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Disruptive, Impulse Control and Conduct Disorders

Comorbidity of Disruptive Behavior Disorders and ADHD

A child with ODD (Oppositional Defiant Disorder) or conduct disorder is more likely to be diagnosed with ADHD (Attention-Deficit/Hyperactivity Disorder) than a child with ADHD is to be diagnosed with ODD or conduct disorder. Research indicates that 50% of children with ADHD will either develop ODD or conduct disorder at some point in their development, which can explain why the percentage of adults and adolescents with ADHD and comorbid conduct disorder is higher than the percentage of children with ADHD or conduct disorder alone. About 40 % of individuals with ADHD have ODD, 27 % of children with ADHD have conduct disorder, 50 % of adolescents and 25 % of adults with ADHD have conduct disorder.

Attention Deficit Disorder, more commonly known as ADHD, is a struggle to live with on its own, but if a Disruptive Behavior Disorder gets tossed into the mix, it becomes even more complicated. Children with comorbid ADHD and conduct disorder engage in more delinquent behaviors than their peers and are at a higher risk of engaging in criminal behaviors in the future. They display “behavioral profiles similar to adult psychopaths” (Rapposelli, 2015). Those with comorbid ADHD and ODD express behaviors such as arguing, losing one’s temper, refusing to follow rules, blaming others for their behaviors, and deliberately annoying others. They are often angry, resentful, spiteful, and vindictive. In addition to this, youth with comorbid ADHD and ODD experience greater academic difficulties and rejection from their peers than youth with ADHD alone. There is an extremely strong relationship between academic failure, learning disabilities, and conduct disorder.

When there is a comorbidity between two disorders, it makes treating and living with both conditions complicated. A comorbidity of ADHD and ODD or ADHD and conduct disorder means that the quality of life will be very low due to the characteristics of both disorders. An individual with ADHD has the ability to learn information and skills, but they do not know how to use the information or implement those skills. This can cause them frustration and agitation. Throw in ODD, and you now have a person who is frustrated and agitated because their brain doesn’t let them use the information they have and they have a disregard for authority and rules. Conduct disorder involves extreme aggression, damaging property, and hurting other people and animals. When these symptoms are mixed with symptoms of ADHD, such as difficulty paying attention and the feelings associated with both these disorders, it becomes clear why these individuals have a low quality of life. But what can be done to help them?

Treatment options are available in the forms of therapy and medication, but emphasis is placed on preventative measures. Schools have psychologists and social workers who can help children with these disorders, but they cannot intervene at the early stages because there isn’t much research on the early signs of these comorbid disorders. Parents can be the first line of defense. Parents should be aware of their children’s behaviors, and if they notice their child acting overly aggressive, or having extreme difficulties in school, they should talk to a medical professional about it.

Early intervention after diagnosis is inherently important because the long term outcomes of children with comorbid ADHD and conduct disorder or ODD are vastly different from those with ADHD alone. One study followed two groups of children with ADHD. One group had comorbid ADHD and conduct disorder, the other group had ADHD only. At fourteen, 30% of the group with comorbid ADHD and conduct disorder had engaged in drug and alcohol abuse. There was no case of substance abuse in the other group. A similar study showed that one third of boys with ADHD and conduct disorder had committed multiple crimes as teenages whereas less than four percent of boys diagnosed with only ADHD had committed multiple crimes.

Research has also shown that early intervention can help individuals with comorbid ADHD and ODD or conduct disorder to have better academic performance, engage in social behaviors in a positive manner, and improve the overall quality of life. But in order to have early intervention, parents and schools need more resources and information about these disorders and their relationship to each other. Further research must be conducted in order to provide these resources to parents and schools.

References

Children and Adults with Attention-Deficit/Hyperactivity Disorder. (n.d.). Coexisting Conditions. Retrieved April 17, 2019, from https://chadd.org/about-adhd/coexisting-conditions/

Rabiner, D., Ph.D. (n.d.). Behavior Disorders that often co-occur with ADHD. Retrieved April 17, 2019, from http://www.helpforadd.com/co-occurring-disorders/

Rapposelli, D. (2015, September 9). Nipping ADHD and conduct disorder in the Bud. Retrieved April 17, 2019, from https://www.psychiatrictimes.com/adhd/nipping-adhd-and-conduct-disorder-bud

Skitterphoto. (n.d.). [Girl standing in field]. Retrieved April 17, 2019, from https://pixabay.com/photos/girl-bicycle-garden-people-outdoor-535251/

Turgay, A. (2005). Treatment of comorbidity in conduct disorder with attention-deficit hyperactivity disorder (ADHD). Retrieved April 17, 2019, from https://www.ncbi.nlm.nih.gov/pubmed/16222912

Virginia Commission on Youth. (2017). Disruptive, Impulse-Control, and conduct disorders. Retrieved April 17, 2019, from http://vcoy.virginia.gov/documents/collection/021 Disruptive ODD2.pdf

Categories
Disruptive, Impulse Control and Conduct Disorders

Parents of Children with Conduct Disorder

“My son is a monster.”

“Everywhere we go we are the talk of the town. ‘The circus act.’”

“I need advice on how to keep our family [safe] when [our] son wakes up at 2 AM.”

Did you ever imagine being a parent and believing one of the above statements about your child? Parents of children with conduct disorder have. According to Mental Health America, “Conduct disorder is a repetitive and persistent pattern of behavior in children and adolescents in which the rights of others or basic social rules are violated.” Conduct disorder is characterized by aggressive behavior that can cause harm to other people or animals; non-aggressive but destructive behaviors such as arson or deliberate damage of property; deceitfulness or theft; and serious rule violations that usually require some sort of action to be taken.

Conductdisorders.com is an online support forum for parents of children with conduct disorder. User InTheMoment shares that their son, who is currently in a mental health facility, went around punching other children and the police had to get involved. User Lost in Parenthood shares that their son has been kicked out of various programs because of his behavior problems. They write that their son “curses like a sailor” even though neither parent uses language like that. User Pixie Dusted is a target for their son, he tells them he hates them. He also steals, hurts his siblings, and breaks things. Sail 24 talks about their 15-year-old son who has gotten in trouble with the police for stealing, has been evicted from boarding schools, and abuses drugs and alcohol. They talk about how different their life was when their child was not home, “…I could relax, we could breathe again…We did the things we always wanted to do all those times we’d say, ‘If only he was different.’”

Caring for a child with conduct disorder is extremely taxing on the parents. Feelings similar to those of the parents in the forum are common. However, this does not mean that the parents love their children any less. Support groups, online forums, and family therapy can be very helpful for parents. Forums and support groups lets these parents know that they aren’t alone. They can ask each other for advice or just talk about challenging moments they have had. Lost in Parenthood says that deep down, their son “is the sweetest boy a mom can ask for” and they “cry just seeing how people treat him because they do not know” of his disorder. These parents would do anything for their child, like every other parent. But parents are humans too; they have feelings like every one of us. What makes it even more difficult for the parents of children with conduct disorder is that ultimately they hold themselves responsible for their children’s actions and behaviors. They can feel like they are held captive by their child’s disorder, and it hinders them from living their own lives.

