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Ban needed on ‘torturous’ electroconvulsive therapy

Electroshock’s brutal and sordid history ranges from its use to help slaughter pigs, to punishment, painful “aversion therapy” on homosexuals, inflicting brain damage on children and others, and to torture humans.

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Mental health watchdog Citizens Commission on Human Rights (CCHR) International announced that a ban of electroshock treatment — the practice of up to 460 volts of electricity to the brain to “treat mental disorder” — should be imminent in light of increasing reports of patients being damaged and deaths.

In Texas in the US, the only state to record deaths within 14 days of electroshock being administered, reported a death rate in recent years that represents an estimated 300 deaths nationally each year. The most frequent causes of death have been cardiac events and suicide, according to one study [1].

Electroshock’s brutal and sordid history ranges from its use to help slaughter pigs, to punishment, painful “aversion therapy” on homosexuals, inflicting brain damage on children and others, and to torture humans.

The US Food and Drug Administration (FDA) has never obtained a single clinical trial from the manufacturers of the electroshock devices proving their safety and efficacy. Under Section 516 of the Food, Drug and Cosmetics Act, the FDA has a duty to ban devices that present “substantial deception or unreasonable and substantial risk of illness or injury.” Electroshock, also called electroconvulsive therapy or ECT, can cause brain damage, long-term memory loss and death, constituting more than a “substantial risk” and is far from safe and effective, according to thousands of survivors’ complaints.[2] Ignoring these dangers, the FDA has instead limited bans under this Section to prohibiting the use of powdered gloves in medical or surgical procedures and prosthetic hair fiber implants that may trigger inflammation and hypersensitivity reactions, the latter, the FDA says, were misrepresented in marketing as “safe, effective and causing little or no discomfort.”

While the FDA allows the ECT device to remain on the market, it doesn’t regulate how it is used, giving psychiatrists a free-for-all to administer it to whomever they choose. This has meant that children younger than five and toddlers have been subjected to the violence of this shock procedure in at least five states that CCHR has established through Freedom of Information Act requests. Despite a report from the United Nations committee on Torture and Other Cruel Inhuman or Degrading Treatment or Punishment that warns electroshock without consent constitutes torture, ECT continues to be given to involuntary patients without consent.[3]

Pregnant women and their unborn babies are also not protected from ECT, despite the World Federation of Societies of Anesthesiology saying that ECT is “absolutely contraindicated” in pregnancy.[4] Researchers of Maine Medical Center have found brain damage in a baby whose mother had undergone ECT while pregnant.[5] The Journal of Maternal-Fetal & Neonatal Medicine also warns of potential spontaneous abortion, placental abruption, cardiac arrhythmias, fetal burn and intrauterine fetal death when a pregnant woman experiences general electrical shock.[6] Yet, the APA claims that it’s safe during all trimesters.[7]

Jan Eastgate, president of CCHR International, said: “Electroshock is mental euthanasia, with a long history of being used for torture and abuse. Electric shock eradicates memory. It should never be condoned or permitted because quite apart from its inhuman aspects, patients consider it bluntly criminal, especially when forced on them. Psychiatrists and the FDA pass off electric shock machines as wonderful, even though they can kill patients.” Sign CCHR’s Petition to Ban the Electroshock (ECT) Device.

The impact of any electrical shock upon a body for any purpose is very dangerous. Researchers from the University of Montreal have shown that any electric shock above 120 volts can “cause neurologic and neuropsychological symptoms in humans. Following an electrical injury, some patients may show various emotional and behavioral aftereffects, such as memory loss and symptoms of depression.”[8] ECT uses up to 460 volts, deliberately inducing a grand mal seizure that the American Psychiatric Association (APA) says can last up to 30 minutes.

