Categories
Neurocognitive Disorders

Neurocognitive Disorders: What Are They?

When people think about different types of disorders that can affect the brain, many different things might come to mind. Depression, anxiety, epilepsy, autism spectrum disorder and other types of psychological and neurological disorders, probably top the list; however, there are plenty of other disorders that can have a significant impact on daily living and impact a huge number of people. One of these, in particular, is neurocognitive disorders.

Now, you might be asking yourself “what is a neurocognitive disorder?” If you are, don’t fret, there’s a reason you might not be as familiar with the diagnosis. The diagnosis of neurocognitive disorders was only added to the DSM-V, the most recent iteration of the manual. Prior to that, the closest diagnosis that existed was Delirium, Dementia, Amnestic, and Other Cognitive Disorders. The current diagnosis of neurocognitive disorders covers individuals with cognitive decline across many domains. While this might sound complex, this means that individuals who have issues with attention, executive functioning, like planning and organization, memory and/or language, that causes some significant level of impairment in their daily functioning would meet the qualifications to be diagnosed with a neurocognitive disorder.

There are two different methods that are used to classify neurocognitive disorders. The first way is by establishing the severity of symptoms with one of two diagnoses: major and minor neurocognitive disorders. For individuals that feel there are severe decline and significant impact on daily functioning, a diagnosis of major NCD would be more appropriate, whereas those with a mild decline and modest impairment would most likely be diagnosed with minor NCD. While some health care providers feel that the division between the two disorders are unnecessary and even artificial, most find this division to be helpful in terms of establishing a diagnosis much earlier than it has been previously.

The other classification within these diagnoses are based on the etiology, or the underlying issue, causing the neurocognitive issues. Some examples of these categories include Alzheimer’s NCD, vascular NCD, and frontotemporal NCD. This can be extremely helpful to specify what type of treatment an individual should be receiving. For example, the term dementia is frequently used synonymously with neurocognitive disorders. Using this term, however, might cause some to think that the associated disorders are exclusively Alzheimer’s disease, Lewy body disease or other types of neurodegeneration. These, however, are not the only types of diseases or disorders that can cause neurocognitive disorder to be diagnosed. Parkinson’s disease, vascular disease, HIV, substance abuse, traumatic brain injury and Huntington’s disease are all highly related with the cognitive decline that can be classified as a  neurocognitive disorder. Each of these specific diseases and disorders may all have a different underlying reason for how the cognitive issues came about, and therefore most likely would need different types of treatments to help resolve the symptoms that the individual is facing.

Though this is a new diagnosis, the symptoms that the individuals diagnosed with these disorders are faced with are not new. The prior confusing diagnoses did not fully explain why individuals were having cognitive problems and what these cognitive challenges are. This makes it much more complicated for both those with the diagnosis as well as those who are trying to understand or treat the individual. Hopefully, having a clear diagnosis will allow more people to get treated effectively for these cognitive complaints that come along with so many different diseases and disorders.

References:

Blazer, D. (2013). Neurocognitive Disorders in DSM-5. American Journal of Psychiatry, 170(6), 585-587. doi:10.1176/appi.ajp.2013.13020179

Ganguli, M., Blacker, D., Blazer, D. G., Grant, I., Jeste, D. V., Paulsen, J. S., . . . Sachdev, P. S. (2011). Classification of Neurocognitive Disorders in DSM-5: A Work in Progress. The American Journal of Geriatric Psychiatry, 19(3), 205-210. doi:10.1097/jgp.0b013e3182051ab4

Symptoms of Major Neurocognitive Disorder. (2017, August 24). Retrieved from https://psychcentral.com/disorders/symptoms-of-major-neurocognitive-disorder/

Symptoms of Minor Neurocognitive Disorder. (2018, February 04). Retrieved from https://psychcentral.com/disorders/symptoms-of-minor-neurocognitive-disorder/

Categories
Obsessive Compulsive Disorder

Peace in Calamity

You made sure multiple times to unplug your steam iron but now you’re in your Chemistry lab, unable to focus on your lab report for the past half an hour because you can’t seem to be sure if you really did unplug it and if it would cause the entire building to burn down. You’re having thoughts about walking back to the dormitory and seeing everything aflame. Police cars, ambulance, fire trucks and people crying all over because you forgot to unplug that iron. How will you ever live past being responsible for the lives of all those unsuspecting students? Jail is waiting for you and you’ll have to give up all your dreams of getting into grad school. What would your family and friends think? How would you console the parents of these students? This is the thought process of those enduring symptoms related to the checking form of Obsessive Compulsive Disorder (OCD).

