The promise of real-time health care

BY ELIZABETH SCOTT  

The battle against chronic illness is long, expensive and can involve a lot of guesswork. But closer monitoring of our body in real time is improving chances for better long-term health – and, ultimately, quality of life.

Over the past decade, the evolution of medical technology has produced sophisticated, hi-tech and non-invasive tools. Devices like advanced brain scans and semi-invasive blood sugar sensors are opening exciting new doors to research – and in the face of new data, whole medical disciplines are shifting focus as science debunks theories of the past.

For a long time, brain researchers could only theorize about how the brain worked; there was no way watch it in living colour.

But thanks to neuroimaging, “what we know today compared to a decade ago blows your mind,” says Stan Kutcher an expert in adolescent mental health based at Dalhousie University in Halifax.

“Explanations for mental disorder [used to be] what I would call ‘brainless,' ” Dr. Kutcher says. They were “based on theories of mind or psychological models in which the brain did basically nothing.”

This was because, until recently, data gleaned from CAT scans and EEGs wasn't sufficiently sharp.

“The data was overwhelming, but it wasn't specific enough because both psychoneuroendocrinology and our special EEG analysis of function were still so far removed from what was actually going on inside the brain itself. They were very, very rough tools. So it was like trying to have sex wearing five condoms. You're sort of in the general area, but you haven't got a clue what should be going on.”

But where brain scans of the mid- to late eighties proved there were structural differences in the brains of people with mental disorders compared with healthy ones, today we can also actually watch the brain in action as it functions, both in health and in disease: “How does the brain control anger, listen to music, read, express love?” Dr. Kutcher asks.

Answers to those questions are being found, thanks to today's functional MRIs and PET scans – technology that has eclipsed former scanning methods. Dr. Kutcher believes that will soon lead to direct diagnosis. The hope is that brain illness – from injury to stroke to mental illness – will become precisely and accurately diagnosable, in turn making targeted, consistently successful treatments possible.

“I wouldn't be surprised if in the next 15 to 20 years two things happen,” Dr. Kutcher says. “We will have abandoned our current nomenclature, which is based on science and symptoms, for one based on a much better understanding of brain dysfunction and the symptoms that are a result of that … and at that time neuroimaging may well become diagnostic.”

Brain Awareness Week: How to Keep your Brain Healthy

This week is Brain Awareness Week (BAW). BAW is an international campaign dedicated to advancing public awareness about the progress and benefits of brain research.

According to the Dana Foundation:

Brain Awareness Week began in 1996 as a modest effort involving 160 organizations in the United States. BAW was created to bring together diverse groups from academia, government, professional, and advocacy groups and unite them with a common theme that brain research is the hope for treatments and preventions, and possibly cures, for brain diseases and disorders, and to ensure a better quality of life at all ages. In 1998, the campaign became international, first as a day and then as a week. Since that time, BAW has evolved into a powerful global initiative with more than 2,200 partners in 76 countries (as of the 2008 campaign).

What is the brain made of and how does it work?

The brain is made of millions and millions of special cells called neurons and other special cells called glial cells. Each of these cells is connected to many many many other cells by long “arms”. These long arms let different cells talk to each other. The places that the arms touch other cells are made specially to help cells talk to each other. Cells talk to each other by sending electrical and chemical messages to each other.

There are more connections in the brain then there are stars in the sky. The human brain is the most complex thing that we know about – and we are learning more about it every day. All things that we do and are as human beings comes from the human brain. It writes our greatest stories, builds our most complicated machines and buildings, creates music and art, plays games, builds social networks, lets us fall in love and directs us to do all the good and not so good things in life.

The brain remembers everything that happens to a person and stores little bits and pieces of those happenings in different parts – we call that memory. The brain takes information from the environment and checks that information against its memory. Then the brain decides what it will do. Every thought we have, every feeling we have, and everything that we do is decided by our brains. It is really important for us to keep our brains healthy.

Here are some ways to help your brain to be healthy.