References:

In The Moment. (2019, March 31). I need advise on how to keep our family save when son wakes up at 2 AM. Retrieved April 1, 2019, from https://www.conductdisorders.com/community/threads/i-need-advise-on-how-to-keep-our-family-save-when-son-wakes-up-at-2-am.66156/

Lost in Parenthood. (2019, March 22). My son is a monster. Retrieved April 1, 2019, from https://www.conductdisorders.com/community/threads/my-son-is-a-monster.66127/

Mental Health America. (2013, October 14). Conduct Disorder. Retrieved April 1, 2019, from http://www.mentalhealthamerica.net/conditions/conduct-disorder

Pixie Dusted. (2019, March 23). What do I do? Retrieved April 1, 2019, from https://www.conductdisorders.com/community/threads/what-do-i-do.66132/

Quintana, I. (n.d.). Retrieved April 1, 2019, from http://www.citationmachine.net/bibliographies/433956074?new=true

Sail24. (2018, March 12). 15 year old with conduct disorder needs to leave our home. Retrieved April 1, 2019, from https://www.conductdisorders.com/community/threads/15-year-old-with-conduct-disorder-needs-to-leave-our-home.64966/

Categories
Disruptive, Impulse Control and Conduct Disorders

President Trump and His “Defiance Disorder”

“Oh my God, he just tweeted this,” said Reince Priebus, President Trump’s former chief of staff. The tweets in question essentially banned transgender individuals from serving in the military. Priebus was supposed to attend a meeting that very same day to discuss four different policy options instead of the total ban, but there was “no longer need for a meeting.” Incidents like this are not uncommon in President Trump’s administration. His erratic behavior has been noticed, not only by his aids and the media but also by the rest of the world. Questions about Trump’s mental and physical wellbeing are rampant. Many individuals and professionals have attempted to diagnose the president from afar. But are any of the diagnoses valid? These individuals are not President Trump’s official health care providers. President Trump’s aids are present in the White House and they have daily, firsthand observations of his behavior, but they aren’t trained healthcare professionals. On the other hand, healthcare professionals who have attempted to diagnose the president, don’t have a presence in the White House. All of these factors have impacts on the validity of these diagnoses.

The scene laid out above was recounted in Howard Kurtz’s book, Media Madness: Donald Trump, the Press, and the War over the Truth. Kurtz works for Fox News, and has worked for the Washington Post as well. In his book, he claims that “Trump’s aides even privately coined a term for Trump’s behavior—‘Defiance Disorder’” (Parker, 2018). According to an article published by the Washington Post, this phrase refers to the President’s “seeming compulsion to do whatever it is his advisers are most strongly urging against, leaving his team to handle the fallout.” This statement specifically refers to Oppositional Defiant Disorder, ODD, which is a childhood disorder characterized by negativistic, argumentative, and hostile behavior patterns (Sue, Sue, Sue, Sue, 2017). Furthermore, this disorder can only be diagnosed in children. While the validity of this term can be argued, evidence revealing that the president has made his staff feel like he would do whatever he wanted and they would be left to clean up his messes cannot.

“Kurtz describes White House aides waking up one Saturday morning in March, confused and ‘blindsided,’ to find that Trump had — without any evidence — accused former president Barack Obama on Twitter of wiretapping him during the campaign…‘Nobody in the White House quite knew what to do,’ Kurtz writes.” (Parker, 2018)

The president also allegedly replaced Reince Priebus with then-homeland security secretary John Kelly without informing him. Kurtz writes “Typically, Trump announced the decision without telling Priebus and without having made a formal offer to Kelly.” Kurtz is not the only one to write a book about the inner-workings of the Trump administration. In his book, Fire and Fury: Inside the Trump White House, journalist Michael Wolff claims, “people close to Donald Trump consider him a ‘moron’ who acts ‘like a child” (Frisk, 2018).

Conflicting and misleading statements from Trump and his top aides have fueled questions about the White House’s credibility. It has sowed mistrust and instability within the West Wing and left some congressional Republicans wondering if they have a “good faith negotiating partner in the president” (Pace, 2018). A former GOP leadership aide said that Republicans were having difficulty negotiating with White House officials because of “the president’s willingness to undermine his own team’s public and private assurances” (Pace, 2018). White House officials have been put in a predicament which is resulting in them urging lawmakers to ignore some of the president’s statements. Representative Charlie Dent of Pennsylvania has been openly critical about the president, stating “Disorder, chaos, instability, uncertainty, intemperate statements are not conservative virtues in my opinion” (Pace, 2018). The president seems comfortable changing facts that vary in scope from the size of his inaugural crowd to the scope of tax bills (Pace, 2018). Furthermore, “the president rarely appears to be embarrassed or ashamed about repeating statements that have been proven false” (Pace, 2018). This has a serious impact on the credibility of the Trump Administration. A survey from Quinnipiac University showed that fifty-four percent of Americans believe that Trump is not honest, and numerous reports corroborate these findings. When a majority of the public feels as though the President is not honest, it is no surprise that they doubt his well-being.

Concerns about the president’s health, both mental and physical, extend beyond the White House. President Trump’s personal doctor, Harold Bornstein, declared him “the healthiest individual ever elected to the presidency” (Strauss, Dickerman, Eizenstat, Kruse, 2017). Yet that didn’t stop Politico Magazine from claiming “no occupant of the Oval Office has evinced less interest in his own health” (Strauss, et al., 2017). The president seems to believe that exercise leads to health complications (Strauss, et al., 2017). Mental health professionals started a petition on change.org, stating:

“We…believe in our professional judgment that Donald Trump manifests a serious mental illness that renders him psychologically incapable of competently discharging the duties of President of the United States. And we respectfully request he be removed from office, according to article 4 of the 25th amendment to the Constitution, which states that the president will be replaced if he is ‘unable to discharge the powers and duties of his office.’” (Gartner, n.d.)

A book has even been published titled The Dangerous Case of Donald Trump: 27 Psychiatrists and Mental Health Experts Assess a President. The president has been called out on his slurred speech, incoherence, and “increasingly erratic (and Freudian) tweets” (Levitz, 2018). Michael Wolff said “…inside of 30 minutes he’d repeat, word-for-word and expression-for-expression, the same three stories…” the repetitions would become more frequent, and Wolff claimed that Trump’s tweets were often a manifestation of these repetitions (Levitz, 2018). Journalist Eric Levitz argues that Wolff’s reporting establishes that Trump’s cognitive decline is affecting his daily functioning. Levitz writes that in response to President Trump’s tweet about “the size and potency of his nuclear button” one hundred mental-health professionals signed a statement claiming the president is “further unraveling” in ways that contribute to his “belligerent nuclear threats” (Levitz, 2018). They “urge those around him” and elected officials to take urgent action to “restrain his behavior” in order to diminish the potential of “nuclear catastrophe that endangers not only Korea and the United States but all of humankind” (Levitz, 2018).