ECT: Slaughters Pigs and Tortures

ECT was invented in fascist Italy in 1937 by psychiatrist Ugo CerlettiDarius Rejali, author of Torture and Modernity, wrote of Cerletti “having killed a few dogs by experimentation” and then “discovered that Roman slaughterhouses used electrocution to slaughter pigs.” Cerletti “discovered that pigs could be shocked several times and would revive after a few minutes.” He then applied ECT to humans, his first victim screaming that it was “deadly.” “The torture and ‘treatments’ of the insane” historically has derived from the “application to animals in abattoirs,” Rejali stated.[9]

Cerletti’s device very rapidly pressed into political service, Rejali said. In August 2017, a paper published in History of Psychiatry documented how “The Nazi political and medical establishment” regarded ECT as a means “to empty psychiatric institutions, thereby relieving the state of the burden…” Psychiatrist Emil Gelny “added four extra electrodes to existing ECT machines, which were attached to patients’ wrists and ankles to deliver the lethal shocks after patients were knocked unconscious by the initial current applied to the head.”[10]

In the 1950s, the U.S. Central Intelligence Agency (CIA) expressed considerable interest in ECT devices. In 1951, Project Artichoke, then MK-ULTRA under Deputy CIA Director Richard Helms in 1953, aimed to control human behavior through hallucinogenic drugs and electroshock.[11] Dr. Ewen Cameron, the first president of the World Psychiatric Association, while professor of psychiatry at McGill University in Canada in the 1950s and 60s, developed his own version of shock treatment, using the UK Page-Russell electroshock device invented in 1948. Cameron called his shock technique “de-patterning” deliberately wiping out patient memories by the use of intensive ECT. The CIA funded his work.[12] He described the procedure on a patient to the 2nd World Congress of Psychiatry in 1957, stating: “There is complete amnesia for all events of his life.”[13]

Electroshock ‘took away her soul’

In 2017, 60 years after Cameron’s experiments left her mother damaged for life, Alison Steel obtained a $100,000settlement from the Canadian government over Cameron’s experiments. “She was never able to really function as a healthy human being because of what they did to her,” Steel stated. “Her emotions were stripped. It took away her soul.”[14]

Electroshock is also used for torture, including on prisoners of the French during the 1954-62 Algerian War.[15] Journalist Gordon Thomas reported that in 1961, Moroccan king Hassan II’s security service was fully staffed with doctors who supervised a wide range of tortures of political detainees using several Page-Russell electroshock machines.[16] Chinese dissidents and members of the religious group The Falun Gong are still subjected to electroshock and “other barbaric forms of torture designed by prison guards to humiliate and inflict maximum pain.”[17]

Until 1973, when the APA de-classified homosexuality as a mental disorder, electroshock treatment was used in an effort to prevent or eliminate homosexual behavior.[18] Other forms of shock included jolts of electricity administered to the skin and body, sometimes directly to the genitals.[19] Voltage of such devices ranged anywhere from 150-200 volts and on children for behavioral control, 300-400 volts.[20] Allegations that psychiatrists and any others recommending ECT to treat the LGBT community today are homophobic and cruel, CCHR says.[21]

Brain Damage and Memory Loss

Yet the FDA and APA continue to ignore the perils of ECT.

  • In March 2016, a coroner from Sunderland County in the UK determined Elsie Tindle died after electroshock triggered an epileptic fit which caused irreparable brain damage.[22]
  • A 2012 study published in Proceedings of the National Academy of Sciences reported a considerable “decrease in functional connectivity” between the prefrontal lobes of the brain and other parts of the brain after ECT. The most extensive long-term follow-up study indicates that “most ECT patients will never recover from the damage in the form of persistent severe mental deficits.”[23]
  • Austin, Texas, psychologist John Breeding, who heads the Coalition for the Abolition of Electroshock, said, “The bottom line is that ECT ‘works’ to the extent that it damages and disables the brain.”[24] Breeding dispels psychiatric theories that the procedure is safer today than its “One Flew Over the Cuckoo’s Nest” days in the 60s. He says that ECT has more potential for harm than ever. Much higher voltages are employed in the modern procedure because muscle relaxants and anesthetics raise the seizure threshold, with more electricity required to produce a seizure. The greater heat and electricity themselves cause more brain cell death, he says. He concludes “Given what we know about the resulting brain damage, I think this is a form of assault…”[25]
  • Leading ECT researcher and advocate, psychologist Harold Sackeim admitted in an editorial in The Journal of ECT that “virtually all patients experience some degree of persistent and, likely, permanent retrograde amnesia.”[26] In a January 2007 study published in Neuropsychopharmacology, Sackeim and colleagues acknowledged that ECT may cause permanent amnesia and permanent deficits in cognitive abilities, which affect ability to function.[27]
  • In 2005, Santa Barbara Superior Court Judge Denise de Bellefeuille ruled that a psychiatrist and Santa Barbarapsychiatric facility deceived its patients by failing to tell them that ECT causes irreversible memory loss. The psychiatrist (who had performed shock treatment for over 20 years), admitted that neither he nor anyone else understands how shock treatment works, and that the consent form Johnson provided to patients was “decidedly misleading in a critical regard,” concerning the permanency of memory loss.[28]

