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Jul 12, 2018 · Ways to "be there" for someone with anxiety or depression

Erik Soderstrom/Flickr

When a family member or friend is feeling sad or anxious, it can be awkward when you don’t know what to say. You want to help — and you definitely don’t want to make matters worse – but how?

Lekeisha Sumner and Emanuel Maidenberg, both psychologists and clinical professors of psychiatry and biobehavioral sciences at UCLA, have recommendations about how to help someone who’s in distress.

1. It’s not always what you say, but rather, how you show up. Offering a consistent, calm, and reassuring presence communicates that a person is loved and supported and has someone to provide perspective and problem-solve.

2. Remind your friend or family member of their strengths. Do you recall a time that they overcame a tough situation? What qualities did they utilize in that circumstance? Often people feel disconnected from the most positive aspects of themselves when suffering from depression and anxiety.

3. Be prepared to have your suggestions rebuffed. Be patient and continue to show up. Encourage them to take care of themselves, such as by exercising and eating healthy.

4. Here are some helpful phrases: “I can see how what happened makes you feel upset,” “I wish I could do something to help you feel better” and “Can I tell you what helps me when I feel stressed and upset?”

5. Here are some phrases to avoid: “You have so much to be grateful for. How can you be sad?” “Try to get over it,” and “I know how you feel.”

Keep in mind that depression and anxiety, although common, can be debilitating and may worsen over time. An assessment for formal diagnosis and treatment from a mental health professional may be necessary for some people, Maidenberg and Sumner say. Depression and anxiety are usually treated with medication, psychotherapy, or both.

Jul 11, 2018 · After FDA approves first drug made from marijuana, what happens next?

Marc Fuya/flickr

On June 25, the U.S. Food and Drug Administration approved the first drug made from marijuana – Epidiolex — to treat two rare and devastating forms of epilepsy, Dravet syndrome and Lennox-Gastaut syndrome.

Dr. Shaun Hussain, a pediatric neurologist at UCLA who treats children with epilepsy, believes the medication will be a game-changer for many patients.

“This is huge,” Hussain said. “The cognitive consequences of these diseases are severe. A lot of these kids aren’t in regular school, they’re not getting jobs, they’re not growing up to be independent. So there’s a tremendous unmet need for effective treatment.”

We asked Hussain a few questions about the new drug.

Dr. Shaun Hussain

What is Epidiolex?

Cannabis produces two main “cannabinoids” known as THC and CBD. THC is the compound that makes you “high,” gives you the munchies and fights nausea. CBD, or cannabidiol,  which doesn’t make you high, is the active ingredient in Epidiolex. It’s extracted from a proprietary strain of marijuana, mixed in an oil, and taken twice daily by mouth.

The FDA-approved drug contains almost pure CBD, with only trace amounts of other cannabinoids. This is different from the varieties of non-prescription CBD oil you might find at a medical marijuana dispensary. These contain numerous other cannabinoids, including at least small amounts of THC.

How does it work?

In clinical trials, Epidiolex was shown to reduce the number of seizures by about 40 percent in patients with Dravet or Lennox-Gastaut syndrome. That is significant, because these diseases start in early childhood and causes countless seizures, which can interfere with normal neurodevelopment. In those trials, some of the drug’s side effects were sedation, elevated liver enzymes and diarrhea.

It’s unclear exactly how Epidiolex works. A few novel receptors have been identified in the brain that may mediate the actions of cannabidiol. I would note that the No. 1 epilepsy drug in the U.S., levetiracetam, acts via largely unknown mechanisms as well. This phenomenon, where drugs work but we don’t know exactly why, is common among epilepsy treatments.

How much will it cost?

It will cost in the thousands per month. Presumably, insurance companies will pay.  For example, another recently-approved drug for Lennox-Gastaut syndrome costs $5,000 to $10,000 a month.

Some parents were already giving their children CBD oil that they bought from other sources; will they switch?

Parents trying to help their children with CBD oil have been spending about $400 to $2,000 a month. That’s cheaper than Epidiolex, but it’s not covered by insurance. And in many cases, it’s not helping very much. Now, is that because CBD won’t help their child and Epidiolex is unlikely to help as well? Or will Epidiolex, with greater consistency and dosage, yield better results? In clinical trials, Epidiolex was given at a dosage of 20 to 40 milligrams per kilogram of body weight per day. That dosage is about 10 times higher than how people use non-prescription CBD oil.

Are we likely to see the FDA approve more cannabis-derived drugs?

It is a pivotal moment. We’re going from the position that marijuana is only harmful, that it’s a ‘gateway drug,’ to the belief that cannabis actually has some real, therapeutic potential. That said, products that fall under the umbrella of medical marijuana will still face challenges from regulators. For example, forms of medical marijuana with high CBD concentrations that most resemble Epidiolex, and which inspired its development, are illegal under federal law. To date, legislators on both sides of the aisle have been reluctant to change the regulation and legal standing of marijuana. We shall see if Epidiolex’s approval leads to regulatory changes.