Levitz argues that the president can be diagnosed from afar. The basis of this claim is that we have detailed accounts of the president’s behavior from people who work closely with him. He does not mention the possibility that these accounts are biased. They are not confidential conversations with a healthcare professional, in fact, they are the opposite. If the same people who have issued statements about the president’s health were to speak to a therapist, perhaps they would say something different. Generally, when a psychologist or psychiatrist makes a diagnosis, they have met with the individual being diagnosed and observed their behavior first-hand. They may meet with people who interact with the individual consistently, but those accounts alone are not usually the base for the diagnosis — they act more as supporting documents. How efficient is it to analyze someone using only testimonies from others?

Esquire magazine conducted a rather interesting “experiment” to determine whether the president’s behavior could be deemed “irascibly childish” (Fontana, 2017). They claim “His speeches and tweets are dominated by the kind of constant name-calling, defensive outbursts, mendacious gossip and repugnant innuendos usually overheard during schoolyard recess” (Fontana, 2017). They described “symptoms” to Dr. Megan Seltz, a clinical psychologist specializing in children with cognitive disorders. Dr. Seltz was under the impression that the patient whose symptoms were presented was an 8-year-old boy. Dr. Seltz’s opinion at the conclusion of the interview was that this hypothetical child is exhibiting signs of conduct disorder, but she could not diagnose him without a complete evaluation (Fontana, 2017). The source of all this controversy and diagnosis from afar seems to be that Trump publicly displays symptoms of mental disorder or neurological problems, and there is no office or position in place to evaluate his mental health.

The need for a role to determine a person’s mental capability to run a country is becoming increasingly more evident, as seen in Dr. James Hamblin’s article in The Atlantic. He writes, “A president could be actively hallucinating, threatening to launch a nuclear attack based on intelligence he had just obtained from David Bowie, and the medical community could be relegated to speculation from afar.” Factors such as age, and the magnitude of the weapons we now possess play a role on how stressful taking a seat in the oval office can be. The Constitution sets a lower limit for the age of the president, but there is no upper limit set. President Trump is seventy-two years old. Ronald Reagan was seventy-three when elected for his second term, making him the oldest president elected. Trump, if elected for a second term, will take his place.

With age, comes cognitive decline and a loss of brain matter. According to Dr. Hamblin, “After age 40, the brain decreases in volume by about 5 percent every decade” with the most apparent loss being in the frontal lobe, which controls speech and motor functioning. While this reasoning may not seem like enough to warrant the creation of a new role, it certainly raises the question of if there should be an upper age limitation as well. The magnitude of our weapons today is such that it is possible to “unilaterally destroy a continent, or the entire planet, with one quick decision” (Hamblin, 2018). Dr. Hamblin explains that the people responsible for actually launching missiles are tested three times a month on their ability to execute protocols. They are required to score at least 90 percent. He goes on to explain that ‘down-playing’ the president’s mental decline is not far from precedent. Franklin Delano Roosevelt hid his polio-induced paralysis from the public so as not to be seen as “weak or helpless.” It must be taken into consideration that the country’s circumstances during FDR’s presidency were immensely different. FDR became president during the height of the Great Depression, when 13 million Americans were unemployed. The country needed a strong leader to help boost morale. While unemployment rates are high today, they are not nearly at the same scale. It is also easier to hide paralysis than a mental illness. Hamblin also points out Trump’s speech patterns and how his ability to speak clearly and convey a message has declined over time. He mentions that the 25th Amendment assumes that “the president would be willing to undergo diagnostic testing and be forthcoming about any limitation,” and that this would be difficult with a person who has become known for “denying any hint of weakness or inability” (Hamblin, 2018). If a president had a mental disorder that impaired judgment, they also would not be likely to disclose information that might make them seem “weak.”

In 1994, President Jimmy Carter called for a system that could independently evaluate a president’s health and capacity to serve (Hamblin, 2018). “Carter called on ‘the medical community’ to take leadership in creating an objective, minimally biased process—to ‘awaken the public and political leaders of our nation to the importance of this problem’” (Hamblin, 2018). Twenty-five years later and we still haven’t taken action on this proposal. The questions surrounding President Trump’s mental health have spurred new proposals. Representative Jamie Raskin introduced a bill that would create an 11-member “presidential capacity” commission (Hamblin, 2018).

Dr. Hamblin claims that some may attempt to diagnose Trump from afar for the purpose of “political criticism” (Hamblin, 2018). According to him, this is dangerous for two reasons: (1) Labeling is “counterproductive” to the field because it increases the amount of stigma associated with psychiatric diagnosis, and (2) attributing Trump’s behavior to mental illness risks “devaluting mental illness” (Hamblin, 2018). It is a mental health professional’s job to be unbiased and non-judgemental. Hamblin suggests that a Carter-esque committee be formed, composed of “nonpartisan medical and psychological experts” that “need not have the power to unseat a president, undo a democratic election” (Hamblin, 2018). Hamblin recognizes that bias does play a role, but to a certain degree. And this degree isn’t large enough to render it “useless in assessing presidential capacity” (Hamblin, 2018).

The role of this proposed committee would be to issue a statement regarding the president’s fitness to execute the duties of the office he holds, the rest would be up to the people and their elected officials. This would attempt to provide the public with a transparent analysis of the person running the country. “The same cannot be said of the president’s cognitive processes,” Dr. Hamblin concludes, “We are left only with the shouts of experts from the sidelines, demeaning the profession and the presidency.”

References:

Fontana, K. (2017, October 11). How Do You Solve a Problem Child Like Donald Trump? Retrieved March 17, 2019, from https://www.esquire.com/news-politics/a49595/donald-trump-child-psychologist/

Frisk, A. (2018, January 22). Does Donald Trump have ‘defiance disorder?’: New book claims president’s aides think so. Retrieved March 16, 2019, from https://globalnews.ca/news/3979922/donald-trump-defiance-disorder-new-book-aides/

Gartner, J., Ph.D. (n.d.). Mental Health Professionals Declare Trump is Mentally Ill And Must Be Removed. Retrieved March 17, 2019, from Mental Health Professionals Declare Trump is Mentally Ill And Must Be Removed

Hamblin, J., Dr. (2018, January 03). Is Something Neurologically Wrong With Donald Trump? Retrieved March 17, 2019, from https://www.theatlantic.com/health/archive/2018/01/trump-cog-decline/548759/

Levitz, E. (2018, January 04). The President Is Mentally Unwell – and Everyone Around Him Knows It. Retrieved March 17, 2019, from http://nymag.com/intelligencer/2018/01/trump-is-mentally-unwell-and-everyone-around-him-knows-it.html?gtm=top

Pace, J. (2018, March 24). Trump’s impulses put White House credibility on the line. Retrieved March 17, 2019, from https://apnews.com/0a508c9559db4200aebe9d92c3c857ee

Parker, A. (2018, January 21). ‘Defiance Disorder’: Another new book describes chaos in Trump’s White House. Retrieved March 16, 2019, from https://www.washingtonpost.com/politics/defiance-disorder-another-new-book-portrays-chaos-in-trumps-white-house/2018/01/21/9362d160-febd-11e7-93f5-53a3a47824e8_story.html?noredirect=on&utm_term=.ca1502a70a99

Strauss, B., Dickerman, S., Eizenstat, S. E., & Kruse, M. (2017, July 18). Is the President Fit? Retrieved March 17, 2019, from https://www.politico.com/magazine/story/2017/07/18/is-the-president-fit-215385

Sue, D., Sue, D. W., Sue, D., & Sue, S. (2017). Essentials of Understanding Abnormal Behavior.