Last year, psychologist John Read, professor of clinical psychology at the University of East London concluded from a comprehensive review of 91 studies on ECT that “Given the well-documented high risk of persistent memory dysfunction, the cost-benefit analysis for ECT remains so poor that its use cannot be scientifically, or ethically, justified.”[29]

Eastgate says, “To treat mental problems by electric shocks is brutality in the name of mental health care. The high death rate, severe memory loss and the brain atrophy and damage ECT causes warrants it being banned under existing FDA law.”

REFERENCES:

[1] “An Analysis of Reported Deaths Following Electroconvulsive Therapy in Texas, 1993-1998,” 1 Aug 2001https://ps.psychiatryonline.org/doi/10.1176/appi.ps.52.8.1095.

[2] Jonathan Emord & Associates, Citizens Petition filed with the FDA Commissioner, 14 Aug. 2016, pp. 14, 27 and 42, http://emord.com/blawg/wp-content/uploads/2016/08/1-ECT-Citizen-Petition.pdf.

[3] A/HRC/22/53, “Report of the Special Rapporteur on torture and other cruel, inhuman or degrading treatment or punishment, Juan E. Méndez,” United Nations, General Assembly, Human Rights Council, Twenty-second Session, Agenda Item 3, 1 Feb. 2013, p. 1, Summary.

[4] https://www.wfsahq.org/documents/306%20Anaesthesia%20for%20Electro-convulsive%20Therapy%20ECT.pdf.

[5] http://www.mindfreedom.org/kb/mental-health-abuse/electroshock/pregnancy-study, citing Jacquelyn BlackstoneMichael G. PinetteCamille SantarpioJoseph R. Wax, “Electroconvulsive Therapy in Pregnancy.” Obstetrics & Gynecology, 2007, American College of Obstetricians and Gynecologists, http://greenjournal.org/cgi/content/short/110/2/465.

[6] “Electric shock in pregnancy: a review,” The Journal of Maternal-Fetal & Neonatal Medicine, Vol. 29, 2014, Issue 2, http://www.tandfonline.com/doi/abs/10.3109/14767058.2014.1000295?journalCode=ijmf20.

[7] https://www.healthyplace.com/depression/articles/electroconvulsive-therapy-during-pregnancy.

[8] https://www.sciencedaily.com/releases/2008/05/080515113311.htmUniversity of Montreal. “Electric Shocks Can Cause Neurologic And Neuropsychological Symptoms.” ScienceDaily16 May 2008https://www.sciencedaily.com/releases/2008/05/080515113311.htm.

[9] Darius Rejali, “Electricity: The Global History Of A Torture Technology,” http://www.reed.edu/poli_sci/faculty/rejali/articles/History_of_Electric_Torture.htmlPetr Skrabanek, PhD., “Convulsive Therapy – A Critical Appraisal of its Origins and Value,” Irish f’.’lcdicaIJourIlo,, June 1986, Volume 79, No. 6.

[10] https://psmag.com/news/nazis-ruin-everything; G Gazdag, GS Ungvari, and H Czech, “Mass killing under the guise of ECT: the darkest chapter in the history of biological psychiatry,” History of Psychiatry, Sage Publications, 2017.

[11] Stephen Lendman, “Meet Maryam Ruhullah: A Victim of MK-ULTRA,” Countercurrents.org16 Feb. 2010https://www.countercurrents.org/lendman160210.htm.

[12] Leonard Roy Frank, “Electroshock: Death, Brain Damage, Memory Loss, and Brainwashing,” The Journal of Mind and Behaviour, Summer and Autumn 1990; Leonard Roy Frank, Editor, “The Electroshock Quotationary,” June 2006http://www.endofshock.com/102C_ECT.pdfhttp://www.brown.uk.com/brownlibrary/FRANK.htm.

[13] Op. cit.Leonard Roy Frank, “The Electroshock Quotationary.”

[14] https://stillnessinthestorm.com/2017/11/canadian-government-quietly-compensates-daughter-of-mkultra-victi/.

[15] Leonard Roy Frank, Editor, The History of Shock Treatment, 1978.