 

Jun 7, 2018 · If not Alzheimer's, what is it? Memory symptoms may be due to other conditions-and often are treatable

 

Brain imaging may distinguish causes of memory decline.

 

Alzheimer’s disease is the much-feared, most common cause of memory problems in the elderly. Sometimes, however, memory problems are caused by something else entirely, including conditions that can be treated if diagnosed, according to doctors at UCLA.

Here are three treatable conditions that can mimic Alzheimer’s disease symptoms:

1) Hypertension. High blood pressure can cause memory loss and a slowdown in information processing, resulting in behavior that may resemble Alzheimer’s disease. Symptoms may improve with effective treatment of hypertension, including changes in lifestyle and medications.

2) Substance abuse. Heavy alcohol use can cause memory loss, which can be mistaken for Alzheimer’s disease. Cognition often improves when the person stops using alcohol.

3) Psychiatric disorders. Bipolar disorder and depression, for example, can cause memory loss. Adjustment to the patient’s medications and an increase in physical activity may lessen these symptoms.

“There are multiple treatable problems that lead to memory loss,” said Dr. David Merrill, an associate professor of psychiatry and biobehavioral sciences at UCLA. “Understanding these causes leads to better cognitive health because treatment for Alzheimer’s is different from other causes of cognitive decline.”

UCLA researchers are testing a new method to identify such problems.

In a recent, unpublished study of 22 patients at UCLA’s Cognitive Health Clinic, participants had MRI scans, and scientists used a software program designed to measure the volume of multiple brain regions and computerized neuropsychological tests to evaluate the participants’ brains.

Only five of the people with memory loss showed brain shrinkage patterns characteristic of Alzheimer’s disease. The remaining cases were a combination of causes from vascular disease, depression, head trauma and substance abuse.

The results suggest that brain measurements could be used to rule out Alzheimer’s and guide treatment, but the methods need to be studied further with more people.

Mar 16, 2018 · 300 LAUSD students visit UCLA for Brain Awareness Week

No doubt about it: Brains are cool.

Just ask the 300 local K-12 students who visited the 10th UCLA Brain Awareness Week at the David Geffen School of Medicine at UCLA. They got a close-up look at a real human brain — as well as the brains of mice, sheep and cats – and no one went “Ewwwww!” (Few people, anyway.)

UCLA undergraduate and graduate students in neuroscience organized and staffed the entire event, held March 12-16. The point of Brain Awareness Week, sponsored by UCLA’s Brain Research Institute, is to raise interest in research and get students thinking about careers in science.

It seems to have worked.

Vidya Saravanapandian, a graduate student in the UCLA Centre for Autism Research and Treatment, fielded many of the questions from the visitors and can vouch for the inherent fascination of looking at, and learning about, brains.

“The younger kids, just looking at a human brain, they were so excited,” Saravanapandian said. “They were like, ‘Oh my god! Is this actually from a real person? How do these people agree to give their brains to science?’”

Older students were curious about the different labs and the research conducted within them, as well as more prosaic matters – such as whether UCLA has dorms and where college students eat.

“These are all amazing questions, especially when you are trying to motivate kids to pursue higher studies,” Saravanapandian said.

Brain Awareness Week is an annual, worldwide celebration of research and progress in brain science, launched 23 years ago by The Dana Foundation, a philanthropic organization that supports brain research.

Feb 28, 2018 · How to survive the high anxiety of college admission decisions

Justin/Flickr

Some high school seniors and their parents are feeling a little tense right now. The regular admission deadline for college applications was around the first of the year; that means many students applying to highly ranked colleges receive word of acceptance – or rejection – in March and in April.

When a young person feels like their entire future hangs in the balance with a college decision, this is often an emotionally fraught time for families.

Parents can have a broader perspective and guide their child to do the same, says Kate Sheehan, a licensed clinical social worker and managing director of the UCLA Center for Child Anxiety Resilience Education and Support. Sheehan has some survival tips for navigating the wait.

Don’t confuse your past with your child’s future. You may regret not getting to attend your dream school, or think you would have been happier or wealthier if you had. Don’t project those thoughts onto your child, Sheehan says.

“If we do that, we’re making assumptions about what sort of future a particular school will provide for them,” she says. “And we just don’t know.”

Avoid all-or-nothing style thinking. Your student may be imagining an overly dire result of not getting into their top college choice: a lousy job, less income, embarrassment among their peers. However, parents can help prepare them by discussing the advantages of their other college choices and emphasizing that the negative impacts are not as bad as they imagine.