(3rd ed.). [Chegg]. Retrieved from https://ereader.chegg.com/#/books/9781305854703/

Categories
Disruptive, Impulse Control and Conduct Disorders

Intermittent Explosive Disorder

You’re at your favorite coffee shop on a beautiful morning. You’re happy; your morning has gone ideally, and it’s one of the best days you’ve had in a while. They call out your name to get your favorite drink, you take a large sip and…spit it all out.

Instantly, you are filled with a blinding rage—they’ve messed up your order!

You hurl it at the counter, cursing and screaming at everyone and everything around you.

You storm out, but by the time you get to your car, immense guilt has settled in.

You feel so bad, but you can’t face going back to apologize. You drive off and never return.

For someone with intermittent explosive disorder (IED), this happens regularly. Small things, like getting stuck in traffic on their way to work, can cause episodes of rage so intense, that the individual with this disorder can pose a threat to others or to themselves. Intermittent explosive disorder is a lesser-known mental disorder marked by episodes of unwarranted anger. It is commonly described as “flying into a rage for no reason” (Cleveland Clinic). Behavioral outbursts in an individual with intermittent explosive disorder are often disproportionate to the situation and often manifests itself in what seems like “adult temper tantrums” (Cleveland Clinic). Throwing objects, fighting for no reason, road rage, and domestic abuse are examples of intermittent explosive disorder. The outbursts typically last less than 30 minutes. After an outburst, an individual may feel a sense of relief – followed by regret and embarrassment.

IED often remains undiagnosed because of the nature of the disorder. People with this disorder are often labeled as “angry” and “impulsive”. The people around them don’t think to explore the underlying causes of the behaviors. Treatment options include cognitive behavioral therapy and medications, but they aren’t always effective. IED isn’t curable. These treatments attempt to make IED manageable by identifying triggers and teaching coping methods. However, the quality of life for many individuals who suffer from IED is still very low.

Carolina, age 31, who suffers from IED on a daily basis says, “I wish almost every day I could wake up and be someone else—a bubbly, happy, laughing girl who everyone likes and no one fears.”  She would see people shrug off incidents that would trigger her and feel both amazed and jealous. IED holds her back from the life she wants saying, “…I am dying for a family of my own and fear I won’t get it. All I’ve ever wanted was to be a mother and a wife. This is such a lonely life. Why am I this way?”

In her post on a support forum, she shared that two ex-boyfriends who were close to proposing left her because of her angry outbursts. One of them told her “he didn’t want to raise children in an environment where their mother would curse, shout and break things.”

She’s been fired for throwing a plant across the room at work. She also admits to calling her parents and yelling at them to the point where her mother starts crying. She feels regret and shame once the episodes pass, but she cannot control them:

“I was arrested in January for simple assault. I was in a verbally abusive relationship and my ex knew how to push my buttons. He one day went through my phone and said a bunch of crap to a guy friend of mine and then blocked him. When I found out the next day, I became enraged and physically beat my boyfriend to the point he called the police. Not only was I arrested but I was held in jail for two days…It was the lowest point of my life.” (Moon, C)

Carolina also shared that she has been taking medications and trying to manage her disorder for the past ten years. She says the medications will help calm her nerves with minor annoyances, such as road rage incidents. But she still struggles with IED every day, and she feels it is ruining her life.

Carolina’s feelings are not uncommon among those with IED. Many people feel like their disorder is ruining their lives and there isn’t much they can do about it. They worry about hurting those around them and themselves. Carolina is able to control some of her rage because she is receiving treatment. She understands that her disorder has a lot to do with her outbursts. However, someone who never received a diagnosis may be left wondering what is wrong with them. Caring for someone with IED is also a challenge. Support groups and classes are available to help caretakers understand what their loved ones need, and the best way to support them. IED is a relatively uncommon, often undiagnosed disorder. Parents assume their child is just being ‘difficult’ and don’t express their concerns to doctors or therapists. Expressing these concerns is crucial. Living with IED is not easy on the individual with the disorder or those around them, but living with undiagnosed, untreated IED is far worse.

References:

Cleveland Clinic. (n.d.). Intermittent Explosive Disorder Management and Treatment. Retrieved February 12, 2019, from https://my.clevelandclinic.org/health/diseases/17786-intermittent-explosive-disorder

Moon, C. (2016, July 20). IED is ruining my life: Intermittent Explosive Disorder Forum. Retrieved March 3, 2019, from https://www.psychforums.com/intermittent-explosive-disorder/topic184139.html

Staff. (2018, September 19). Intermittent explosive disorder. Retrieved March 3, 2019, from https://www.mayoclinic.org/diseases-conditions/intermittent-explosive-disorder/symptoms-causes/syc-20373921

Categories
Disruptive, Impulse Control and Conduct Disorders

Disruptive Behavior Disorders: What Are They?

Most of us have witnessed a toddler throwing a temper tantrum. For parents, toddler-hood entails endless screaming and crying. Toddlers behave in this way because they are experiencing emotions, but they do not have the tools to express them the way older children and adults do. As we age, we are supposed to outgrow these behaviors. We express our anger with words instead of fists pounding on the ground, we have the ability to explain why we are sad or frustrated. When a child fails to outgrow these behaviors, when they repeatedly lash out, are defiant and incapable of controlling their tempers, it can impair performance in school and cause serious family turmoil.

It’s easy to jump to the conclusion that a child who’s pushing or hitting or throwing tantrums is angry, defiant or hostile. But in many cases disruptive, even explosive behavior stems from anxiety or frustration that may not be apparent to parents or teachers. This “emotional dysregulation,” as clinicians refer to it, can reflect a number of underlying issues within broader umbrella of disruptive behavior disorders (DBDs). A major difference between DBDs and other mental health conditions is that with DBDs, the distress is focused outwards instead of inward. The dysregulated behavior is directed towards other people and property. This outward manifestation allows these disorders to be easily identified, however, the precise cause remains unknown. Risk factors include a family member with ADHD/Oppositional Defiant Disorder (ODD), depression or an anxiety disorder and environmental factors like stress in the home from divorce, separation, abuse, parental criminality or series of conflicts within the family. The disorders are also more likely to occur along with other conditions such as ADHD.

        Disruptive behavior, impulse control, and conduct disorders refer to a group of disorders that include oppositional defiant disorder, conduct disorder, intermittent explosive disorder, kleptomania, and pyromania. An estimated 6 percent of children are affected by oppositional defiant disorder or conduct disorders, and each year an estimated 2.7 percent of children and adults in the U.S. are affected by intermittent explosive disorder. Conduct disorders tend to begin in childhood or adolescence and are more common in males than females. Kleptomania and pyromania are rare, affecting 1 percent or fewer of people in the U.S.