[16] Gordon ThomasJourney Into Madness, The True Story of Secret CIA Mind Control and Medical Abuse, (Bantam Books) 1989.

[17] https://www.news.com.au/world/asia/extreme-torture-inside-chinas-correctional-facilities/news-story/7e4a796bc1401d593f5cc58d7fd32ecb.

[18] Patrick Strudwick, “This Gay Man Was Given Repeated Electric Shocks By British Doctors to Make Him Straight,” Buzz Feed30 Sept 2017https://www.buzzfeed.com/patrickstrudwick/this-gay-man-was-given-repeated-electric-shocks-by-british?utm_term=.orlQxe4JR#.coV1dRZOn.

[19] https://www.huffingtonpost.com/jamie-scot/shock-the-gay-away-secrets-of-early-gay-aversion-therapy-revealed_b_3497435.htmlhttps://www.madinamerica.com/2014/09/fda-panel-rejects-aversive-therapy-shock-devices/https://www.masslive.com/news/index.ssf/2016/07/inside_judge_rotenberg_center.html.

[20] https://www.madinamerica.com/2014/09/fda-panel-rejects-aversive-therapy-shock-devices/https://books.google.com/books?id=qpcuDwAAQBAJ&pg=PT137&lpg=PT137&dq=aversion+therapy+electroshock+used+70+volts+of+electricity&source=bl&ots=3dqOdCCa7X&sig=-ddCLbjl6FUOI6LspJdjZEBm4-M&hl=en&sa=X&ved=2ahUKEwiawZX-p8fcAhWWFjQIHf8ACNk4ChDoATADegQIAxAB#v=onepage&q=aversion%20therapy%20electroshock%20used%2070%20volts%20of%20electricity&f=false.

[21] Emily Reynolds, “The cruel, dangerous reality of gay conversion therapy,” Wired7 July 2018https://www.wired.co.uk/article/what-is-gay-conversion-therapy.

[22] Petra Silfverskiold, “Electric shock therapy led to Sunderland patient having permanent fit,” Daily Mail (UK), 10 Mar. 2016http://www.sunderlandecho.com/news/local/all-news/electric-shock-therapy-led-to-sunderland-patient-having-permanent-fit-1-7786233.

[23] Peter Breggin, “New Study Confirms Electroshock (ECT) Causes Brain Damage,” Huffington Post, 9 Apr. 2012https://www.huffingtonpost.com/dr-peter-breggin/electroshock-treatment_b_1373619.html.

[24] John Breeding, Ph.D., “Electroshocking Children: Why It Should Be Stopped,” Mad in America11 Feb. 2014https://www.madinamerica.com/2014/02/electroshocking-children-stopped/.

[25] Op. cit.John Breeding, Ph.D., “Electroshocking Children: Why It Should Be Stopped”; John Breeding, Ph.D., “Chapter 9: Electroshock,” http://www.wildestcolts.com/psych_opp/d-electroshock/1-shock.html.

[26] IbidJohn Breeding, Ph.D., “Electroshocking Children: Why It Should Be Stopped.”

[27] Ibid., citing, Sackeim et al., “The Cognitive Effects of Electroconvulsive Therapy in Community Settings” Neuropsychopharmacology, Volume 32, Number 1, 2007.

[28] Charles D. Morgan, “Milestone case: Hospital ordered to cease shocking patients,” https://suemypsychiatrist.wordpress.com/category/ect/.

[29] John ReadChelsea Arnold, “Is Electroconvulsive Therapy for Depression More Effective Than Placebo? A Systematic Review of Studies Since 2009,” Ethical Human Psychology and Psychiatry Volume 19, Number 1, 2017, pp. 5-23(19), http://www.ingentaconnect.com/content/springer/ehpp/2017/00000019/00000001/art00002.

Health & Wellness

Love hormone also forms important link between stress and digestive problems

Oxytocin, an anti-stress hormone, is released from the hypothalamus in the brain which acts to counteract the effects of stress. For a long time, the actions of oxytocin were believed to occur due to its release into the blood with only minor effects on the nerves within the brain that regulate gastrointestinal functions.

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New research published in The Journal of Physiology shows that oxytocin, known as the love hormone, plays an important role in stress’ disruption of digestion such as bloating, discomfort, nausea and diarrhea.  