“There is a tendency toward black-and-white thinking,” Sheehan says. “All or nothing. I’m either going to get into every school, or no school. And my whole life depends on it.” Parents can help teens notice unusual paths to success in their friend circle or among high achievers like Albert Einstein or Bill Gates.

Discuss best-case and worst-case scenarios. We tend to imagine catastrophe. Your child might think that not getting accepted by their No. 1 college choice means they won’t be able to get a job, support themselves or have a family. The parent might say, “Maybe you will get an offer from your top college. Or maybe you’ll go to a different school and find an area of interest you didn’t even know about.”

Voicing the worst-case scenario we have playing in our head can take away some of its power, while naming the best-case scenario can help us recognize wants or needs we may not have articulated before.

Remind your teen who they are as a whole person. Help them focus on their strengths, as talented photographer, a mentor to a young relative, etc. That’s what they’ll be building on wherever they go to school. Their worth shouldn’t boil down to a GPA or an SAT score.

Practice daily stress-relieving skills – for yourself. Go on regular walks or runs, do yoga or practice mindfulness techniques. Encourage your child to do the same. A parent labeling their stress relief as such can help your child build their own toolbox for managing her own stress.

“The more everyone can keep their eyes on the big picture, and keep the waiting period into the context of their larger life, “ Sheehan says, “the easier it will be to maintain a bigger-picture outlook when they hear back, especially if there’s a disappointment.”

Feb 14, 2018 · Mapping HIV in sub-Saharan Africa reveals patterns

Sally Blower, a professor in the department of psychiatry and biobehavioral sciences at UCLA’s Semel Institute, has devoted her career to understanding how infectious diseases such as HIV, syphilis, genital herpes, tuberculosis and leprosy spread.

But instead of donning a white coat and examining patients, Blower uses her skills as a biomathematician and evolutionary biologist to help shape health policy.

Her latest project, a study which appeared Feb. 9 in the medical journal BMC Medicine, centers on Malawi, a largely rural country in southeast Africa with a high incidence of HIV/AIDS. The study suggests that, in order to substantially reduce the HIV epidemic, interventions are needed to reduce high-risk behaviors in both rural areas and cities.

“Your risk of getting HIV really depends on where you live,” said Laurence Palk, a postdoctoral fellow in Blower’s lab and the study’s first author.

The findings provide information that could influence the design of HIV epidemic control strategies in Malawi and other sub-Saharan Africa countries.

The researchers found that there is substantial geographic variation in the severity of the HIV epidemic in Malawi. In almost every community, the HIV epidemic is more severe in women than in men. In Malawi, 13 percent of women and 8 percent of men are infected with the virus that causes AIDS. Yet many HIV-infected women have only had one or two lifetime sex partners, according to the study.

There is also substantial geographic variation in sexual behavior. High-risk men and women are scattered throughout the country; surprisingly, most of them are in rural areas. Only approximately 20 percent of high-risk women and approximately 15 of high-risk men live in urban areas.

In Malawi, as in many other countries in that region of Africa, populations are highly mobile and those who travel more are at a greater risk of HIV infection than those who travel less. People with HIV who travel from larger urban centers, where HIV infection is more common, play a significant role in spreading infection to rural communities, the researchers found.

Globally, the vast majority of the 36.7 million people living with HIV are in low- and middle-income countries. Sub-Saharan Africa is the most affected region, with an estimated 25.6 million people living with HIV in 2015.

According to the Joint United Nations Programme on HIV/AIDS (UNAIDS), about 66% of new HIV infections in 2015 occurred in sub-Saharan Africa. In Malawi, the epidemic plays a critical role in the country’s low life expectancy of just 57 years for men and 60 years for women.

The maps above illustrate the results of HIV testing and behavior data gathered from 14,000 participants in the 2010 Malawi Demographic and Health Survey.

The first map on the left depicts the highest to lowest concentrations of women with HIV. The next map depicts sexual behavior, or concentrations of women belonging to high risk groups (HRGs), defined as having a high number of sex partners.

The third map from the left depicts concentrations of men with HIV; the fourth map shows concentrations of men engaging in risky behavior.

“Our maps reveal that HIV-infected individuals are dispersed throughout Malawi and live in all types of communities – urban, semi-urban, and rural,” said Blower, director of the Center for Biomedical Modeling at UCLA, and the study’s senior author. “All of these communities, at some point, must have ‘imported’ HIV.”

The research was supported with funds from the National Institutes of Health, including the National Institute of Allergy and Infectious Diseases.

Jan 26, 2018 · Feeling overwhelmed by barrage of distressing news? Try doing good as an antidote

Volunteer work may help you feel better amid a barrage of distressing news.