Disruptive behavior disorders are made up of two subtypes: Oppositional Defiant Disorder (ODD) and Conduct Disorder. ODD is the less severe of the two, and is more understood than Conduct Disorder. Both are the more common of all the DBDs. Children with ODD display a persistent pattern of angry outbursts, arguments and disobedience. While this behavior is usually directed at authority figures, like parents and teachers, siblings, classmates and other children can also turn into its target. Conduct disorder is a highly complex condition, and its causes aren’t fully understood. It can involve cruelty to animals and people, other violent behaviors and criminal activity.

Treatment is available for DBDs, most often in the form of therapy. Cognitive behavioral therapy is the most common for treating DBDs, although group therapy and family therapy has also proven quite successful especially in children. Medication may be given to treat symptoms of ODD. Parents and caregivers of children are often taught ways to cope with and manage their child’s disorder. It is important for anyone suffering from any of these disorders to get help because DBDs greatly affect quality of life. Left untreated, these disorders can cause major problems in all aspects of life, often leading to substance abuse disorders.

References

DeMaso, D. R., MD. (2011). Disruptive Behavior Disorders | Boston Children’s Hospital. Retrieved February 20, 2019, from http://www.childrenshospital.org/conditions-and-treatments/conditions/d/disruptive-behavior-disorders

Ehmke, R. (n.d.). What Is Oppositional Defiant Disorder? Retrieved February 12, 2019, from https://childmind.org/article/what-is-odd-oppositional-defiant-disorder/

Nicklaus Childrens Hospital. (n.d.). Disruptive Behavior Disorders. Retrieved February 12, 2019, from https://www.nicklauschildrens.org/conditions/disorders/disruptive-behavior-disorders

Parekh, R., M.D., M.P.H. (2018, January). What Are Disruptive, Impulse-Control and Conduct Disorders? Retrieved February 12, 2019, from https://www.psychiatry.org/patients-families/disruptive-impulse-control-and-conduct-disorders/what-are-disruptive-impulse-control-and-conduct-disorders 

Categories
Neurodegenerative Disorders

Stem Cell Therapy: A Question of Ethics

Imagine you have been diagnosed with a disease, and you are told that there is no cure. There are treatments available to help with your symptoms, but they do not guarantee your quality of life, nor how much time you have left. Your doctor tells you that there are experimental treatments available, research studies you can participate in. The study mentioned in particular involves the use of embryonic stem cells.

Medicine is no stranger to the use of stem cells. A stem cell is defined as “a cell that has the ability to continuously divide and differentiate (develop) into various other kinds of cells [or] tissues” (Barker et al., 2013). In 1956, Dr. E. Donnall Thomas performed the first bone marrow transplant in Cooperstown New York. Bone marrow is a spongy tissue found in the center of bones, and it contains cells called haematopoietic (or blood-making) stem cells. Bone marrow is usually extracted from the lower spine using a needle. To obtain embryonic stem cells, however, scientists must harvest an embryo.

Scientists learned how to harvest stem cells from embryos in 1998, and while it was a major breakthrough, controversy also sparked as a result of it. Embryonic cells have a huge potential to help cure diseases and form treatments, but they could not be obtained without “destroying human embryos”. In 2006, scientists learned how to manipulate human cells to behave like stem cells. This breakthrough could have ended the controversy, but embryonic stem cells were still needed. The manipulated cells, called pluripotent cells, are compared to embryonic stem cells to determine how well they will work. Embryonic stem cells are also used as a control group in experiments. However, the other ethical issue present is that the manipulated cells  have the potential to turn into clones of the donor. Most countries have passed laws to prevent this from happening, but it remains an ethical issue.

We now know what makes embryonic stem cell therapy so controversial, but does the end justify the mean? Is it ethical to use embryonic stem cell therapy to help treat diseases that have no known cure? What if embryonic stem cells can be used to cure diseases that were otherwise incurable? In the case of neurodegenerative disorders, there are no known cures. Doctors treat symptoms to help improve the quality of life of those who have neurodegenerative disorders. But, could stem cell therapy help reverse the damage done by the disorders?

Stem cells have been used for the purpose of replacing and restoring cells lost through neurodegeneration in patients with Parkinson’s Disease, Multiple Sclerosis, Huntington’s Disease, Motor Neuron Disease, and others (Pen et al., 2016). Trials were designed to replace dopamine cells in patients suffering from Parkinson’s Disease; many younger participants benefited, but were not protected from disease progression (Pen et al., 2016). The common thread among various neurodegenerative disorders is the atypical protein formation and the induction of cell death  (Barker et al., 2013). Stem cells, whether they are pluripotent cells that have been synthesized in a lab or embryonic stem cells, can be grown and differentiated into a relevant cell type to replace cells lost in a disease process (Barker et al., 2013). Clinical trials are not abundant because pluripotent cells, which is seemingly the more ethical of the two, are still being refined (Barker et al., 2013). In addition to this, trials have not been conducted on humans because choosing who gets to participate poses another ethical dilemma (Barker et al., 2013). Factors such as age, disease type, duration of the disease, prognosis must all be considered when determining the subject pool for a study. Neurodegenerative disorders are not identical from person to person, thereby making the recruitment process of finding individuals whose diseases and situations resemble each others quite difficult.

Stem cell transplantation has been used in closely related fields, such as spinal cord injuries. For example, patients with complete spinal cord injuries were able to improve their neurological functions with the use of stem cells without severe adverse effects, and the damage done to the white matter tracts in the spinal cords were repaired (Barker et al., 2013). This lead to improvement in transmission of signals to and activity of the muscles in their legs. This change shows that the use of stem cells holds a new potential for treatments in the spectrum of neurological diseases (Barker et al., 2013). Scientists believe the same techniques can also be applied to  diseases such as Alzheimer’s Disease and Parkinson’s Disease, hopefully, reversing the damage done by the neurodegeneration. Stem cell use in the treatment of any disease will cause ethical questions to arise, it is no different when talking about its use in the treatment of neurodegenerative disorders. Stem cells have the potential to improve quality of life, decrease the progression of disease, and maybe even cure these disorders. However, we must ask ourselves, is it benefitting the greater good?

