Sunday, January 19, 2020

Action needed to improve poor health and disadvantage in the youth justice system

by University of Melbourne JANUARY 16, 2020

Children and adolescents detained in the youth justice system experience poor health across a range of physical and mental health domains, according to new research.

In the first global review, researchers from the University of Melbourne, Murdoch Children's Research Institute (MCRI) and University of Sheffield in the UK have examined the health of detained adolescents from 245 peer-reviewed journal articles and review publications.

Researchers found that detained adolescents have a significantly higher prevalence of mental health disorders and suicidal behaviours than their peers in the community, along with substance use disorders, neurodevelopment disabilities, and sexually transmitted infections.

In a concurrent paper also published today, researchers examined the ways poor health and poverty drive children into youth justice systems.

Researchers found that learning disabilities, poor mental health, and experiences of trauma and adversity in childhood can increase the risk that a young person will be exposed to the criminal justice system. This risk is further amplified by societal factors including inequality and disadvantage.

University of Sheffield Professor of Adolescent Health and Justice, Nathan Hughes said the research highlights the need for a whole-of-system approach to addressing health and social inequalities in childhood and adolescence.

"Research shows that it is our most disadvantaged and unwell young people who end up in the youth justice system," Professor Hughes said.

"Their health and welfare needs are complex, and many detained adolescents have multiple, co-occurring health issues that are compounded by communication difficulties, risky substance use and trauma."

Head of the Justice Health Unit at the University of Melbourne and MCRI, Professor Stuart Kinner said that to reduce the rates of reoffending and improve health outcomes for vulnerable adolescents and the community, appropriate evidence-based treatment during and after detention must also be provided.

"Investment in coordinated health, education, family, and welfare services for our most disadvantaged young people must be a priority, both to keep them out of the youth justice system, and to ensure that their health and social needs are met if they do end up in detention," Professor Kinner said.

"We need to recognise that these vulnerable young people typically spend only a short time in detention, before returning to the disadvantaged communities from which they have come.

"If we can screen for health and developmental difficulties while adolescents are in the justice system, we can identify unmet needs—often for the first time—and tailor evidence-based support to improve health outcomes and reduce reoffending once they return to the community. However, to make these improvements a reality we need greater investment in transitional programs and public health services."

This research was published today in The Lancet Child & Adolescent Health and The Lancet Public Health.

Black kids and suicide: Why are rates so high, and so ignored?

by Rheeda Walker, The Conversation JANUARY 17, 2020

Teen suicide rates among black youth are increasing. In 2016 and again in 2018, national data revealed that among children age 5-11, black children had the highest rate of death by suicide. For the years 2008 to 2012, 59 black youth died by suicide, up from 54 in the years 2003-2007.

Also, the 2015 Centers for Disease Control and Prevention's biennial Youth Risk Behavior Survey reported that, compared to non-Hispanic white boys, black high-school age boys are more likely to have made serious suicide attempts that require medical attention.

I am a professor of psychology and also director of the culture, risk and resilience research laboratory at the University of Houston, and I recently co-authored a study that suggests that new risk profiles may be needed for better suicide prediction in African Americans in particular.

Comprehensive suicide awareness

Suicide has become a leading cause of death in the U.S. among all age groups, but particularly in youth and young adults. It is the second leading cause of death among 10- to 34-year-olds. Parents, teachers and professionals must be able to both talk about it and understand the risks for vulnerable children of any race. But those of us who work with black youth may also need to address some myths about suicide in the African American community.

For example, one such myth has its start almost three decades ago, Kevin Early and Ronald Akers' interviews with African American pastors concluded that suicide is a "white thing" and that black people are accustomed to struggling through life challenges without succumbing to suicide. those authors concluded that black people see suicide as a "white thing" but it is a myth that black people do not die by suicide.

Based on anecdotal conversations that many others and I have heard in day-to-day conversations and that sometimes emerge in popular media, this opinion about suicide in the black community has shifted relatively little.