• Eat proper food. A healthy diet is important for a healthy brain.
• Gets lots of sleep. Your brain needs sleep to grow properly and to remember things better.
• Don’t use drugs. Drugs damage the brain.
• Get lots of fresh air and physical exercise. Your brain needs oxygen to work properly and physical exercise is good for your brain because it reminds the brain to send “feel-good” messages to itself and to the body.
• Spend time enjoying music, dance or art. Your brain uses these things to help it work better at all sorts of activities.
• Take time to learn things. The more you practice skills or lessons the better your brain will be at doing what you want to do.
• Learn how to decrease stress. Your brain can be hurt by too much stress. Learn what makes you relax – such as exercise, hanging out with your friends, playing music, etc. and when you are feeling stressed out try to do those things that decrease your stress.
• Make good friends. Your brain develops best in a social network. Good friends are important.

Science News: National Institute of Mental Health

Ever wonder where funding for mental health research goes? Or how research evidence informs medicine and practice?

The scientific evidence used in medicine comes from a pool of tens of thousands of published research studies. There are many types of studies, and the design of any given study usually depends on the question that the researchers want answered. Studies can differ considerably in the way they are designed and conducted, and can therefore differ considerably in quality.

Often the scientific community behind mental health research, studies and reports don't get a lot of attention or gratitude, but without them our knowledge of mental health and mental illness would develop pretty slowly.

Evidence-based medicine is extremely important in the treatment of mental illness in general, and is particularly important in the treatment of mental illness in children and adolescents.

Here are some recent examples of research related to adolescents conducted by the National Institute of Mental Health.

(Our group is not affiliated with any of these studies, their results or NIMH)

Anxious andDepressed Teens and Adults: Same Version of Mood Gene, Different BrainReactions

An NIMH study using brain imaging shows that some anxious and depressed adolescents react differently from adult patients when looking at frightful faces. This difference occurs even though the adolescent and adult patients have the same version of a mood gene. Researchers in the NIMH Mood and Anxiety Disorders Program and colleagues reported these findings online October 31, 2008, in the Journal Biological Psychiatry.

DepressionRelapse Less Likely Among Teens Who Receive CBT After Medication Therapy

Adolescents with major depression who received cognitive behavioral therapy (CBT) after responding to an antidepressant were less likely to experience a relapse or recurrence of symptoms compared to teens who did not receive CBT, according to a small, NIMH-funded pilot study published in the December 2008 issue of the Journal of the American Academy of Child and Adolescent Psychiatry.

SuicidalThinking May Be Predicted Among Certain Teens with Depression

Certain circumstances may predict suicidal thinking or behavior among teens with treatment-resistant major depression who are undergoing second-step treatment, according to an analysis of data from an NIMH-funded study. The study was published online ahead of print February 17, 2009, in the American Journal of Psychiatry.

Getting Closer to Personalized Treatment for Teens with Treatment-resistant Depression

Some teens with treatment-resistant depression are more likely than others to get well during a second treatment attempt of combination therapy, but various factors can hamper their recovery, according to an NIMH-funded study published online ahead of print February 4, 2009, in the Journal of the American Academy of Child and Adolescent Psychiatry.

What does the doctor talk to your teenager about?