References

Australian Cancer Research Foundation. (2017, January 17). The first bone marrow transplantation in 1956 changed cancer treatment. Retrieved November 28, 2018, from https://home.cancerresearch/1956-the-first-successful-bone-marrow-transplantation/

Barker, R. A., & Beaufort, I. D. (2013). Scientific and ethical issues related to stem cell research and interventions in neurodegenerative disorders of the brain. Progress in Neurobiology,110. doi:10.1016/j.pneurobio.2013.04.003

Genetic Science Learning Center. (2014, July 10). The Stem Cell Debate: Is it Over? Retrieved November 28, 2018, from https://learn.genetics.utah.edu/content/stemcells/scissues/

Pen, A. E., & Jensen, U. B. (2016). Current status of treating neurodegenerative disease with induced pluripotent stem cells. Acta Neurologica Scandinavica,135(1). doi:10.1111/ane.12545

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Neurodegenerative Disorders

Multiple Sclerosis: A Neurodegenerative Disease

Multiple Sclerosis, more commonly known as MS, is a disease in which the body’s immune system attacks the central nervous system. The central nervous system is composed of the brain, spinal cord, and optic nerves. In individuals with MS, the immune system causes inflammation in the central nervous system that damages the myelin sheath, the protective covering of nerve fibers (also known as axons), as well as the nerve fibers themselves. The axonal destruction unfortunately causes irreversible neurological damage, which is why Multiple Sclerosis is primarily considered a neurodegenerative disorder (Ciffeli et al., 2002). Myelin is a fatty substance that surrounds, insulates, and protects the axons. Therefore, when the myelin sheath is damaged or destroyed, the central nervous system’s ability to send and receive messages is altered or stopped completely. The resulting damaged areas then develop scar tissue, which is where the disease gets its name — multiple areas of scarring or multiple sclerosis (condition of hardening or scarring).

Multiple Sclerosis is still widely regarded as a disease of the white matter in the brain, but recent evidence shows that there may be significant involvement of gray matter too (Boraschi et al., 2002). Grey matter contains nerve cell bodies, dendrites, and axon terminals of neurons (Villines, 2018). The gray matter is where all the synapses are. A synapse is the intersection between two dendrites. White matter, on the other hand, is where axons connect different areas of gray matter. Impulses are carried from the cell body through the dendrites, into the synapse. There, the axon from the receiving cell will pick up the impulse. In this process, the job of white matter is to conduct, process, and send nerve signals up and down the spinal cord. Therefore, damage to the white matter of your brain or spinal cord can affect your ability to move, use your sensory faculties, or react appropriately to external stimuli. Some people with damaged white matter may also experience deficits in reflexive reactions (Villines, 2018).

The damage to various areas of the central nervous system produces a variety of neurological symptoms that vary based on severity. Common symptoms of MS may include fatigue, numbness or tingling, difficulty walking, spasticity, and cognitive dysfunction, while less common symptoms may include speech problems, swallowing and breathing problems, tremors, seizures, and hearing loss (National Multiple Sclerosis Foundation).

While the cause of multiple sclerosis is still unknown, scientists believe it is triggered by a combination of factors. Therefore, research is ongoing in the areas of immunology (the study of the immune system), epidemiology (the study of disease patterns in large groups of people), and genetics (understanding genes that may not be functioning correctly in people who develop MS). Infectious agents are also being studied to see if there is a correlation between infections and multiple sclerosis. While there is no single risk factor that has been identified, a variety of factors are believed to contribute to the overall risk of developing multiple sclerosis.

Among these “risk factors” are geographical location, insufficient levels of vitamin D , smoking history, and obesity. For example, multiple sclerosis is known to occur more frequently in individuals who live in areas further from the equator. Data also suggests that exposure to some environmental agents before puberty may predispose an individual to develop multiple sclerosis. In addition, growing evidence has shown that low vitamin D levels are a risk factor for developing multiple sclerosis. Sunlight is a natural source of vitamin D, and areas closer to the equator are exposed to greater amounts of sunlight year-round than people living closer to the north and south poles. Another risk factor is smoking. As with many other diseases, smoking increases the risk for developing multiple sclerosis, and also increases the progression of the disease. Fortunately, the evidence also suggests that quitting smoking is associated with reduced risk and a slower progression of the disease. Lastly, childhood and adolescent obesity, particularly in females, may increase one’s risk of developing multiple sclerosis later on in life.

Although multiple sclerosis is not an inherited disease, there is a genetic risk factor associated with it. The probability of developing multiple sclerosis increases if a first degree relative (mother, father, siblings, children) has the disease. In identical twins, if one twin has the disease, the other twins risk for developing MS is about one in four. Approximately 200 genes have also been identified as contributing a small amount to the overall risk of developing multiple sclerosis, but additional research needs to be done to better understand these factors that contribute to the development of this disease.

Multiple sclerosis is thought to affect more than 2.3 million people worldwide. While the disease is not contagious or directly inherited, epidemiologists have identified factors in the distribution of MS around the world that may eventually help determine what causes the disease (National Multiple Sclerosis Foundation). These factors include gender, genetics, age, geography and ethnic background. Most people are diagnosed between the ages of 20 and 50, and although MS can occur in young children it is more prevalent in older adults. MS is at least two to three times more common in women than in men, thereby suggesting that hormones may also play a significant role in determining an individual’s susceptibility to acquiring multiple sclerosis. Overall, MS is a debilitating neurodegenerative disease that renders an individual unable to go about their day to day activities without experiencing pain and other symptoms. While no cure currently exists, there are various treatment options that can be utilized to treat the symptoms of this disease and improve one’s quality of life.

References

Boraschi, D., & Penton-Rol, G. (2016). Immune rebalancing: The future of immunosuppression. Amsterdam: Elsevier/Academic Press.

Cifelli, A., Arridge, M., Jezzard, P., Esiri, M. M., Palace, J., & Matthews, P. M. (2002). Thalamic neurodegeneration in multiple sclerosis. Annals of Neurology,52(5), 650-653. doi:10.1002/ana.10326

National Multiple Sclerosis Society. (n.d.). What Is MS? Retrieved from https://www.nationalmssociety.org/What-is-MS  

Villines, Z. (2018, August 02). Gray Matter vs. White Matter in the Brain. Retrieved from https://www.spinalcord.com/blog/gray-matter-vs-white-matter-in-the-brain

 

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Neurodegenerative Disorders

You Are What You Eat: The Role of Nutrition in Neurodegenerative Disorders

In my elementary school cafeteria, there was a poster right at the front of the lunch line. It was a “Got Milk” poster. When I went to middle school and high school, I found the same poster in the same spot. I grew up learning how important it was to eat my vegetables, and spent days watching Rachel Ray teach parents how to “trick” their kids into eating brussels sprouts and broccoli.

Our mindsets have changed since the fast food craze of the 1950’s. More notably in the recent years, our culture is starting to shift away from McDonald’s and Burger King towards healthy grocery stores like Whole Foods and Trader Joe’s. If you walk into a grocery store in 2018, words like “vegan”, “non-GMO”, “organic”, “gluten-free”,”soy-free” and “dairy-free”are not uncommon, which wasn’t the case a mere 15 years ago. Today, the government has even launched a campaign promoting water over juices and soft drink. Why is all of this important? We are told eating healthy and exercising is good for us. But, is it so good that it can prevent and/or delay neurodegenerative disorders?

The brain is an organ, and as any other organ it needs nutrients to build and maintain its structure. It needs to function harmoniously and protect itself from premature aging and diseases. Neurological development can be compromised in the presence of dietary deficiencies. For example, iron misregulation and accumulation in the brain is a possible cause for neurodegenerative disorders (Ke, et al, 2003). The brain needs nearly all nutrients; but, too many of the wrong vitamins and minerals can be harmful as well. Diet and exercise together can reduce age-related cognitive decline and the risk of neurodegeneration (Ke, et al, 2003).