Stress disrupts gastrointestinal functions and causes a delay in gastric emptying (how quickly food leaves the stomach). This delay in gastric emptying causes bloating, discomfort, and nausea and accelerates colon transit, which causes diarrhea.  

Oxytocin, an anti-stress hormone, is released from the hypothalamus in the brain which acts to counteract the effects of stress. For a long time, the actions of oxytocin were believed to occur due to its release into the blood with only minor effects on the nerves within the brain that regulate gastrointestinal functions.  

The study used new ways to manipulate the neurons and nerves (neurocircuits) that oxytocin released from the hypothalamus acts upon and measured the effects on the response of gastric emptying to stress. They have shown that, contrary to previous assumptions, these oxytocin circuits play a major role in the response of the stomach to stress.  

Activation of these oxytocin circuits reversed the delay in gastric emptying that occurs normally in response to stress, by increasing muscle contractions (motility) of the stomach, while inhibition of these neurocircuits prevented adaptation to stress.  

The new research, conducted at Penn State University- College of Medicine and was sponsored by a grant from the National Institute of Health, USA, employed cutting-edge tools that allow selective manipulation of the circuits that receive hypothalamic oxytocin inputs together with simultaneous measurements of gastric emptying and motility in response to stress.  

The authors used a rat model of different types of stress – acute stress, appropriate adaptation to stress, and inappropriate adaptation to stress. The authors infected the neurons controlling the oxytocin nerves and neurocircuits with novel viruses that allowed them to be activated or inhibited and measured muscle activity in the stomach, as well as gastric emptying (the time for food to leave the stomach).  

The researchers have shown that these oxytocin neural circuits play a major role in the gastric response to stress loads. Indeed, their activation reversed the delayed gastric emptying observed following acute or chronic responses to stress, thus increasing both gastric tone and motility. Conversely, inhibition of these neurocircuits prevented adaptation to stress thus delaying gastric emptying and decreasing gastric tone.   

These data indicate that oxytocin influences directly the neural pathways involved in the stress response and plays a major role in the gastric response to stressors. ​ 

The ability to respond appropriately to stress is important for normal physiology functions. Inappropriate responses to stress, or the inability to adapt to stress, triggers and worsens the symptoms of many gastrointestinal disorders including delayed gastric emptying and accelerated colon transit.  

Previous studies have shown that the nerves and neurocircuits that regulate the function of gastric muscle and emptying respond to stress by changing their activity and responses.  

In order to identify targets for more effective treatments of disordered gastric responses to stress, it is important to first understand how stress normally affects the functions of the stomach. Their study provided new information about the role that oxytocin plays in controlling these nerves and circuits during stress and may identify new targets for drug development. 

Commenting on the study R Alberto Travagli said: “Women are more vulnerable to stress and stress-related pathologies, such as anxiety and depression, and report a higher prevalence in gastrointestinal disorders. Our previous studies showed that vagal neural circuits are organized differently in males versus females. We are now finalizing a series of studies that investigate the role and the mechanisms through which oxytocin modulates gastric functions in stressed females. This will help to develop targeted therapies to provide relief for women with gastrointestinal disorders.”

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Health & Wellness

Sexual minority men who smoke report worse mental health, more frequent substance use

LGBTQ+ people are more likely to smoke than their cisgender and heterosexual peers to cope with an anti-LGBTQ+ society, inadequate health care access and decades of targeted tobacco marketing. Those social stressors drive the health disparities they face, which are compounded by a lack of LGBTQ-affirming healthcare providers, research shows.

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Cigarette smoking is associated with frequent substance use and poor behavioral and physical health in sexual and gender minority populations, according to Rutgers researchers.

The study, published in the journal Annals of Behavioral Medicine, examined tobacco use by sexual minority men and transgender women to better understand the relationships between smoking, substance use and mental, psychosocial and general health.

The researchers, who are part of the Rutgers School of Public Health’s Center for Health, Identity, Behavior and Prevention Studies, surveyed 665 racially, ethnically and socioeconomically diverse sexual minority men and transgender women, 70 percent of whom reported smoking cigarettes.

They found that smoking was associated with participants’ race/ethnicity, marijuana and alcohol use and mental health. Current smokers were more likely to be white and reported more days of marijuana use in the past month. The study also found that current smoking was associated with more severe anxiety symptoms and more frequent alcohol use.