More importantly, black youth at risk may even be more difficult to identify than non-black youth. One study referred to college age racial/ethnic minority people, including African Americans, as "hidden ideators" who are less likely than other youth to disclose thoughts of suicide. Because suicide is occurring and at shockingly young ages, comprehensive efforts are needed to address this public health problem.

Studies suggest that stigma about mental illness and the feeling that one will be outcast further or ignored may keep black youth from sharing their thoughts. Also, public health and mental health experts may be unaware that suicide risk factors could show up differently depending on ethnic group.

Simply put, a one-size-fits-all approach does not work for identifying suicide risk. And little or no action has been taken to address the increasing crisis. As an African American psychologist, I find this frustrating when children's lives are lost—lives that could be saved.

Unique needs in African American mental health

Most mental health services are not designed with cultural and social nuances in mind. My research team has found consistently that the challenges that black kids face in navigating dual cultural contexts may increase their risk of suicidal thoughts.

In research on adults, we found that black men and women who used more Eurocentric or individualist approaches that was more self-focused rather than managing stress via the belief in a Higher Power were more likely to consider suicide. This was not true for those who used more culturally meaningful, spiritual coping.

When there are cultural differences, therapists must be willing to "think outside of the box" to fully evaluate risk for suicide. As an example, the racism that black Americans encounter increases stress for many. Thus, their stressors and mental health issues will need different solutions and approaches than treatments that work for white people.

In another study published in Comprehensive Psychiatry, we observed different patterns of risk for black adults compared to white adults who were admitted for psychiatric care. We examined sleep-related problems, which are elevated among black Americans, and suicide because sleep issues are a serious but understudied risk factor for suicide crisis. It turns out that inadequate sleep can escalate an emotional crisis. Our research found that problems staying awake for activities such as driving or engaging in social activities, which reveal inadequate sleep, were associated with a four-fold greater risk for suicide crisis compared to non-suicide crisis in black adults who were admitted for psychiatric treatment.

We have also found that experiencing racism is associated with thoughts about suicide for black youth and adults.

How to find help

Caring adults are a child's first line of defense. If a child discloses that he is thinking about dying, it is important to ask him to share more about his ideas and if he knows he might die. If a child has a suicide plan, it is time to get professional help. The Crisis Text Line at 741741 could be an option for teens who need help to cool down in a crisis.

When it comes to finding a mental health professional, parents need an expansive list of referral options, including university-affiliated mental health clinics that offer evidence-based services on a sliding scale and federally qualified health centers for the uninsured. Regardless of the setting, a well-trained therapist may be of a different race.

Parents and caregivers must be willing to sit, listen and try to fully understand what is most upsetting for a child who is experiencing a difficult situation and a lot of emotions.

For those who believe that the alarming statistics will eventually reverse course without any action, this may be true. In the meantime, saving one life is worth the effort.

Thoughts of suicide do not mean that a child or teen needs to be hospitalized. It means they are in emotional pain and want the pain to end. Adults can investigate the problem and remove it or help the child deal with it. Online resources such as Stopbullying.gov include interactive videos that are useful to parents, educators and youth. Suggesting to a child that she "get over it" is less than helpful. A child who is already in a vulnerable state cannot problem-solve without meaningful support from the caring adults in charge.

If you are having thoughts of suicide, call the National Suicide Prevention Lifeline at 1-800-273-8255 (TALK). The website is National Suicide Prevention Lifeline.

JANUARY 16, 2020

No clear evidence of increase in adolescent suicide after '13 Reasons Why'

by Annenberg Public Policy Center of the University of Pennsylvania

Contrary to the findings of a 2019 study that associated the release of the Netflix series "13 Reasons Why" with an increase in monthly suicide rates among adolescent boys, a reanalysis of the data by the Annenberg Public Policy Center finds no evidence of contagion. The reanalysis, published today in PLOS ONE, found that after controlling for the dramatic increase in adolescent suicide in recent years, the show's release had no clear effect.

The reanalysis found that the increase in the suicide rate for boys observed in the original study by Bridge and colleagues for three months after the series' release was no longer evident after controlling for the ongoing trend in adolescent suicide. In addition, the increase seen during the first month of the release began the month prior to the release, making it difficult to attribute the rise to the show. The reanalysis found no effects in the subsequent months of that year.

