stress. However, parents who care for a child with a serious mental illness (SMI) are at increased risk for adverse physical symptoms resulting from stress. Those who care for an adult child with SMI are even more likely to experience the negative effects of stress because of the length of time that they have had to cope with the difficult task of caring for a loved one with mental health issues. Although there is a vast amount of evidence showing how caring for a child with SMI can negatively impact a parent’s psychological health, there is scant clinical evidence highlighting the deleterious physiological effects to the caregiver. Erin T. Barker of the Waisman Center at the University of Wisconsin-Madison addressed this specific dynamic in a recent study by examining the cortisol levels in individuals charged with the care of adult children with SMI.

For her study, Barker asked 61 parents of adults with depression, schizophrenia, or bipolar to complete a stress diary and submit daily saliva samples over a period of several days. The cortisol levels of the participants were compared to the levels of 321 parents of adult children who had no mental health concerns. Barker discovered that the cortisol awakening response (CAR) of the parents of adult children with SMI increased less significantly half an hour after they arose in the morning than the control group. This suggests that the caregivers had a higher stress level upon waking than did the control group. Additionally, Barker found that the cortisol levels of the caregivers declined less throughout the day than did the cortisol levels found in the parents of adult children who did not have SMI.

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“The fact that a similar pattern of hypoactivated daily cortisol in response to stress has been found across studies of parents of individuals with different diagnoses (i.e., schizophrenia, autism, developmental disabilities, and in the present analysis, SMI) and that used different measures of stress (i.e., behavioral problems of the adult child with the diagnosis, time spent with the adult child, and in the present analysis, daily stress not necessarily associated with the adult child) provides strong converging evidence for this effect,” Barker said. She added that these findings underscore the importance of addressing the mental health, physiological health, and coping needs of aging parents who care for adult children with serious mental health issues.

Reference:
Barker, E. T., Greenberg, J. S., Seltzer, M. M., Almeida, D. M. Daily Stress and Cortisol Patterns in Parents of Adult Children with a Serious Mental Illness. Health Psychology 31.1 (2012): 130-34. Print.

Abilify (aripiprazole), manufactured by Bristol-Myers Squibb, was approved for use by the U.S. Food and Drug Administration in 2002. An antipsychotic medication, Abilify has shown noteworthy success in treating the symptoms of schizophrenia. Since its introduction, this medication has also been used for easing manic depression in adults. In people who have not responded well to traditional antidepressants, Abilify is sometimes prescribed as a secondary, additional treatment. As a result of increasingly diverse uses, this medication has entered the top 15 in terms of total drug sales. Like all psychotropic drugs, Abilify works by altering the levels of certain chemicals in the brain called neurotransmitters.

Determining the toxic dose of any new medication is essential in developing appropriate safety guidelines. According to the authors of a study published in Clinical Toxicology, “Limited data exist describing the characteristics of [Abilify] poisonings” (Young et al., 2009). Part of the reason for such limited data is undoubtedly the newness of the medication itself. In an effort to fill in these gaps in knowledge, researchers performed an analysis of Abilify overdose events recorded in the California Poison Control Center database. They excluded cases where the record was not sufficiently complete or other substances were ingested along with Abilify. After eliminating such results, researchers were left with 286 usable cases.

Slightly more than half of these cases were female, and the overall median age was about 19 years. The youngest recorded overdose patient was 6 months old. Researchers divided the cases into three distinct age groups (0-6, 7-17, 18+ years) to determine whether there might be an age-related response to Abilify overdose. A standard dosage for this medication depends a great deal on the individual case; however, dosage typically starts at 2 mg for pediatric patients and can increase to 15 mg for adults. It should be noted that Abilify is not prescribed for children less than 13 years old (PubMed Health, 2011). Researchers also placed each case into a group based on dosage level. Group 1 consisted of doses less than 20 mg. In group 2, dosage ranged from 21 to 90 mg. All doses of 91 mg or higher fell into group 3.

Results of the analysis showed that out of 286 cases, 128, or nearly half, showed no symptoms whatsoever. For those who did report symptoms, drowsiness was the most common complaint, followed by nausea/vomiting, muscle twitch, and tremors. In no case was the overdose considered life threatening, and none of the patients appeared to have experienced permanent effects. For adults, only those in dosage group 3 (91 mg+) were statistically likely to experience symptoms. In pediatric cases, symptoms presented themselves even at the group 2 level. In 176 cases of overdose, no treatment was required other than observation. When treatment was administered, activated charcoal given orally was the most common course of action.