Beth J. Harpaz, The Associated Press

NEW YORK -- If you're the parent of a tween or teen, chances are you've been asked to leave the room during your child's visit to the doctor so they can have a private chat. Now of course I believe that teenagers should have a trusting relationship with their doctors. But while I'm sitting there alone in the waiting room, watching the younger mommies bounce babies on their knees, I can't help but wonder what my kids are telling the doctor behind that closed door. See, I'm a nosy mom, and if something's going on with my children's health, I want to hear about it. I mean, if your kid was suicidal, or a heroin addict, and somehow you didn't know it, would the doctor tell you? Turns out the answer is yes. "If we are concerned that someone is in danger, we are compelled to share that information," said Dr. Joseph Hagan, who is part of the American Academy of Pediatrics' Bright Futures initiative to improve children's health. But Hagan emphasized that giving kids a chance to speak privately with doctors "is not about secrecy. It's about autonomy. A 16-year-old should begin to ask his own questions about his health." In fact, if your pediatrician doesn't ask you to leave the room during teen visits, maybe he or she should."The pediatrician should spend most of the office visit alone with the adolescent," according to Dr. David Tayloe, president of the American Academy of Pediatrics. "It's very important for teenagers to have confidential conversations with their pediatricians." Tayloe said "the emphasis on confidential appointments for adolescents has become more the norm over the last 10 years." Tayloe added that 75 per cent of teenagers are sexually active by their senior year of high school, and Hagan said he starts talking to kids about sexuality around age 12, to let them know that sexual feelings are normal and to answer questions. But he also tries to get patients and parents communicating. "If a girl is concerned about pregnancy, I might say, 'What do you think your parents would say if you talked to them about this? Shall we tell them together?"' Some of the other things that keep me up at night - oh, the usual nightmares about teen smoking, car accidents and too much pepperoni and soda - are also on doctors' lists for teenage checkups. According to Tayloe, at least two-thirds of teen traffic fatalities involve teens who are not wearing seat restraints. Thirty per cent of teens are overweight and need to be enrolled in fitness and nutrition programs. And the vast majority of adult smokers began smoking by age 18. Tayloe added that most teenagers have experimented with alcohol by the time they are high-school seniors. "Pediatricians need to level with teens about alcohol," he said, including the fact that underage drinking contributes to car accidents and unplanned pregnancies. He also said that 20 per cent of children have mental health problems, but only 20 per cent of those kids are getting help. Pediatricians should screen adolescents for depression, anxiety, attention deficit disorder and suicidal thoughts. Kids who are teenagers now may also have missed some of the newer vaccines that became available after their early childhood inoculations against diseases like polio, mumps and measles. The AAP recommends that kids 11 to 12 and older be vaccinated against meningitis, a disease that can spread in settings like sleepaway camps and college dormitories, according to Dr. Meg Fisher, a member of the AAP committee on infectious diseases. Fisher says AAP also recommends that girls get the human papillomavirus vaccine, which protects against cervical cancer. And kids who were not inoculated against tetanus, diphtheria and pertussis when they were little need a one-dose combination vaccine against those diseases. By the way, some doctors are interested in parents' behaviour too. If you do meet the doctor with your teen, you might just get asked whether you smoke, or whether you wear your bike helmet. So while you're out there in the waiting room thumbing through a copy of Babies magazine that no longer holds any meaning for you, don't just worry about what's going on with your kids. Take a look at yourself as well.

Two Steps Forward, One Step Back: The Case of Vince Li

The case of Vince Li, the man who beheaded a victim aboard a Greyhound bus last year, made international headlines yesterday as judge ruled Mr. Li was not criminally responsible due to mental illness. The ruling means that Vince Li will be treated in a mental institution instead of going to prison.

While the ruling is probably the right one, the resulting media frenzy is doing little to dispel the myth that people with mental disorders are violent. It also begs the question: what is the role and responsibility of media in reporting on cases that involve mental illness?

A selection of headlines from major news networks clearly seek to sensationalize the case of Vince Li and in the process make a link between violence and mental illness :"Canada judge: Vince Li not responsible for bus beheading due to mental illness" (Associated Press), "Canada bus killer found mentally ill" (The West Australian), "Judge rules bus beheading suspect mentally ill" (CNN.com), "Crazy bus cannibal sent to mental institution" (Healthcare Industry Today). Even accompanying photographs (like the one above) attempt to "demonize" Li again reinforcing the idea that people with mental disorders look frightening.

While some people who suffer from mental illness do commit antisocial acts, mental illness does not equal criminality or violence - despite the media's tendency to emphasize a suspected link (e.g. psychotic serial killers). In fact, people with mental illness are no more likely to commit violence than the general public, but they are 2.5 times more likely to be victimized and are more likely to inflict violent behaviours on themselves. Furthermore, the general public is more likely to be violently victimized by someone who does not have a mental illness rather than by someone who suffers from mental illness.

From Reuters:

According to Chris Summerville, the Chief Executive Officer of the SchizophreniaSociety of Canada, the likelihood of violence by people with mental illness is exceptionally low. In fact, people living with mental illness are more often the victims of violence. "Fortunately, studies show that when people who were or would have been dangerous receive psychiatric treatment they are no more dangerous than people without a diagnosis. But they have to receive the treatment," says Dr. John Gray, a board member of the British Columbia Schizophrenia Society.

Some evidence suggests that certain medications might rarely be associated with aggression, but this doesn't mean there is a link between psychiatric medications and violent behaviour. In fact, the drug that is most often associated with aggressive behaviour is alcohol! Many medications used to treat mental disorders are also helpful in treating violent behaviour. It is important to remember that the best known predictor for future violent behaviour is past violent or criminal behaviour, not mental illness.