"Our reanalysis casts considerable doubt on the show having an effect on boys," said author Dan Romer, Ph.D., research director of the Annenberg Public Policy Center (APPC) of the University of Pennsylvania. The paper, "Reanalysis of the Bridge et al. study of suicide following release of 13 Reasons Why," was published January 15, 2020, in PLOS ONE.

The original time-series analysis of suicide rates by Bridge et al. found an additional 195 suicide deaths among boys ages 10 to 17 during the nine months following the series' release, on March 31, 2017, but did not find a similar result among adolescent girls. Romer said he questioned that finding for two reasons: "First, contagion would be expected to be stronger for girls than boys because this show focuses on the suicide of a high school girl. Second, the prior analysis didn't take into account strong secular trends in suicide, especially in boys from 2016-2017."

APPC's reanalysis did find a modest rise in the suicide rate among adolescent girls during the first month following the release of "13 Reasons Why," but it was not statistically reliable.

Rising suicide rates for adolescents

Suicide rates for both adolescent males and females have been rising since 2008 and the rise in 2017 was particularly strong. The rate for young males ages 15 to 19 increased by 21 percent between 2016 and 2017. Suicide among female adolescents ages 15 to 19 increased by 7 percent.

There has been disagreement about the causes of the recent rise in adolescent and young adult suicide. Some researchers have suggested that the rise is due to increased use of social media. But a recently published analysis by Romer suggested that the trend may be attributable in part to lingering economic stress from the 2008 financial crisis in combination with increased pressure on teens from their parents to succeed academically.

'13 Reasons Why' and suicide contagion

When the first season of the Netflix show appeared in 2017, it created widespread concern that its graphic portrayal of a teenage girl's suicide would lead to imitation among vulnerable young people, especially adolescent girls. This concern prompted researchers to see whether there was evidence of contagion in U.S. suicide rates following the show's release.

The first such study, by Bridge et al., found evidence of a jump in suicides among boys ages 10 to 17 in the three months following the show's release, but no effect for girls. Romer said that analysis relied on a forecasting method to project the likely trend in suicide for 2017. But that forecast failed to anticipate the actual trend.

A second study by different researchers (Niederkrotenthaler et al.) in JAMA Psychiatry had a similar problem, Romer said. That study found an effect in boys and girls 10 to 19 years old in the three months following the series' release. But it similarly failed to control for the secular trend in suicide, again making it difficult to separate the effects of the show from the trend.

Potential for harm

APPC's analysis does not rule out the possibility that the show had an adverse effect, especially on girls. A previous study by Romer and colleagues that examined the effects of the second season of "13 Reasons Why" found that viewing the show had both beneficial and detrimental effects on young adult viewers. The small increase observed in girls in this current reanalysis of the first season data may have been the net result of these opposing effects, Romer said.

In mid-2019, over two years after the release, Netflix edited a graphic suicide scene from the Season 1 finale and asserted that the show encouraged young people "to start conversations about difficult issues such as depression and suicide and get help—often for the first time."

"Despite that, it does not appear that the show reversed or slowed the ongoing increase in adolescent suicide," Romer noted. "Even if the series also had a positive effect for some viewers, the producers should recognize the potential for harm to vulnerable audience members. It should be possible to produce a show that highlights the challenges that young people face without also producing suicide contagion."

Romer thanked Jeffrey Bridge for providing the data that were not available in his paper, which is in press in the Journal of the American Academy of Child & Adolescent Psychiatry.

Tendency to correlate uptick in suicides and social media is not backed by data

Psychology program for refugee children improves well-being

by Queen Mary, University of London JANUARY 17, 2020

A positive psychology program created by researchers at Queen Mary University of London focuses on promoting wellbeing in refugee children. It is unusual in that it focuses on promoting positive outcomes, rather than addressing war trauma exposure.

This is the first positive psychology-based intervention to be systematically evaluated for use with refugee children.