“Evidence also tells us that smoking is associated with worse mental health and increased substance use, but we don’t know how these conditions are related to each other, exacerbating and mutually reinforcing their effects,” said Perry N. Halkitis, dean of the Rutgers School of Public Health and the study’s senior author.

LGBTQ+ people are more likely to smoke than their cisgender and heterosexual peers to cope with an anti-LGBTQ+ society, inadequate health care access and decades of targeted tobacco marketing. Those social stressors drive the health disparities they face, which are compounded by a lack of LGBTQ-affirming healthcare providers, research shows.

“Our findings underscore the importance of holistic approaches to tobacco treatment that account for psychosocial drivers of substance use and that address the complex relationships between mental health and use of substances like alcohol, tobacco and marijuana,” said Caleb LoSchiavo, a doctoral student at the Rutgers School of Public Health and the study’s first author.

The study recommends further research examining the social determinants of disparities in substance use among marginalized populations and how interpersonal and systemic stressors contribute to poorer physical and mental health for minority populations.

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Notable percentage of trans men who have sex with men never got tested for HIV, bacterial and viral STIs

When considering screening for HIV and sexually transmitted infections (STIs), transgender men who have sex with men (TMSM) represent an understudied population. A study found that a notable percentage of TMSM had never tested for HIV and bacterial and viral STIs.

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When considering screening for HIV and sexually transmitted infections (STIs), transgender men who have sex with men (TMSM) represent an understudied population. A study found that a notable percentage of TMSM had never tested for HIV and bacterial and viral STIs.

In “Sociodemographic and behavioural factors associated with testing for HIV and STIs in a US nationwide sample of transgender men who have sex with men” – done by Nadav Antebi-Gruszka, Ali J. Talan, Sari L. Reisner and Jonathon Rendina, and published in BMJ Journals – researchers tried to examine HIV and STI testing prevalence among TMSM along with the factors associated with testing in a diverse sample of TMSM. They used data from a cross-sectional online convenience sample of 192 TMSM, analyzed using multivariable binary logistic regression models to examine the association between sociodemographic and behavioral factors and lifetime testing for HIV, bacterial STIs and viral STIs, as well as past year testing for HIV.

The researchers found that more than two-thirds of TMSM reported lifetime testing for HIV (71.4%), bacterial STIs (66.7%), and viral STIs (70.8%), and 60.9% had received HIV testing in the past year. Engaging in condomless anal sex with a casual partner whose HIV status is different or unknown and having fewer than two casual partners in the past six months were related to lower odds of lifetime HIV, bacterial STI, viral STI and past year HIV testing.

Being younger in age was related to lower probability of testing for HIV, bacterial STIs and viral STIs.

The domiciles of the TMSM also affected their health-seeking behaviors. In this study, those residing in the South of the US were less likely to be tested for HIV and viral STIs in their lifetime, and for HIV in the past year.

Finally, lower odds of lifetime testing for viral STIs was found among TMSM who reported no drug use in the past six months.

According to the researchers, these findings indicate that a notable percentage of TMSM had never tested for HIV and bacterial and viral STIs, though at rates only somewhat lower than among cisgender MSM despite similar patterns of risk behavior.

They recommend for “efforts to increase HIV/STI testing among TMSM, especially among those who engage in condomless anal sex.”

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People with anorexia and body dysmorphic disorder show brain similarities, differences

Eating disorders and body dysmorphic disorder are more than simply choosing to eat or not eat or not liking how you look. These are brain abnormalities, and how we treat those brain abnormalities could be with psychotherapy, or psychiatric medications, but brain changes need to happen in order to address these disorders.

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A new UCLA study shows partially overlapping patterns of brain function in people with anorexia nervosa and those with body dysmorphic disorder, a related psychiatric condition characterized by misperception that particular physical characteristics are defective.

The study, published in the peer-reviewed journal Brain Imaging and Behavior, found that abnormalities in brain function are related to severity of symptoms in both disorders, and may be useful in developing new treatment methods.

The results reinforce the understanding that eating disorders and body dysmorphic disorder are more than simply choosing to eat or not eat or not liking how you look. “These are brain abnormalities, and how we treat those brain abnormalities could be with psychotherapy, or psychiatric medications, but brain changes need to happen in order to address these disorders,” says Dr. Wesley Kerr, neurology resident and biostatistics researcher at UCLA.

