Tag Archives: disorder

Dr. Weil’s Anti-Inflammatory Food Pyramid

Imagine this for a food pyramid – topped off by dark chocolate and red wine, dairy nowhere to be seen, and fruits/vegetables as the foundation.

 

(drweil.com)

 

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Criteria for Autism is changing as the DSM-5 creates a new category: Autism Spectrum Disorder

The American Psychiatric Association (APA) has proposed new diagnostic criteria for Autism in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5).

While final decisions are still months away, the recommendations reflect the work of dozens of the nation’s top scientific and research minds and are supported by more than a decade of intensive study and analysis.

The proposal recommends a new category called autism spectrum disorder which would incorporate several previously separate diagnoses, including autistic disorder, Asperger’s disorder, childhood disintegrative disorder and pervasive developmental disorder not otherwise specified.

The proposal asserts that symptoms of these four disorders represent a continuum from mild to severe, rather than a simple yes or no diagnosis to a specific disorder. The proposed diagnostic criteria for autism spectrum disorder specify a range of severity as well as describe the individual’s overall developmental status–in social communication and other relevant cognitive and motor behaviors.

This change will help clinicians more accurately diagnose people with relevant symptoms and behaviors by recognizing the differences from person to person, rather than providing general labels that tend not to be consistently applied across different clinics and centers.

Field testing of the proposed criteria for autism spectrum disorder does not indicate that there will be any change in the number of patients receiving care for autism spectrum disorders in treatment centers–just more accurate diagnoses that can lead to more focused treatment.

via American Psychiatric Association

DSM is the manual used by clinicians and researchers to diagnose and classify mental disorders. The APA will publish DSM-5 in 2013, culminating a 14-year revision process.

For ADHD drugs it's dependence vs abuse, not addiction vs dependence

Amy and I had a strong debate today about the difference between addiction and dependence. Both of us were using different explanations, so we resorted to the official definitions in the DSM-IV, the American Psychiatric Associations big book of disorders and definitions.

As you will read below their is no mention of addiction in the manual. They purposely excluded that term in favor of more descriptive ones. Which means that addiction is now classified as dependence or abuse.

Substance Dependence

The essential feature of Substance Dependence is a cluster of cognitive, behavioral, and physiological, symptoms indicating that the individual continues use of the substance despite significant substance-related problems.

There is a pattern of self-administration that can result in tolerance, withdrawal, and compulsive drug-taking behavior. A diagnosis of Substance Dependence can be applied to every class of substances except caffeine.

Substance Abuse

The essential feature of Substance Abuse is a maladaptive pattern of substance use manifested by recurrent and significant adverse consequences related to the repeated use of substances.

Unlike the criteria for Substance Dependence, the criteria for Substance Abuse do not include tolerance, withdrawal, or a pattern of compulsive use and instead include only the harmful consequences of repeated use.

Addiction vs Dependence/Abuse

The DSM views abuse and dependency as a continuum, meaning addiction is not, in their eyes, an on-or-off proposition, but a disorder with degrees of affliction. The distinction is important when compared to 12-step programs, which preach that one is either addicted or not, and if you are, you are powerless over such addiction.

via Powerless No Longer

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For ADHD drugs it’s dependence vs abuse, not addiction vs dependence

Amy and I had a strong debate today about the difference between addiction and dependence. Both of us were using different explanations, so we resorted to the official definitions in the DSM-IV, the American Psychiatric Associations big book of disorders and definitions.

As you will read below their is no mention of addiction in the manual. They purposely excluded that term in favor of more descriptive ones. Which means that addiction is now classified as dependence or abuse.

Substance Dependence

The essential feature of Substance Dependence is a cluster of cognitive, behavioral, and physiological, symptoms indicating that the individual continues use of the substance despite significant substance-related problems.

There is a pattern of self-administration that can result in tolerance, withdrawal, and compulsive drug-taking behavior. A diagnosis of Substance Dependence can be applied to every class of substances except caffeine.

Substance Abuse

The essential feature of Substance Abuse is a maladaptive pattern of substance use manifested by recurrent and significant adverse consequences related to the repeated use of substances.