The purpose of the intervention, known as Strengths for the Journey, is to build positive psychological resources in young refugees—such as positive emotions, character strengths, optimistic thinking, community and nature connectedness, hope, and mindfulness—in order to promote their wellbeing and resilience.

In a study, published in the journal Development and Psychopathology, the researchers show that the intervention improved the children's positive outcomes (wellbeing, optimism, and self-esteem) and reduced their depressive symptoms.

Specifically, it more than doubled participants' ratings of their wellbeing and optimism and led to dramatic reductions in depressive symptoms.

Dr. Sevasti Foka, lead author of the study from the Department of Biological and Experimental Psychology at Queen Mary University of London, said: "The key finding of the study is that the Strengths for the Journey intervention seems to be quite effective. Our results suggest that short, inexpensive positive psychology interventions such as Strengths for the Journey can lead to real improvements in refugee children's mental health and wellbeing, even when those children are experiencing the many challenges of living in a refugee camp."

The program is delivered over a seven-day period and was evaluated in refugee camps in Lesvos, Greece, with 72 children ranging from 7 to 14 years-old. The children were predominantly displaced from Syria and Afghanistan.

Over a million refugees have arrived by sea in Greece in the last four years, almost half of whom are under 18 years old. Upon arrival in Greece, many are placed in camps with limited access to school and mental health services, and report high rates of attempted suicide, panic attacks, anxiety, and aggressive outbursts.

The intervention is one of very few programs to be developed specifically for use with kids living in refugee camps. Refugee camps are quite a different context from resettlement or settlement in communities and are very challenging places for children to live.

The researchers suggest that the intervention should be expanded to a larger group of refugee children in Greece—and potentially those living in refugee camps elsewhere—because it has real potential to improve their mental health and wellbeing.

Isabelle Mareschal, an author of the study from Queen Mary University of London, said: "It seems like child refugees living in low-resource settings like refugee camps would benefit from Strengths for the Journey or other short positive psychology interventions that promote resilience."

In the study, the researchers ran a pilot evaluation using a wait-list controlled trial design to see whether the intervention improved children's mental health and wellbeing. This involved providing the program to one group of children and then providing it to the next group a little later in order to compare outcomes while still providing treatment for all participants.

The researchers were improving on most previous work in three ways: by doing a controlled trial, focusing on children living in refugee camps, and by looking at positive outcomes rather than just psychopathology.

Dr. Kristin Hadfield, the corresponding author of the study from Queen Mary University of London, added: "In addition to the intervention being different, our evaluation of it is also different. Very few interventions for use with refugees are rigorously evaluated. NGOs and governments spend a lot of money attempting to improve refugee children's outcomes through various programmes, but many do not actually check whether these are effective. We have compared changes in the kids who took part in Strengths for the Journey with changes in kids living in the camps who did not take part to see whether those who took part in Strengths for the Journey did better."

Poverty may be more critical to cognitive function than trauma in adolescent refugees

More information: 'Promoting wellbeing in refugee children: An exploratory controlled trial of a positive psychology intervention delivered in Greek refugee camps'. Sevasti Foka, Kristin Hadfield, Michael Pluess, Isabelle Mareschal. Development and Psychopathology.

Whooping cough evolving into a superbug

by Caroline Tang, University of New South Wales JANUARY 16, 2020

Whooping cough bacteria are becoming smarter at colonizing and feeding off unwitting hosts, strengthening calls for a new vaccine, according to UNSW researchers.

Australia needs a new whooping cough vaccine to ensure our most vulnerable are protected from the emergence of superbug strains, new UNSW research has shown.

The current vaccine, widely used since 2000, targets three antigens in the bacteria of the highly contagious respiratory disease which can be fatal to infants.

All babies under six months old—in particular, newborns not protected by maternal immunization—are at risk of catching the vaccine-preventable disease because they are either too young to be vaccinated or have not yet completed the three-dose primary vaccine course.

Australia's whooping cough epidemic from 2008 to 2012 saw more than 140,000 cases—with a peak of almost 40,000 in 2011—and revealed the rise of evolving strains able to evade vaccine-generated immunity.