For the study, the researchers recruited 64 female participants: 20 with anorexia nervosa, 23 with body dysmorphic disorder, and 21 healthy controls. Patients with anorexia nervosa have a distorted body image and an intense fear of gaining weight, leading them to eat very little. Body dysmorphic disorder (BDD) is characterized by obsessions with a particular body part or a perceived flaw rather than with weight.

Eating disorders and body dysmorphic disorder are more than simply choosing to eat or not eat or not liking how you look.

Participants were shown images of male and female bodies while researchers observed their brain activity via MRI. Three types of images were used: normal photos, “low spatial frequency” (LSF) images, which had details blurred out, and “high spatial frequency” (HSF) images, in which the edges and details were accentuated.

Functional MRI is a brain imaging technique that detects the blood flow within the brain, allowing researchers to see which parts of the brain are active while a person is doing various tasks. It can also be used to understand what brain regions’ activities are in sync with each other; that is, “connected.”

Each of the women performed a “matching” task while inside the MRI scanner. On the top of the screen, the person would see an image of a body, and would have to choose the matching body from two images shown on the bottom of the screen.

While viewing the images that differed from those of healthy individuals, people with anorexia nervosa and those with BDD showed patterns of activity and connectivity in visual and parietal brain networks. These abnormalities in activity were different in BDD and anorexia nervosa, whereas the connectivity abnormalities were largely similar. The more severe the symptoms, the more pronounced the pattern of brain activity and connectivity when the images were viewed, particularly for the LSF images. Further, connectivity and activity abnormalities were associated with how the participants judged the appearance and body weight of the individuals in the photos.

What the researchers saw indicated that while the brains of patients with anorexia nervosa and those with BDD abnormally process images with high, low, or normal levels of detail, the abnormalities for low level of detail, that is “low spatial frequency” images, have the most direct relationships to symptom severity and body perception. The results may help researchers understand the underlying neurobiology that leads to the characteristic body image distortions in both cases.

“This gives us a clearer picture of neurological basis for what is one disorder, what is the other, and what characteristics they share,” said Dr. Jamie Feusner, senior author and professor of psychiatry and biobehavioral sciences at the Jane and Terry Semel Institute for Neuroscience and Human Behavior at UCLA.

A next step for the research will be to see whether, with existing psychotherapy and medication treatments, the brain activity in patients begins to normalize, or else changes in a different way to compensate for underlying abnormalities.

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Health & Wellness

Why ‘one day at a time’ works for recovering alcoholics

“One day at a time” is a mantra for recovering alcoholics, for whom each day without a drink builds the strength to go on to the next. A new brain imaging study by Yale researchers shows why the approach works.

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“One day at a time” is a mantra for recovering alcoholics, for whom each day without a drink builds the strength to go on to the next. A new brain imaging study by Yale researchers shows why the approach works.

Imaging scans of those diagnosed with alcohol use disorder (AUD) taken one day to two weeks after their last drink reveal associated disruptions of activity between the ventromedial prefrontal cortex and striatum, a brain network linked to decision making. The more recent the last drink, the more severe the disruption, and the more likely the alcoholics will resume heavy drinking and jeopardize their treatment and recovery, researchers report in the American Journal of Psychiatry.

However, the researchers also found that the severity of disruption between these brain regions diminishes gradually the longer AUD subjects abstain from alcohol.

“For people with AUD, the brain takes a long time to normalize, and each day is going to be a struggle,” said Rajita Sinha, the Foundations Fund Professor of Psychiatry and professor in the Child Study Center, professor of neuroscience and senior author of the study. “For these people, it really is ‘one day at a time.'”

The imaging studies can help reveal who is most at risk of relapse and underscore the importance of extensive early treatment for those in their early days of sobriety, Sinha said.

“When people are struggling, it is not enough for them to say, ‘Okay, I didn’t drink today so I’m good now’,” Sinha said. “It doesn’t work that way.”

The study also suggests it may be possible to develop medications specifically to help those with the greatest brain disruptions during their early days of alcohol treatment. For instance, Sinha and Yale colleagues are currently investigating whether existing high blood pressure medication can help reduce disruptions in the prefrontal-striatal network and improve chances of long-term abstinence in AUD patients.

Former Yale postdoctoral researcher Sarah K. Blaine, now at Auburn University, is lead author of the study.

Alcoholism is a big issue in the LGBTQIA community.