Ballistic Missile Threat Inbound To Hawaii. Seek Immediate Shelter. This Is Not A Drill,” the emergency alert read. Although it was a false alarm sent out by mistake in mid-January, the missile warning seemed plausible in today’s anything-can-happen, extreme news environment.

“The sheer volume of stressful events occurring on a near-daily basis can make people feel pessimistic or fearful,” says Emanuel Maidenberg, a clinical professor of psychiatry at UCLA.

Our need for information is natural, Maidenberg says. Overexposure to the news, however, can lead to something called “vicarious trauma,” a term introduced in 1990 to describe the experiences of therapists, rescue workers and medical professionals. The American Counseling Association describes vicarious trauma as a “state of tension and preoccupation with the stories and trauma experiences described by clients.”

Wildfires, mudslides, government shutdowns, school shootings, and more. The barrage of disturbing news can cause people to feel tense, sad, anxious or preoccupied.

While everyone has different methods for coping with the daily stresses of life, Maidenberg offers the following suggestions:

• What’s worked for you in the past? Increase leisure activities that you find pleasant, get more physical exercise and maintain a consistent sleep schedule, for example. The balance of self-care in light of the vicarious negative experience is crucial to give your mind and body time to digest and accommodate the upsetting news.

• When feeling overwhelmed, social support is important. Joining a book club, a social group or political action organization may provide much-needed validation, as an opportunity to express your emotions and get support from others.

• Gain a sense of control by doing good. For instance, attending a local rally, making a donation, or volunteering your time to help others can counteract feelings of helplessness.

• Limit your exposure to news coverage. Engage only at certain times of day or certain days of the week. It may be helpful to limit your sources of media information. For example, you may want to read an online newspaper but not scroll through Twitter.

“As we continue adapting to the ever-increasing speed of the news cycle,” Maidenberg says, “it’s important to take a moment to explore the impact it is having on how we feel, behave and think to better take care of ourselves.”

Nov 17, 2017 · For children with autism, sleep is the essential ingredient in any treatment plan

When Dr. Shafali Jeste first started seeing children through UCLA’s Developmental Neurogenetics Clinic, she expected most visits to focus on the medical management of epilepsy, attention deficit-hyperactivity disorder, or behavioral challenges.

Jeste, a behavioral child neurologist, specializes in children with rare genetic variants and syndromes associated with autism spectrum disorder. Almost half of her patients need medication for seizures, mood disturbances or behavioral outbursts.

Yet the issue she most often must manage in these patients is insomnia – a seemingly mild problem, but one that can have a significant domino effect in these families’ lives.

“Difficulty falling asleep or staying asleep disrupts the well-being of not only the child, but the entire family,” said Jeste, an associate professor in psychiatry and neurology at UCLA. “Families come to the clinic exhausted and somewhat desperate for relief.”

Up to 80 percent of children with autism have insomnia, which exacerbates the symptoms a child is already experiencing. Insomnia is associated with greater cognitive and social communication impairment, reduced attention, irritability, impulsivity, challenging behaviors, and anxiety.

The good news is insomnia can be addressed through multiple strategies. Treatments can be tailored to the genetic syndromes underlying each child’s sleep problems. For example, a child with autism due to dup15q syndrome may wake up throughout the night because of seizures. A child whose autism stems from fragile X syndrome may have difficulty falling asleep because of anxiety. Some children with autism caused by a mutation in the CHD8 gene may have insomnia for days at a time.

Jeste often provides the following advice to families about insomnia.

1) Keep a sleep diary. Log the child’s bedtime each night, the time the child actually fell asleep, and the timing and duration of any nighttime awakenings. This helps Jeste identify triggers for insomnia and track the effectiveness of interventions.

2) Modify nighttime routines. Jeste works with parents to develop a more consistent sleep routine. The child’s evening exposure to light and electronic screens may need to be tweaked. Eliminating bedtime hunger or gastrointestinal distress may be an important piece of the puzzle.

3) Consider modifying medications. Certain medications, such as antiepileptic drugs, stimulants or mood stabilizers, can disrupt sleep. Jeste may modify the child’s medication regimen, particularly the dose or timing of administration.

4) Try melatonin. Melatonin is a hormone naturally released by the brain to cue the onset of sleep. It has been shown in clinical trials to reduce the time needed to fall asleep.

If melatonin is not the right solution, Jeste considers a class of drugs known as alpha agonists, commonly used to treat high blood pressure. She starts with a low dose and monitors children carefully for daytime sleepiness or irritability. These medications have been shown to reduce nighttime awakenings.

“We all have experienced the ill effects of a poor night’s sleep. Imagine the impact that chronic sleep problems can have on the well-being of a child with autism, particularly a child with an underlying genetic syndrome,” Jeste says. “With better screening and therapeutic trials, we can help children and their families feel more rested.”