In a series of UNSW studies, with the latest published today in Vaccine, UNSW researchers took this knowledge further and showed, in a world-first discovery, that the evolving strains made additional changes to better survive in their host, regardless of that person's vaccination status. They also identified new antigens as potential vaccine targets.

First author and microbiologist Dr. Laurence Luu, who led the team of researchers with Professor Ruiting Lan, said whooping cough's ability to adapt to vaccines and survival in humans might be the answer to its surprise resurgence despite Australia's high vaccination rates.

"We found the whooping cough strains were evolving to improve their survival, regardless of whether a person was vaccinated or not, by producing more nutrient-binding and transport proteins, and fewer immunogenic proteins which are not targeted by the vaccine," Dr. Luu said.

"This allows whooping cough bacteria to more efficiently scavenge nutrients from the host during infection, as well as to evade the body's natural immune system because the bacteria are making fewer proteins that our body recognizes.

"Put simply, the bacteria that cause whooping cough are becoming better at hiding and better at feeding—they're morphing into a superbug."

Dr. Luu said it was therefore possible for a vaccinated person to contract whooping cough bacteria without symptoms materializing.

"So, the bacteria might still colonize you and survive without causing the disease—you probably wouldn't know you've been infected with the whooping cough bacteria because you don't get the symptoms," he said.

"Another issue with the vaccine is that immunity wanes quickly—so, we do need a new vaccine that can better protect against the evolving strains, stop the transmission of the disease and provide longer lasting immunity."

Vaccination still key but new vaccine needed

Prof Lan said while he would like to see a new vaccine developed and introduced in the next five to 10 years, the research team's important discovery did not render Australia's whooping cough vaccine redundant.

"It is critical that people are vaccinated to prevent the spread of whooping cough—the current vaccine is still effective for protecting against the disease—but new vaccines need to be developed in the long-term," Prof Lan said.

"We need more research to better understand the biology of the whooping cough bacteria, how they cause disease and what proteins are essential for the bacteria to cause infection, so that we can target these proteins in a new and improved vaccine.

"This will all help to future-proof new vaccines against the evolving whooping cough strains."

Dr. Luu agreed it was crucial that Australia maintained its high vaccination coverage for whooping cough.

"Although the number of whooping cough cases has increased during the past decade, it's still nowhere near as high as what it was before the introduction of whooping cough vaccines," Dr. Luu said.

"Therefore, we emphasize that Australia must maintain its high vaccination coverage to protect vulnerable newborns who are not protected by maternal immunity and cannot complete the three-dose primary vaccine course until they are six months old.

"So, vaccination is especially important for children, people who are in contact with children and pregnant women who need the vaccine to produce antibodies to protect their newborns from developing whooping cough in the first few weeks of life."

In addition to babies under six months having a high risk of catching the disease, the elderly, people living with someone who has whooping cough and people who have not had a booster in the past 10 years, are also most at risk.

Whooping cough is characterized by a "whooping" sound and sufferers find it difficult to breathe.

The disease is more common during spring and spreads when an infected person coughs or sneezes and other people breathe in the bacteria.

Whooping cough vaccine recommended for pregnant women amid spike in cases

More information: Laurence Don Wai Luu et al. Surfaceome analysis of Australian epidemic Bordetella pertussis reveals potential vaccine antigens, Vaccine (2019). DOI: 10.1016/j.vaccine.2019.10.062

Laurence Don Wai Luu et al. Proteomic Adaptation of Australian EpidemicBordetella pertussis, PROTEOMICS (2018). DOI: 10.1002/pmic.201700237

Laurence Don Wai Luu et al. Comparison of the Whole Cell Proteome and Secretome of Epidemic Bordetella pertussis Strains From the 2008–2012 Australian Epidemic Under Sulfate-Modulating Conditions, Frontiers in Microbiology (2018). DOI: 10.3389/fmicb.2018.02851

As superbugs spread, WHO raises alarm over lack of new antibiotics

JANUARY 17, 2020

The World Health Organization warned Friday that a dire lack of new antibiotics was threatening efforts to curb the spread of drug-resistant bacteria, which kill tens of thousands of people each year.