In 2017, for instance, a study noted that bisexual people had higher odds of engaging in alcohol use behaviors when compared with people from the sexual majority. This study also found that bullying mediated sexual minority status and alcohol use more particularly among bisexual females.

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Health & Wellness

Hormone therapy may be cause of porphyria in trans women

High levels of estrogen associated with hormone therapy changes, along with risk factors such as smoking, may lead to porphyria cutanea tarda (PCT) in transgender women.

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High levels of estrogen associated with hormone therapy changes, along with risk factors such as smoking, may lead to porphyria cutanea tarda (PCT) in transgender women.

This is according to a case study, whose findings add to the increasing body of evidence highlighting the higher risk of skin problems in trans women on long-term hormone therapy.

The case study, “Porphyria cutanea tarda unmasked by supratherapeutic estrogen during gender-affirming hormone therapy”, was published in the journal JAAD Case Reports.

PCT – which is the most common form of porphyria – is caused by a deficiency in the uroporphyrinogen decarboxylase enzyme, which leads to the buildup of porphyrins in the skin, making it extremely sensitive to sunlight.

There are various factors contributing to PCT, including genetic mutations and environmental factors. Some of the factors associated with the disease include: excessive iron levels in the liver, alcohol consumption, smoking, estrogen, hepatitis C, HIV infections, as well as mutations in the HFE gene.

Because of the link of high estrogen levels associated with hormone therapy and PCT, the researchers in the case study suggest for physicians to “recognize the potential risk for PCT in this patient population and consider hormone therapy adjustments, without undermining its importance in affirming gender identity”.

For many members of the trans community, hormone therapy helps affirm their gender identity, potentially easing gender dysphoria (or extreme discomfort caused by a discrepancy between a person’s sex at birth and their gender identity). This, therefore, could help improve quality of life.

But such therapy can also lead to unwanted skin-related side effects, including acne, changes in hair distribution or density, and skin darkening.

In trans women in particular, hormone therapy involves higher estrogen doses than those used for other indications. This is a cause of concern due to risk for conditions associated with estrogen exposure, including PCT.

Physicians should “recognize the potential risk for PCT in this patient population and consider hormone therapy adjustments, without undermining its importance in affirming gender identity”.

The researchers – Stephanie Jackson Collision, Jaroslaw Jedrych and Alaina James – particularly reported on the case of a 55-year-old trans woman who developed PCT following a change in hormone therapy that led to estrogen levels above the therapeutic range (supratherapeutic).

This woman was admitted to the hospital with a three-month history of burning pain, itching, and recurrent blisters on her hands and forearms after exposure to sunlight.

Though she had no personal or family history of liver disease, iron abnormalities, or blistering eruptions, the woman was a smoker and reported drinking two beers a day.

While she had been taking oral estradiol (the most active form of estrogen) daily for the past 23 years, her hormone therapy changed one month before symptom onset. To better control gender dysphoria, she began a trial of oral progesterone (100 mg/day), the other main female hormone, and increased her daily estradiol dose from 2 mg to 4 mg.

Analyses revealed supratherapeutic total estrogen levels (1945 picograms/mL; therapeutic range: 600-1000 picograms/mL), high levels of porphyrins in the blood and urine, and a mutation in the HFE gene.

Overall, the evidence pointed to PCT, likely induced by a combination of supratherapeutic estrogen and other known risk factors, such as tobacco and alcohol use, and HFE mutations.

Attending physicians recommended she stopped taking oral progesterone and temporarily interrupt estrogen therapy, followed by a dose reduction. The woman was also advised to quit smoking, lower her alcohol consumption, and avoid sun exposure.

Clinical remission was achieved within five months without reductions in tobacco or alcohol use. At that time, the woman was reintroduced to hormone therapy with skin patches of 0.025 mg estradiol twice weekly, without PCT recurrence.

For many members of the trans community, hormone therapy helps affirm their gender identity, potentially easing gender dysphoria (or extreme discomfort caused by a discrepancy between a person’s sex at birth and their gender identity).

“The current lack of clear evidence-based hormone therapy (HT) treatment algorithms and barriers to HT access foster therapeutic inconsistency and hormone level fluctuations, which increase the risk of PCT and other cutaneous side effects of HT in transgender females,” the researchers wrote. “It is important to recognize the potential risk for PCT in this growing demographic and consider a multifaceted treatment approach that includes HT adjustment as a therapeutic option, while being mindful of its important role in affirming gender identity.”

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