While this was only one study of one database, the data seem to indicate that Abilify is not an especially toxic medication. However, the effects of overdose vary from person to person, and underlying conditions may play a role in an individual’s response. As always, keeping medications in a secure location and following dosage instructions to the letter are essential safety measures.

References

1. PubMed Health [Internet]. (n.d.). Bethesda (MD): National Library of Medicine. Retrieved February 19, 2012. Available from: http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0000221/
2. Mayo Clinic. (n.d.). Dystonia. Retrieved February 19, 2012. Available from: http://www.mayoclinic.com/health/dystonia/DS00684
3. Young, M. C, Shah, N., Cantrell, F. L., Clark, R. F. (2009). Risk assessment of isolated aripiprazole exposures and toxicities: a retrospective study. Clinical Toxicology, 47, 580-583.

Feelings of psychological defeat are common symptoms of many mental health problems. In some research, psychological defeat has been linked to the onset of psychosis and other challenges. “Defeat may also contribute to the development and maintenance of schizophrenia,” said Judith Johnson of the School of Psychology at the University of Birmingham in the UK and lead author of a recent study on defeat and emotion. “Perceptions of defeat have been associated with the onset and exacerbation of a range of psychiatric conditions and disorders, including depression, anxiety, and suicide,” said Johnson. “Thus, the aim of the current research was to investigate the extent to which the emotion regulation strategy of reappraisal moderated the impact of failure on perceived defeat among both a nonclinical sample and individuals diagnosed with a schizophrenia-spectrum disorder, for whom perceived defeat may be particularly important.”

For her study, Johnson focused on the effects of trait reappraisal, the frequency with which people use reappraisal. In the first part of the study, over 100 undergraduate students were evaluated for trait reappraisal as they completed tasks designed to elicit feelings of failure or success. “Specifically it was found that higher frequency of reappraisal was associated with greater increases in sadness and negative affect and greater decreases in calmness after an experience of failure,” said Johnson. In the second part, Johnson examined trait reappraisal in people diagnosed with schizophrenia and found similar results. “Supporting the prediction, it was found that reappraisal amplified the difference in defeat between individuals in the failure and success conditions. Specifically, results suggested that the highest increases in self-reported defeat were among frequent reappraisers who experienced failure,” said Johnson, noting that the findings have significant clinical implications. She added, “Frequent use of reappraisal may confer vulnerability to subjective defeat in response to stressful life events among nonclinical and clinical populations and could be an area for relapse prevention interventions to target.”

Reference:
Johnson, Judith, Patricia A. Gooding, Alex M. Wood, Peter J. Taylor, and Nicholas Tarrier. “Trait Reappraisal Amplifies Subjective Defeat, Sadness, and Negative Affect in Response to Failure versus Success in Nonclinical and Psychosis Populations.”Journal of Abnormal Psychology 120.4 (2011): 922-34. Print.

Professor Paul Bebbington, head of the Department of Mental Health Sciences at the University College London, told the Congress of the Royal College of Psychiatrists 2011, that children who are abused or engage in non-consensual sexual intercourse are at a significantly increased risk for the development of schizophrenia. In a recent article, Bebbington explained that when this type of abuse is experienced before the age of 16, it contributes to more than 15 percent of all psychotic problems, including schizophrenia. “The worse the abuse, the more it increases the risk of developing psychosis. Someone who has experienced non-consensual sexual intercourse before the age of 16 is 10 times more likely to develop the mental disorder,” Bebbington told the Congress. He added, “This is especially significant because sexual abuse is common in childhood. Eight in every 100 people have experienced molestation while one per cent of men and three per cent of women report having had non-consensual sexual intercourse under the age of 16. It is possible to calculate that if childhood sexual abuse ceased, there might be as much as a 17 per cent reduction in people suffering from schizophrenia.”

Bebbington was is senior author of new research which has shown that this type of abuse is linked to psychosis. The research also revealed that sexual molestation and even unwelcome sexual talk, was also linked to the development of mental health problems. Bebbington said, “The increased risk of psychosis may be linked to the intrusive nature of childhood sexual abuse and having no control over what is happening to you. It has disastrous effects on self-esteem and psychological well-being, and is linked to paranoia and suspiciousness – even in people who don’t go on to develop psychosis.” Bebbington added that services should be made available to all victims of this type of abuse in order to prevent the mental health problems associated with these traumas from developing.