The UN health agency published two new reports revealing that there are few new effective antibiotics in the pipeline, meaning that the world is running out of options for fighting so-called superbugs.

"Never has the threat of antimicrobial resistance been more immediate and the need for solutions more urgent," WHO chief Tedros Adhanom Ghebreyesus said in a statement.

"Numerous initiatives are underway to reduce resistance, but we also need countries and the pharmaceutical industry to step up and contribute with sustainable funding and innovative new medicines," he said.

Antibiotic resistance happens when bugs become immune to existing drugs, rendering minor injuries and common infections potentially deadly.

An estimated 33,000 people die in Europe every year from such drug-resistant bacteria, according to EU data, while the US estimates the death toll there is around 35,000.

"We see that this is spreading and we are running actually out of antibiotics that are effective against these resistant bacteria," Peter Beyer, of WHO's essential medicines division, told reporters in Geneva.

"This is one of the biggest health threats that we have identified," he said.

Discovered in the 1920s, antibiotics have saved tens of millions of lives by defeating bacterial diseases such as pneumonia, tuberculosis and meningitis.

But over the decades, bacteria have learned to fight back, building resistance to the same drugs that once reliably vanquished them—turning into so-called "superbugs".

To counter bacteria's ability to become resistant to known drugs, a steady stream of new antibiotics is needed, but for pharmaceutical companies, developing competitive new products in this field is complicated, costly, and not seen as very profitable.

According to the WHO, the 60 new products currently in development—50 antibiotics and 10 biologics—"bring little benefit over existing treatments and only two target the most critical resistant bacteria", the so-called Gram-negative bacteria.

A range of other drugs still in pre-clinical testing are more innovative, WHO said, but warned it will take years before they reach the market.

Of the 252 such drugs still in very early-stage testing, the two to five first products could become available in about 10 years, according to an optimistic scenario, WHO said.

"It's important to focus public and private investment on the development of treatments that are effective against the highly resistant bacteria," Hanan Balkhy, WHO Assistant Director-General for Antimicrobial Resistance, said in the statement.

"We are running out of options."

'Invisible pandemic': WHO offers global plan to fight

Scientists reveal ADHD medication's effect on the brain

by Dani Ellenby, Okinawa Institute of Science and Technology JANUARY 17, 2020

Attention-deficit hyperactivity disorder (ADHD) is a neurobiological disorder characterized by symptoms of hyperactivity, inattention and impulsivity. People with the condition are often prescribed a stimulant drug called methylphenidate, which treats these symptoms. However, scientists do not fully understand how the drug works.

Now, researchers at the Okinawa Institute of Science and Technology Graduate University (OIST) have identified how certain areas of the human brain respond to methylphenidate. The work may help researchers understand the precise mechanism of the drug and ultimately develop more targeted medicines for the condition.

Previous research suggests that people with ADHD have different brain responses when anticipating and receiving rewards, compared to individuals without ADHD. Scientists at OIST have proposed that in those with ADHD, neurons in the brain release less dopamine—a 'feel-good' neurotransmitter involved in reward-motivated behavior—when a reward is expected, with dopamine neurons firing more when a reward is given.

"In practice, what this means is that children, or even young adults, with ADHD may have difficulty engaging in behavior that doesn't result in an immediate positive outcome. For example, children may struggle to focus on schoolwork, as it may not be rewarding at the time, even though it could ultimately lead to better grades. Instead, they get distracted by external stimuli that are novel and interesting, such as a classmate talking or traffic noises," said Dr. Emi Furukawa, first author of the study and a researcher in the OIST Human Developmental Neurobiology Unit, led by Professor Gail Tripp.

Scientists believe that methylphenidate helps people with ADHD maintain focus by influencing dopamine availability in the brain. Therefore, Dr. Furukawa and her colleagues set out to examine how the drug affects a brain region called the ventral striatum, which is a vital component of the reward system and where dopamine is predominantly released.

"We wanted to take a look at how methylphenidate affects the ventral striatum's responses to reward cues and delivery," said Furukawa.