Unlike the criteria for Substance Dependence, the criteria for Substance Abuse do not include tolerance, withdrawal, or a pattern of compulsive use and instead include only the harmful consequences of repeated use.

Addiction vs Dependence/Abuse

The DSM views abuse and dependency as a continuum, meaning addiction is not, in their eyes, an on-or-off proposition, but a disorder with degrees of affliction. The distinction is important when compared to 12-step programs, which preach that one is either addicted or not, and if you are, you are powerless over such addiction.

via Powerless No Longer

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Do you have ADD or ADHD? Test yourself against the official criteria from the DSM-IV

The following is excerpted from the DSM-IV, the medical manual used by the American Psychiatric Association to define mental disorders. These definitions are then broadly accepted in the entire health profession.

Go ahead and give yourself the test.
 

Diagnostic criteria for Attention-Deficit/Hyperactivity Disorder

A. Satisfy Either (1) or (2):

1. Six (or more) of the following symptoms of inattention have persisted for at least 6 months to a degree that is maladaptive and inconsistent with developmental level:

Inattention

  • (a) often fails to give close attention to details or makes careless mistakes in schoolwork, work, or other activities
  • (b) often has difficulty sustaining attention in tasks or play activities
  • (c) often does not seem to listen when spoken to directly
  • (d) often does not follow through on instructions and fails to finish schoolwork. Chores, or duties in the workplace (not due to oppositional behavior or failure to understand instructions)
  • (e) often has difficulty organizing tasks and activities
  • (f) often avoids, dislikes, or is reluctant to engage in tasks that require sustained mental effort (such as schoolwork or homework)
  • (g) often loses things necessary for tasks or activities (e.g. toys, school assignments, pencils, books, or tools)
  • (h) is often easily distracted by extraneous stimuli
  • (i) is often forgetful in daily activities

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Amy’s Amygdala: the emotional brain that controls fight-or-flight

The brain evolved from the bottom up and one of its first structures was the Amygdala. An almond-shaped set of neurons located deep in the brain’s medial temporal lobe.

It plays a key role in the processing of emotions and is linked to both fear responses and pleasure. For this reason it is often known as the “emotional brain”.

While a lot of research concentrates on the rational brain in the frontal cortex, not much is said about the Amygdala even though it plays a central role in so many current problems, including alcoholism, drug addiction, depression, and anxiety disorders.

Here is an in-depth look at the Amygdala.

Emotional learning

The Amygdalae perform the primary roles in the brain of the formation and storage of memories associated with emotional events. The most important of which are the memories that elicit fear behavior.

For dangerous situations this behavior can save our life but in today’s modern world it often acts in a role of paralysis, where the central nuclei is the genesis of many fear responses, including freezing (immobility), tachycardia (rapid heartbeat), increased respiration, and stress-hormone release.

Memory modulation

The Amygdala is also involved in the modulation of memory consolidation. Following any learning event, the long-term memory for the event is not formed instantaneously. Rather, information regarding the event is slowly assimilated into long-term (potentially life-long) storage over time, possibly forming permanent neural pathways.

The formation of those permanent pathways, called long-term potentiation, can become vital for behavior. Creating pathways for anxiety, fear conditioning, can be hard to overcome. Whereas, starting with pathways for positive behavior can improve behavior and help during stressful events.

This kind of positive conditioning can be done as an adult. A study performed on Buddhist monks who do compassion meditation have shown that they can modulate their Amygdala during their practice. When tested they showed a calmer reaction to stress than other people.

The Amygdala is most active when emotional. Greater emotional arousal following an event can enhance a person’s retention of that event. Which makes it interesting because it controls both emotion and memory. The full extent of this “bias” is not fully understood.

The obvious studies on fear and anger show positive correlations, where increased fear (emotion) then increase memory of that fear. Not much study has been completed on the opposite, for example, do positive emotions stimulate the Amygdala to create memory as much as negative ones do.

In nature there is certainly a desire to learn quickly from bad experiences, but is there a similarly strong desire to learn from positive outcomes?