OCD is different from person to person and is considered a chronic disease. If diagnosis of this mental illness in itself wasn’t difficult enough due to the existence of the numerous variations (ruminations, contamination, checking, hoarding, etc.), finding the right treatment also becomes problematic. Presently, OCD can be treated through a combination of means, but there is not necessarily a cure. If proper treatments are employed, a chance for recovery over time is definitely possible. A lot of different medications and treatment methods have been tested and were found ineffective and the research is still ongoing. According to Stanford Medicine: Clozapine, carbamazepine, lithium, clonidine, stimulants, ECT, sleep deprivation, and bright light therapy are not effective.

So then, what actually works? Medications such as selective and non-selective Serotonin Reuptake Inhibitors (SRIs), antidepressants, neuroleptics and other psychiatric ones are now commonly being used. Clinical psychologists or psychiatrists may prescribe more than one medication to effectively control OCD symptoms. Side effects are common with any form of medications but the risk for self-harm and suicide is higher with psychiatric meds. Although it’s reported that about 50% of patients respond well with solely behavior therapy, there are still many who have to take medication in conjunction with other forms of behavior therapy as well.

Some patients have tried forms of therapy which include: support groups, cognitive behavioral therapy (CBT), aversion therapy, psychoeducation, rational emotive behavior therapy, Exposure-response prevention (ERP), psychotherapy, systematic desensitization, group psychotherapy, and etc (Mayo Clinic). Out of these, many claim that ERP has been the most effective. Exposure-response prevention is a type of Cognitive Behavior Therapy (CBT) which has the patient face his or her fear without allowing them to perform their rituals (compulsions). It is effective for many, but not for all.

The ERP exposures may be applied in two ways; in real life (in vivo) or in imagination (imaginal). To better illustrate this form of treatment, in vivo ERP for someone experiencing concerns related to contamination would consist of having the patient shake hands with someone and having them resist the compulsions related to hand washing. Imaginal ERP for the same would involve having the patient imagine scenarios where they would shake hands and resist washing their hands. These procedures are followed through a structured manual and even if they don’t necessarily decrease the resulting distress, they are said to increase the tolerance towards the patient’s fears. It is then overtime repeated until the patient’s rituals in response to the fear decreases.

Although it isn’t discussed enough, OCD is one of the most debilitating mental illnesses. For similar reasons, it is often underdiagnosed and therefore, access to specialized treatment is also very limited. Everything related to treatment becomes even more difficult when there are chances of comorbidity with OCD and other forms of mental illnesses. For example, the relationship between obsessional ruminations and depression is particularly close: a diagnosis of obsessive-compulsive disorder should be preferred only if ruminations arise or persist in the absence of a depressive disorder. This makes it strenuous for those who are experiencing a variety of these symptoms. Research revolving more effective treatment is still at large and an ongoing effort. Hopefully, the search leads to giving these patients a peace of mind in their tumultuous times.

References:

The Different Types of Obsessive-Compulsive Disorder. Retrieved October 09, 2017, from www.ocduk.org/types-ocd

My experience of Postpartum OCD (2013, October 13). Retrieved October 09, 2017, from http://www.ocduk.org/my-postpartum-ocd

Obsessive-compulsive disorder (OCD). (2016, September 17). Retrieved October 09, 2017, from http://www.mayoclinic.org/diseases-conditions/obsessive-compulsive-disorder/diagnosis-treatment/treatment/txc-20245962

Behavior Therapy. (n.d.). Retrieved October 09, 2017, from http://ocd.stanford.edu/treatment/psychotherapy.html

Gillihan, S. J., Williams, M. T., Malcoun, E., Yadin, E., & Foa, E. B. (2012, May 30). Common Pitfalls in Exposure and Response Prevention (EX/RP) for OCD. Retrieved October 09, 2017, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3423997/

 