The study, which was recently published in the journal Neuropharmacology, was jointly conducted with scientists at D'Or Institute for Research and Education (IDOR) in Rio de Janeiro, Brazil. The collaboration allowed the researchers to combine expertise across multiple disciplines and provided access to IDOR's functional magnetic resonance imaging (fMRI) facility.

Delving into the brain

The researchers used fMRI to measure brain activity in young adults with and without ADHD as they played a computer game that simulated a slot machine. The researchers scanned individuals in the ADHD group on two separate occasions—once when they took methylphenidate and another time when they took a placebo pill. Each time the reels of the slot machine spun, the computer also showed one of two cues, either the Japanese character み (mi) or そ (so). While familiarizing themselves with the game before being scanned, the participants quickly learned that when the slot machine showed み, they often won money, but when the slot machine showed そ, they didn't. The symbol み therefore acted as a reward-predicting cue, whereas そ acted as a non-reward-predicting cue.

The researchers found that when individuals with ADHD took the placebo, neuronal activity in the ventral striatum was similar in response to both the reward predicting and non-reward predicting cue. However, when they took methylphenidate, activity in the ventral striatum increased only in response to the reward cue, showing that they were now able to more easily discriminate between the two cues.

The researchers also explored how neuronal activity in the striatum correlated with neuronal activity in the medial prefrontal cortex—a brain region involved in decision-making that receives information from the outside world and communicates with many parts of the brain, including the striatum.

When the individuals with ADHD took placebo instead of methylphenidate, neuronal activity in the striatum correlated strongly with activity in the prefrontal cortex at the exact moment the reward was delivered, and the participants received money from the slot machine game. Therefore, the researchers believe that in people with ADHD, the striatum and the prefrontal cortex communicate more actively, which may underline their increased sensitivity to rewarding external stimuli. In participants who took methylphenidate, this correlation was low, as it was in people without ADHD.

The results implicate a second neurotransmitter, norepinephrine, in the therapeutic effects of methylphenidate. Norepinephrine is released by a subset of neurons common in the prefrontal cortex. Researchers speculate that methylphenidate might boost levels of norepinephrine in the prefrontal cortex, which in turn regulates dopamine firing in the striatum when rewards are delivered.

"It's becoming clear to us that the mechanism by which methylphenidate modulates the reward response is very complex," said Furukawa.

Tailoring New Therapies for ADHD

Despite the complexity, the scientists believe that further research could elucidate methylphenidate's mechanism of action, which could benefit millions of people worldwide.

Pinning down how methylphenidate works may help scientists develop better therapies for ADHD, said Furukawa. "Methylphenidate is effective but has some side effects, so some people are hesitant to take the medication or give it to their children," she explained. "If we can understand what part of the mechanism results in therapeutic effects, we could potentially develop drugs that are more targeted."

Furukawa also hopes that understanding how methylphenidate impacts the brain could help with behavioral interventions. For example, by keeping in mind the difference in brain responses when children with ADHD anticipate and receive rewards, parents and teachers could instead help children with ADHD stay focused by praising them frequently and reducing the amount of distracting stimuli in the environment

Cycles of reward: New insight into ADHD treatment

Psychedelic drugs could help treat PTSD

by American College of Neuropsychopharmacology

Clinical trials suggest treatment that involves psychedelics can be more effective than psychotherapy alone. More than three million people in the United States are diagnosed each year with post-traumatic stress disorder, whose symptoms include nightmares or unwanted memories of trauma, heightened reactions, anxieties, and depression—and can last months, or even years.

People with PTSD—difficulty recovering from experiencing or witnessing a traumatic event—have traditionally been treated with a combination of trauma-focused psychotherapy and a regimen of medications. Many sufferers have not responded well to that treatment, but new research to be presented by the Medical University of South Carolina's Dr. Michael Mithoefer and colleagues, at the annual meeting of the American College of Neuropsychopharmacology, suggests that the combination of some psychedelic drugs and traditional psychotherapy holds promise.