A study conducted in Spain formulated a link between diet, inflammation, and neurodegeneration. Inflammation is a the body’s natural response an injury, to defend against foreign invaders, and to repair damaged tissue. Essentially, the body uses inflammation to heal itself, and it is beneficial to us. Inflammation is supposed to last a few days: the process is not instant. But when it lasts longer than the required time to heal, it causes a state of chronic low-grade inflammation, which may trigger the development of several diseases and disorders  by activating the body’s immune response (Wärnberg et al, 2009).

For many years, the brain was regarded as an organ that was not susceptible to inflammation and immune responses. Now we know this is not true (Wärnberg et al, 2009).

Neuroimmunomodulation, the study of inflammation and the nervous system, is a rapidly expanding field of research (Wärnberg et al, 2009). Multiple Sclerosis, or M.S., is a neurodegenerative disease characterized by inflammation that damages the myelin sheath, the protective coating on nerve fibers (National Multiple Sclerosis Society, n.d.). Recently it has been suggested that inflammation also plays a role in Alzheimer’s disease, HIV-related dementia, and memory loss after traumatic brain injury because it involves a substantial loss of nerve cells (Wärnberg et al, 2009).

Wärnberg and his fellow researchers suggest that following a healthy diet has a “dual effect on both reducing inflammation and meliorating neurodegenerative disorders,” (Wärnberg et al, 2009). Foods like grapes, apples, berries, pomegranates, and green tea are rich in antioxidant compounds that have anti-inflammatory properties and other related health benefits. Green tea aids in boosting metabolism, and apples contain fiber which is good for digestive health. Although the number of studies describing a link between foods and inflammation is low, the available evidence indicates that consuming vegetables and fruits, an antioxidant rich diet or vitamins, fiber, and magnesium aid in reducing inflammation. Wärnberg mentions that dietary and lifestyle pattern as a whole is more important than focusing on consuming a single nutrient (2009).

Chronic low grade inflammation can also be related to obesity, even at early ages. Other unhealthy habits, such as the “Western Dietary Pattern”, smoking and drinking, can also be linked  to chronic low-grade inflammation (Wärnberg et al, 2009). The “Western Dietary Pattern” is characterized as being high in refined sugars, starches, saturated fats, trans-fat, and poor in natural antioxidants and fibers from fruits, vegetables, and whole grains. Processed food increases inflammation level in the body, leading to chronic low-grade inflammation. The ideal lifestyle that would satisfy all strategies to reduce inflammation in the body would be characterized by no tobacco use, moderate physical activity, and a high intake of fruits, vegetables, legumes, whole grains, olive oil, and fish.

The Mediterranean diet is mentioned by name and is associated with a lower risk of several forms of cancer, obesity, high cholesterol, high blood pressure, diabetes, heart disease, overall mortality, and reduced levels of inflammatory markers (Wärnberg et al, 2009). The U.S. News lists the Mediterranean Diet as number one in the “Best Diets Overall” category and scores it 4.1 out of 5 stars. There is no calorie counting involved in this diet. Simply put, it involves eating more fruits, vegetables, whole grains, beans, nuts, olive oil, herbs and spices, red wine, and eating fish or seafood at least twice a week (Mediterranean Diet, n.d.). It advises to consume poultry (chicken), eggs, cheese, and yogurt in moderation, while sweets and red meat should be saved for special occasions. Moderate exercise is also advised (Mediterranean Diet, n.d.). This diet is not necessary to reduce inflammation, but a lot of the “do eats” overlap with the list of foods that fit in the ideal diet to reduce inflammation.

Fast food made it convenient and inexpensive to eat, but it wreaks havoc on our bodies. It may be costly and more inconvenient to eat healthy, but it truly has its benefits. What you put in your mouth matters. Eating nutritious foods will keep your body in balance and reduce the risk for many diseases and disorders, premature aging, and add to your quality of life. Incorporating healthier foods into your existing lifestyle is an excellent way to start implementing change. Overall, eating a well-balanced diet and avoiding processed foods reduces the amount of chronic low-grade inflammation in the body, which can prevent or delay the onset of neurodegenerative disorders such as Multiple Sclerosis and Alzheimer’s disease.

References

Ke, Y., & Qian, Z. M. (2003). Iron misregulation in the brain: A primary cause of neurodegenerative disorders. The Lancet Neurology, 2(4), 246-253. doi:10.1016/s1474-4422(03)00353-3

Mediterranean Diet. (n.d.). Retrieved from https://health.usnews.com/best-diet/mediterranean-diet

National Multiple Sclerosis Society. (n.d.). Definition of MS. Retrieved from https://www.nationalmssociety.org/What-is-MS/Definition-of-MS 

Wärnberg, J., Gomez-Martinez, S., Romeo, J., Díaz, L., & Marcos, A. (2009). Nutrition, Inflammation, and Cognitive Function. Annals of the New York Academy of Sciences, 1153(1), 164-175. doi:10.1111/j.1749-6632.2008.03985.x

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Neurodegenerative Disorders

Companion Animals and Alzheimer’s Disease

Alzheimer’s Disease (AD) is the fourth leading cause of death and the fifth leading cause of disability in the United States (Wilson, 2001). AD is a neurodegenerative disorder characterized by impairments in cognitive abilities including memory, language, judgement, and abstract reasoning (Wilson, 2001). Patients with AD constitute a large portion of the nursing home population (Wilson, 2001). The deterioration of the brain that characterizes AD results in numerous difficulties for both the individual suffering from the disease and the caregiver. As the brain deteriorates, the individual’s language abilities become increasingly impaired: this causes communication difficulties between persons with AD and their caregivers (Wilson, 2001). Typically, these disturbed communication patterns have a profound effect on the amount of time persons with AD spend interacting with others. As the communication impairments increase, the time spent interacting with caregivers and loved ones decreases, which is unfortunate because communication is a basic human need that maintains an individual’s contact with the environment while promoting a sense of security (Wilson, 2001). These communication impairments and cognitive impairments make it hard to understand information, thereby resulting in increased levels of stress and agitation for the persons with AD and their caregivers (Churchill, Safaoui, McCabe, & Baun, 1999).

Research studies have proved that using companion animals helps increase socialization and decrease agitation in persons with AD (Churchill et al., 1999). Caregivers can also experience reduced physiological stress by petting companion animals (Wilson, 2001). A study conducted in 1996 showed that having a companion animal reduced the psychological stress of caregivers caring for someone with a neurodegenerative disorder (Fritz, Hart, Farvar, & Kass 1996). Fritz and colleagues (1996) noticed that persons with Alzheimer’s Disease, who were attached to their companion animals, reported significantly fewer mood disorders than those who were not attached to their companion animals. However, they also noted that there was no significant difference in the rate of cognitive decline between those that were exposed to companion animals and those that were not, but there was a significant difference in feelings of agitation and aggression (Fritz et al., 1996). Companion animals have been used in healthcare settings to “reach” individuals who have reduced mental capacity, which hinders their ability to interact with others. Pets provide affection and companionship not contingent on cognitive or physical capacity (Fritz et al., 1996). In other words, pets don’t discriminate based on mental or physical capabilities. They offer  companionship and unconditional love.