Neuropsychological correlates (behavior and disorders)

As early as 1888, rhesus monkeys with a lesioned temporal cortex (including the amygdala) were observed to have significant social and emotional deficits. Heinrich Klüver and Paul Bucy later expanded upon this same observation by showing that large lesions to the anterior temporal lobe produced noticeable changes, including overreaction to all objects, hypoemotionality, loss of fear, hypersexuality, and hyperorality, a condition in which inappropriate objects are placed in the mouth.

These studies and many more discussed below show that the Amygdala plays a substantial role in mental states, and is related to many psychological disorders.

Of particular focus is the left Amygdala and it’s size.

Some studies have shown that children with anxiety disorders tend to have a smaller left Amygdala which increased in size with the use of antidepressant medication.

The Amygdala exists on both sides of the brain.

Other studies found the left side to be linked to social anxiety, obsessive and compulsive disorders, and post traumatic stress, as well as more broadly to separation and general anxiety.

Similarly, depressed patients showed exaggerated left side activity when interpreting emotions for all faces, and especially for fearful faces. This hyperactivity was normalized when patients went on antidepressants. 

Alcoholism and binge drinking also affects the Amygdala by dampening its activation, reducing its ability for emotional processing. This is thought to happen by inhibiting the protein kinase C-epsilon which is important in regulating drug addiction, drinking, and anxiety.

Amygdala Hijack

In 1996, Daniel Goleman wrote the book Emotional Intelligence: Why It Can Matter More Than IQ. In it he described a biological response we sometimes exhibit, naming it the Amygdala Hijack:

“Some emotional reactions and emotional responses can be formed without any conscious, cognitive participation…because the shortcut from thalamus to Amygdala completely bypasses the neocortex (the rational brain)”.

In scientific terms, the Thalamus bypasses the Cortex and routes the signal directly to the Amygdala, which is the trigger point for the primitive fight-or-flight response, and in our modern settings can often result in irrational or destructive behavior.

“Emotions make us pay attention right now – this is urgent – and give us an immediate action plan without having to think twice. The emotional component evolved very early: Do I eat it, or does it eat me?”.

Here is Mr. Goleman explaining it himself:

The emotional response “can take over the rest of the brain in a millisecond if threatened” and exhibits three signs: strong emotional reaction, sudden onset, and post-episode realization that the reaction was inappropriate.

In these cases self-control is crucial so as to avoid a complementary hijacking. For example ‘one key marital competence is for partners to learn to soothe their own distressed feelings…nothing gets resolved positively when husband or wife is in the midst of an emotional hijacking’. 

The danger is that ‘when our partner becomes, in effect, our enemy, we are in the grip of an “Amygdala hijack” in which our emotional memory, lodged in the limbic center of our brain, rules our reactions without the benefit of logic or reason…which causes our bodies to go into a “flight or fight” response’.

On the Upside

Finding ways to enlarge your Amygdala can have multiple obvious benefits beyond emotional stability. One study “suggests that Amygdalar enlargement in the normal population might be related to creative mental activity”. Another found positive correlations with both the size (the number of contacts a person has) and the complexity (the number of different groups to which a person belongs) of social networks.

What was left unsaid was how to increase the size of your Amygdala without the use of antidepressants, or maintain the size after terminating use.

One can infer that for those experiencing anxiety or overcome by fear or other emotions, the size of the Amygdala is small. That smaller size leads one to destructive behaviors, flight-or-flight responses, and limited growth.

The recommendations by nearly every study may provide an insight into how one can increase the size of there Amygdala. The reoccurring suggestion was practice, or regular repetition that allows the neurons in the brain to form new pathways and then strengthen those until they form the dominant behavior.

A method I often practice, although I recommend doing it with a trusted friend or therapist involved. Remember, improvement can always be had and nothing about you is set in stone.

Sources

Wikipedia, Scholarpedia, Science DailyMemory Loss Online (photo)

 

Amy's Amygdala: the emotional brain that controls fight-or-flight

The brain evolved from the bottom up and one of its first structures was the Amygdala. An almond-shaped set of neurons located deep in the brain’s medial temporal lobe.