Categories
Uncategorized

DSM, Diagnoses, and Debate: The Many Dimensions of Mental Health

One of the biggest debates surrounding the field of psychology and its practitioners today is the debate concerning how exactly mental health diagnoses should be made. What defines a mental illness? Who determines what constitutes each specific illness and what gives them the credentials to do so?  In the early years of psychology, this very issue contributed to the struggle psychologists faced in legitimizing their field as a science.  Poor diagnostic techniques and lack of standardization of diagnoses made early psychological ventures appear more philosophically-based than factual and scientific.  Today, however, we have the Diagnostic and Statistical Manual of Mental disorders (DSM for short), first created in 1952 as a collective effort by the American Psychiatric Association to standardize psychological diagnoses and further legitimize the field of psychological study.  While the original DSM was a breakthrough in psychological study and treatment for the mentally ill, specifics on the diagnoses are still fiercely debated, and definitions are continually being revised and reworded to include and exclude certain elements of specific disorders.  These specific diagnostic criteria affect not only the psychologists doing the diagnosing — they also greatly impact the people themselves who are being diagnosed.

The debate over how exactly to diagnose patients and what constitutes each individual illness has become particularly relevant again recently, as the fifth version of the DSM was released just a few short years ago in 2013.  It was released to many mixed emotions over the changes that had been made from the previous version. Many psychologists are concerned with the fact that the DSM-V still emphasizes categorical diagnosis, maintaining the need for patients to meet specific criteria for disease diagnosis, which critics believe is outdated and less clinically relevant. Some have even begun working on an entirely new classification system that relies solely on dimensional diagnosis or diagnosing patients according to a spectrum of impairment or disability.  Proponents of this method argue that someone should not have to merely meet a certain “list” of symptoms, but that the severity of their symptoms should also be weighed heavily in their diagnosis.  

Not all of the updates should be criticized, however; the category for bipolar disorders, for example, has also been changed, expanded to include “an emphasis on changes in activity and energy — not just mood.” The phrase “mixed episode specifiers” has also been included in describing manic, hypomanic, and depressive episodes, allowing for more freedom in how patients describe the highs and lows related to their bipolar disorder.  Categories have also been added that describe episodes of short duration and anxiety-related specifications of bipolar disorder.  Thus, as it relates to bipolar disorder, the changes brought about in the DSM-V actually make diagnosis easier for patients struggling with a wide variety of symptoms, for the most part, and include categories and intricacies of the disease that may have been ignored by previous versions of the DSM.

While the clinical relevance of the DSM diagnostic criteria cannot be ignored, the changes in the definition of these diagnoses and the debate surrounding them impact more than just the list of signs and symptoms needed for a specific diagnosis. What about the patients behind the disorders?  How are these changes in diagnostic criteria affecting patients of specific diseases?  When categories are expanded or done away with, it can have a significant influence of the patients, whose diagnoses often become an integral part of their identity.  Melissa Miles McCarter, an author, academic, and publisher, reflects on her experience with bipolar and how it relates to her career and her everyday life, even becoming intertwined in the two.  She says, “Without medication, I deteriorate and become dysfunctional or am thrust into a deep depression followed by manic psychosis. However, if I had never had these challenges, even the bouts with severe mental illness, would I still be the same person — and would I want to be?” Another example of the effects diagnostic criteria can have on mental health patients is in the removal of Asperger’s Syndrome, placing patients that previously met that criteria into a new broadened category renamed “Autism Spectrum Disorder,” which sparked much debate among the Asperger’s community.  

While criteria specific to bipolar disorder and those diagnosed with this disease may have been benefitted from the DSM-V, many categories of illnesses are still under continuous debate.  Re-wording, rewriting, and recombining signs and symptoms of disorders affect not only the psychologists who must be familiar with diagnostic criteria — they also affect the patients whose identities are oftentimes tied quite closely with a disorder they have come to embrace as their “own.”  Unfortunately, no system is without its flaws, and this fact speaks to the current debates facing psychological diagnoses.  While psychologists continue to strive to make improvements to classifications of mental disorders, the interests of the ones who are actually suffering from the mental disorders must be balanced with the need for better classification systems and criteria.