A study conducted in 2002 in an Alzheimer’s special care unit set out to see what the effect of a “resident” dog would be on the patients. The behavior of the residents was noted one week prior to the dogs arrival and four weeks after the intervention. Results revealed that participants showed significantly fewer behavior problems during the four weeks spent with the dog (McCabe et al., 2002). The benefits of having companion animals around don’t stop there — in another study conducted by Purdue University, patients with AD improved their nutritional intake when they were around fish aquariums (Edwards et al., 2002). Nutritional intake increased when patients were exposed to the fish daily for two weeks, and continued to increase when exposed to the fish once a week for six weeks (Edwards et al., 2002). The participants in this study gained an average of 1.65 pounds and required less nutritional supplements (Edwards et. al. 2002).  

Lastly, companion animals help to decrease stress, anxiety, agitation, and anger levels in individuals. Whether it is a dog or a fish, having pets around has proven to be beneficial to health and has shown to help individuals with neurodegenerative disorders such as Alzheimer’s Disease. Overall, having a companion animal increases the quality of life for persons with AD and their caregivers by creating a less stressful atmosphere.

References

Churchill M., Safaoui J., McCabe B., Baun M. (1999). Using a therapy dog to alleviate the agitation and desocialization of people with Alzheimer’s Disease. Journal Psychosocial Nursing and Mental Health Services, 37(4) 16-22. doi: 10.3928/0279-3695-19990401-12

Edwards, N. E., & Beck, A. M. (2002). Animal-assisted therapy and nutrition in Alzheimer’s Disease. Western Journal of Nursing Research, 24(6), 697-712. doi:10.1177/019394502320555430

Fritz, C. L., Hart, L. A., Farver, T. B., & Kass, P. H. (1996). Companion Animals and the Psychological Health of Alzheimer Patients Caregivers. Psychological Reports, 78(2), 467-481. doi:10.2466/pr0.1996.78.2.467

Mccabe, B. W., Baun, M. M., Speich, D., & Agrawal, S. (2002). Resident Dog in the Alzheimer’s Special Care Unit. Western Journal of Nursing Research,24(6), 684-696. doi:10.1177/019394502320555421

Wilson, C. C. (2001). Companion Animals in Human Health. Thousand Oaks, CA: Sage.

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Neurodegenerative Disorders

The Role of Iron in Neurodegenerative Disorders

Watching a loved one slowly forget everything and everyone in their lives is a painful ordeal, which can be even more aggravating if there is no underlying cause. If a cause cannot be pinpointed, it becomes difficult to justify why such an instance of forgetfulness is occurring. Diseases do not discriminate; major influencers such as Stephen Hawking, Lou Gehrig, Michael J. Fox, Muhammad Ali, and Janet Reno have all suffered from neurodegenerative disorders. But, what is it that causes these disorders? Does it have to do with a person’s lifestyle or genetic predisposition? In actuality, scientists have recently found that the accumulation of iron and iron misregulation in the brain cause neuronal death, which in turn leads to neurodegenerative disorders (Qian, et al, 1998).

Our body needs iron to produce hemoglobin (Cole, 2014). Hemoglobin is the protein that helps red blood cells carry oxygen throughout the body. However, a lack of iron results in reduced levels of hemoglobin, which thereby reduces the amount of oxygen your body is actually absorbing. Being that iron is the most abundant trace metal in the brain, a problem may occur when the iron starts to accumulate and is misregulated.

Researchers have found that mutations in the genes that are supposed to regulate the iron content in the brain are what lead to the misregulation. These mutations can have genetic and non-genetic causes (Ke, et al, 2003). For example, neuroferritinopathy is a movement disorder caused by accumulation of iron in the basal ganglia. The basal ganglia is a group of neurons located deep within the cerebral hemispheres and are primarily involved in processing movement related information. They also process information related to emotions, motivations, and cognitive function. On the other hand, Friedreich’s ataxia is a genetic disease that causes progressive damage to the nervous system. Both of these diseases are associated with mutations in genes that encode proteins and are involved in iron metabolism (Zecca, et al, 2004).

Iron accumulation in the brain is thought to be normal as a person ages. However, high concentrations in certain areas such as the basal ganglia, have been linked to Alzheimer’s and Parkinson’s diseases, both of which are neurodegenerative disorders. In Alzheimer’s disease, iron accumulates in the brain without the age-relate increase in ferritin, which increases the risk of oxidative stress (Zecca, et al, 2004). Oxidative stress is harmful because it disrupts the normal functioning of the cell. Oxidative stress may damage the brain tissue therapy, worsening the progression of the disease or making an individual more susceptible to acquiring a new disease. It is also thought to increase plaque formation through its effects on protein processing. Parkinson’s disease is also associated with the accumulation of iron in the substantia nigra (Zecca, et al, 2004). The substantia nigra is a part of the basal ganglia, and produces the majority of the dopamine that originates in the brain. It is thought to play important roles in learning, drug addiction, emotion, and movement. This causes an increase in oxidative stress and protein aggregation, specifically of the alpha synuclei–the main component in Lewy bodies (Zecca, et al, 2004). Lewy bodies are abnormal aggregates of protein that develop in nerve cells, and are pathological  indicators of Parkinson’s disease.

Researchers believe that if we can understand the timing of iron mismanagement in relation to the loss of neurons in neurodegenerative disorders during aging that such observations can be used as a marker of disease progression. Also, it may assist in diagnosing these disorders before symptoms start to show. This information is also being used to develop new therapeutic strategies for the treatment of neurodegenerative disorders involving iron misregulation. Metal chelators have been used to try and reduce iron concentration in the brain, however there is no significant evidence of its clinical impact (Dusek, 2016). Iron removal therapy has been shown to slow down the progression of neurodegenerative disorders, and may even be able to prevent neurodegeneration. By preventing neurodegeneration, the goal of eradicating neurodegenerative disorders will be closer in reach.

References:

Cole, C., M.D. (2014, June 23). Why is Iron Important in My Diet?[PDF]. University of Michigan Health System.

Dusek, P., Schneider, S. A., & Aaseth, J. (2016, December). Iron chelation in the treatment of neurodegenerative diseases. Retrieved September 16, 2018, from https://www.ncbi.nlm.nih.gov/pubmed/27033472

Ke, Y., & Qian, Z. M. (2003). Iron misregulation in the brain: A primary cause of neurodegenerative disorders. The Lancet Neurology, 2(4), 246-253. doi:10.1016/s1474-4422(03)00353-3

Qian, Z. M., & Wang, Q. (1998). Expression of iron transport proteins and excessive iron accumulation in the brain in neurodegenerative disorders. Brain Research Reviews, 27(3), 257-267. doi:10.1016/s0165-0173(98)00012-5

Zecca, L., Youdim, M. B., Riederer, P., Connor, J. R., & Crichton, R. R. (2004). Iron, brain ageing and neurodegenerative disorders [Abstract]. Nature Reviews. Retrieved September 16, 2018, from https://www.nature.com/articles/nrn1537#references.