Psychedelic substances are often found in nature and have been used in various cultures over thousands of years. Formal medical research into their medicinal uses starting in the 1950s produced promising results published in major journals but was largely halted in the 1970s for political rather than medical or scientific reasons. More recent studies argue that, when administered in a controlled clinical setting, MDMA (more commonly known as ecstasy) and psilocybin (the active ingredient in "magic mushrooms") have acceptable risk profiles —and patients who experienced temporary adverse reactions did not require additional medical intervention.

In the past few years the FDA has granted both MDMA and psilocybin Breakthrough Therapy Designations for PTSD and depression respectively, acknowledging they may improve upon existing therapies, and agreeing to expedite their development and review.

The research by Dr. Mithoefer and his team includes six Phase 2 clinical trials conducted by independent investigators in four countries. In the trials, one group of patients was administered MDMA during their psychotherapy sessions, while the other group was administered a placebo or low dose comparator in conjunction with the same psychotherapy. The overall conclusion from these studies was that MDMA-assisted psychotherapy was significantly more effective at treating patients with persistent PTSD than unassisted psychotherapy.

The researchers aim to both review the successes that have been seen in the use of psychedelic drugs to treat trauma-related disorders and depression, as well as address several of the outstanding questions the medical community may still have concerning the safety, efficacy, and neurobiological functions of these novel treatment options.

'Ecstasy' shows promise for post-traumatic stress treatment

More information: The findings were presented at the 58th Annual Meeting of The American College of Neuropsychopharmacology (ACNP) in Orlando, FL, December 8-11, 2019.

Research shows real risks associated with cannabis exposure during pregnancy

by University of Western Ontario JANUARY 17, 2020

A new study from researchers at Western University and Queen's University definitively shows that regular exposure to THC, the main psychoactive ingredient in cannabis, during pregnancy has significant impact on placental and fetal development. With more than a year since the legalization of recreational cannabis in Canada, the effects of its use during pregnancy are only now beginning to be understood.

The study, published today in Scientific Reports, uses a rat model and human placental cells to show that maternal exposure to THC during pregnancy has a measurable impact on both the development of the organs of the fetus and the gene expression that is essential to placental function.

The researchers demonstrated in a rat model that regular exposure to a low-dose of THC that mimics daily use of cannabis during pregnancy led to a reduction in birth weight of 8 per cent and decreased brain and liver growth by more than 20 per cent.

"This data supports clinical studies that suggest cannabis use during pregnancy it is associated with low birth weight babies. Clinical data is complicated because it is confounded by other factors such as socioeconomic status," said Dan Hardy, Ph.D., Associate Professor at Western's Schulich School of Medicine & Dentistry and co-author on the paper. "This is the first study to definitively support the fact that THC alone has a direct impact on placental and fetal growth."

The research team was also able to characterize how THC prevents oxygen and nutrients from crossing the placenta into the developing fetus. By studying human placental cells, the researchers found that exposure to THC caused a decrease in a glucose transporter called GLUT-1. This indicates that the THC is preventing the placental transfer of glucose, a key nutrient, from the mother to the fetus. They also found a reduction in placental vasculature in the rat model suggesting reduced blood flow from the mother to the fetus.

The researchers say both of those factors are likely contributing to the growth restriction that they observed in the offspring.

The researchers point out that there are currently no clear guidelines from Health Canada on the use of cannabis in pregnancy and some studies have shown that up to one in five women are using cannabis during pregnancy to prevent morning sickness, for anxiety or for social reasons.

"Marjiuana has been legalized in Canada and in many states in the US, however, its use during pregnancy has not been well studied up until this point. This study is important to support clinicians in communicating the very real risks associated with cannabis use during pregnancy," said David Natale, Ph.D., Associate Professor at Queen's and co-author on the paper.

Pot while pregnant: medicine doctors urge caution

More information: Bryony V. Natale et al, Δ9-tetrahydrocannabinol exposure during rat pregnancy leads to symmetrical fetal growth restriction and labyrinth-specific vascular defects in the placenta, Scientific Reports (2020). DOI: 10.1038/s41598-019-57318-6

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