References:

McLeod, S. A. (2011). What is psychology?. Retrieved October 9, 2017, from www.simplypsychology.org/whatispsychology.html

American Psychiatric Association (2017). DSM History. Retrieved October 1, 2017, from https://www.psychiatry.org/psychiatrists/practice/dsm/history-of-the-dsm

Whitbourne, S. K. (2013, May 4). What the DSM-5 Changes Mean for You. Retrieved October 1, 2017, from https://www.psychologytoday.com/blog/fulfillment-any-age/201305/what-the-dsm-5-changes-mean-you

Nauert, R. (2017). New Evidence-Based Diagnostic System Sees Shades of Gray. Psych Central. Retrieved on October 1, 2017, from https://psychcentral.com/news/2017/03/27/new-evidence-based-diagnostic-system-sees-shades-of-gray/118235.html

Grohol, J. (2013). DSM-5 Changes: Bipolar & Related Disorders. Psych Central. Retrieved on October 9, 2017, from https://pro.psychcentral.com/dsm-5-changes-bipolar-related-disorders/004312.html

Ketter, T.A. Solving clinical challenges in bipolar disorder. Presentation at: Psych Congress; September 16-19, 2017; New Orleans, LA.

McCarter, M.M. (2015, April 30). Mental Illness And Identity: Would I Shed My Bipolar Disorder Skin? Retrieved on October 9, 2017, from http://www.huffingtonpost.com/melissa-miles-mccarter/mental-illness-and-identi_b_7176674.html

Berrington, L. (2011, May 21). Asperger’s Removed from the DSM: How Will It Affect Autism Patients? Retrieved on October 1, 2017, from https://www.thedailybeast.com/aspergers-removed-from-the-dsm-how-will-it-affect-autism-patients

Categories
Depression

New Avenues for Treatment: Brain Imaging Study Identifies Different Types of Depression

Most of the estimated 16 million adults who live with depression find little relief with antidepressants. This is a problem that most researchers say lies in the way the disease is diagnosed.

In modern-day psychiatry, depression is diagnosed from a list of criteria. If a patient exhibits low mood and four additional symptoms from a list of nine, they are considered to be clinically depressed. However, depression is often not this black and white. Diagnosing depression from a list of nine very different and specific symptoms has led psychiatrists to use the same medication and treatment methods for a disease that manifests very differently from person to person. One individual might be gaining weight and sleeping a lot, while another might be losing weight and feeling anxious much of the time. However, under today’s protocol, both of these individuals would receive the same types of treatment for their depression.

It is this problem that led Conor Liston, a neurobiologist at Weill Cornell Medicine, to study the neurobiology of depression. Liston and his team realized that the current generalized approach to understanding depression has hindered patients from getting treatment that is tailored to their specific needs. In a recent study, Liston and his colleagues set out to find distinguishing characteristics for different types of depression in the form of biological markers.

In Liston’s study, over one thousand fMRI scans of both depressed and non-depressed individuals were analyzed. For each subject, the researchers analyzed 258 brain areas, measuring how strong the connections were within each area of the brain. Researchers found that one brain area, called the subgenual cingulate cortex, has unusually strong connections with other regions of the brain in people who are depressed. This conclusion led Liston and his team to identify four subtypes of depression. The first two subtypes tend to exhibit more fatigue, while the other two subtypes exhibit more restlessness.

This subtyping has implications for both pharmaceutical treatment and different types of therapy. For example, Liston and his colleagues found that individuals that experienced more fatigue with their depression were more likely to benefit from a newer therapy called transcranial magnetic stimulation, or TMS. This method produces small electrical currents in certain areas of the brain, and is usually reserved for individuals who haven’t been responsive to antidepressants. However, because of the identification of different subtypes of depression, Liston and his team are hoping to be able to tell which individuals will not be responsive to antidepressants at all. He is then hoping to develop a method where the physician could scan the patient’s brain through fMRI and target the under-stimulated areas of the brain with more specificity.

This new avenue of treatment and therapy will open up more avenues to treatment than just antidepressants and therapy. Hopefully, more Americans will be able to find treatment that is tailored to their specific depression symptoms, and fewer individuals will continue to suffer in silence.

References:

Drysdale, A. T., Grosenick, L., Downar, J., Dunlop, K., Mansouri, F., Meng, Y., … Liston, C. (2016). Resting-state connectivity biomarkers define neurophysiological subtypes of depression. Nature Medicine, 23(1), 28-38. doi:10.1038/nm.4246

Liston, C., Chen, A. C., Zebley, B. D., Drysdale, A. T., Gordon, R., Leuchter, B., … Dubin, M. J. (2014). Default mode network mechanisms of transcranial magnetic stimulation in depression. Biological Psychiatry, 76(7), 517-526. doi:10.1016/j.biopsych.2014.01.023