While a tragedy of this scale is awful, it can lead to constructive discussions about the need for improved care and a national mental health strategy.

This tragic event reinforces the urgent need for a national mental health strategy. Despite the significant health, economic and social costs of mental illness, Canada is the only G8 nation without a national strategy on mental illness. Summerville who is also a board member of the Mental Health Commission of Canada, says, "In many areas in Canada, there is a lack of psychiatric beds as well as lengthy wait times to access appropriate mental health care." He adds, "If there were not a comprehensive hospital or community services for people with cancer, heart problems or other medical conditions, we as a society would be outraged. Stigma and the lack of social and political will have resulted in Canada's failed mental health system."

Canada has recently made some important strides in addressing mental health and mental illness. The establishment of the Mental Health Commission of Canada is indeed a vital step. But unfortunately it may be some time before the national discourse and media coverage of people with mental illness catches up, and we stop stigmatizing and sensationalizing people living with mental illness.

 ~ D. Venn & Dr. Stan Kutcher

Teenage students deserve 11am sleep-in

Good piece today in on BBC about how sleep and teens:

Teenage pupils should be given an extra two hours in bed to boost their learning abilities, a Tyneside head teacher has urged.

Dr Paul Kelley, of Monkseaton High School in North Tyneside, said continuous early starts created "teenage zombies" in the classroom. He said research showed allowing teenagers to begin lessons at 11am had a "profound impact" on learning. Dr Kelley has already pioneered shorter lessons at the school.Research suggests teenagers' brains are wired differently to those of adults and work two hours behind adult time, he said. Memory tests performed on Monkseaton pupils by neuroscientist Russell Foster, chair of circadian neuroscience at Brasenose College, Oxford, showed the students' brains worked better in the afternoon. This suggested young people's body clocks may shift as they begin their teens - meaning teenagers got up later not because they were lazy, but because they were biologically programmed to do so. Dr Kelley said depriving teenagers of sleep could have an impact on their mental and physical health as well as their education. He said evidence had shown rousing teenagers from their beds early resulted in abrupt mood swings, increased irritability, depression, weight gain and reduced immunity to disease.

Youth Mental Health and the Criminal Justice System

Mental disorders collectively constitute the largest burden of disease in young people. They have substantial negative short- and long-term outcomes across many domains, yet early identification and effective intervention can improve outcomes and can often lead to recovery. Unfortunately, many young people do not receive the mental health care they require and may consequently enter the justice system. Studies of incarcerated youths show that up to 70% of them have mental disorders. Many of these youth receive primarily custodial care. A variety of social, legal and medical interventions can and should be implemented to ensure that young people suffering from mental disorders do not inappropriately enter the justice system due to lack of access to health care and other services.

While the exact number is unknown, it has been estimated that as many as half of the incarcerated population suffers from mental illness(es), a substance abuse problem, and/or a learning disability. Because of a shortage of services and a lack of understanding by society, the mentally ill are not receiving the care they require and instead are being criminalized by being sent to prisons. Supreme Court Justice Beverly McLaughlin in a statement in on March 8^th, 2007 stated that “Such people are not true criminals, not real wrong-doers in the traditional sense of those words. They become involved with the law because they are mentally ill, addicted or both.”

Similarly, many police officers believe that mentally ill perpetrators represent a disproportionate number of individuals incarcerated for minor crimes. Some family members have noted that crimes may be committed or encouraged to be committed in order for the mentally ill person to be arrested. This may represent a “faint hope” that arrest will lead to treatment which for a variety of different reasons is not otherwise available.

Last week Hon. Judge Michael McKee produced a report calling for 80 recommendations to patch up the cracks in New Brunswick's mental health system.

"The stigmatization of the mentally ill, the criminalization of the mentally ill in our court system and the silos of government not working together, that's something that's gone on for essentially decades and it has to be fixed," Murphy said.

We need to move away from the common misconception that locking someone up and throwing away the key is an appropriate manner by which to address mental health problems in our society. Mental illness and addiction are health issues and are not effectively dealt with by the criminal justice system.

Download: Together into the Future: A transformed mental health system for NewBrunswick ~ Dr. Stan Kutcher & Ainslie McDougall