It plays a key role in the processing of emotions and is linked to both fear responses and pleasure. For this reason it is often known as the “emotional brain”.

While a lot of research concentrates on the rational brain in the frontal cortex, not much is said about the Amygdala even though it plays a central role in so many current problems, including alcoholism, drug addiction, depression, and anxiety disorders.

Here is an in-depth look at the Amygdala.

Emotional learning

The Amygdalae perform the primary roles in the brain of the formation and storage of memories associated with emotional events. The most important of which are the memories that elicit fear behavior.

For dangerous situations this behavior can save our life but in today’s modern world it often acts in a role of paralysis, where the central nuclei is the genesis of many fear responses, including freezing (immobility), tachycardia (rapid heartbeat), increased respiration, and stress-hormone release.

Memory modulation

The Amygdala is also involved in the modulation of memory consolidation. Following any learning event, the long-term memory for the event is not formed instantaneously. Rather, information regarding the event is slowly assimilated into long-term (potentially life-long) storage over time, possibly forming permanent neural pathways.

Continue reading

Can I Be Your Trusted Friend?

The following is an un-edited letter I sent to a friend, similar to the one on Processed Foods. It represents a set of personal beliefs developed through experience, failure, and success. While I believe much of this to be dead-on there is much to disagree with. I welcome an open debate:)

—-

For thousands of years humans lived easily without ADD and ADHD “diseases.” It’s not that these symptoms didn’t exist rather it is that our lifestyles have changed. There is an increasing focus of daily life on controlled seated conditions for an ever increasing amount of people. This is a relatively new environment for humans and our culture has not yet learned how to function in it.

There are basic skills one can learn to alleviate the symptoms of ADD and ADHD, that if not taught by adulthood lead to destructive habits. The foundation of these skills is helping the individual to become self aware. Creating a sense of when things are normal and when they are not. Once that recognition can happen a series of coping mechanisms can be put into play. More on that later, but first some more background.

ADD as a problem (and not a disease) has been studied and worked on for decades in the field of education. The Montessori school system has developed a method of teaching that they believe is superior to public education, while also helping to alleviate the problems of ADHD. Of course their schools are only as effective as the parents allow it to be. Parents are a major problem in education because they often endured harsh conditions without learning these skills and expect their children to endure as well, though for much longer (college and graduate school).

The real battle in our public schools is not over testing but over new teaching styles. To improve the quality of our education we need to teach our students better. School testing is only a measure of how effective these new styles are. The most effective styles to date ironically focus on alleviating the root causes of ADHD, things like group work, outdoor activities, large projects with structured tasks, etc.

Understanding this history in American education helps explain some key issues involved with ADHD, namely culture, environment, and adults. For a child we can help to control all three and make the process of dealing with ADHD easier. For an adult the process is like hardened cement, only making progress through blasting old concrete and recasting new pieces.

Back to the original “cure.” The first step is to become self aware. Doing this often requires a trusted friend. One who can tell the person that they are exhibiting the behavior. It is hard on both parties to develop this routine since ADHD manifests itself in many ways, through boredom, anxiety, depression, over-excitement, and most importantly the individual is unaware of their own behavior. With practice and experience this becomes easily explained and noticed.

The second step is to develop a range of support tactics to employ when suffering an attack. This involves the individual being self aware of the issue and then selecting the right tactic, or trying several until one helps. The tactics can be anything from taking a long walk to reading a magazine. They are entirely situational and often require a fair amount of practice. They act like a bridge where one side is normal and the other side is normal. ADHD acts like the river in the middle always ready to sidetrack and take you away through panic, anxiety, or whatever. Having a bridge allows one to cope during the attack, let it subside, and then safely arrive at normal again.

ADHD is not the scourge of the modern world. It is a problem in our society that only a few truly understand, the rest suffer from it. To fix it requires a simple yet focused set of skills applied over time with another trusted individual. For children this trusted individual is often the parents or a teacher. For an adult it is a boyfriend, friend, or coworker. For those without any of these people it is a drug addiction.