New Links Found Between Brain Rhythm and Dissociation

What’s happening – Dissociation, the experience of feeling outside of the body, is a common symptom affecting people who have experienced a trauma. It can also occur in those with epilepsy. Now, a team of researchers working with the revolutionary neuroscientist Karl Deisseroth, MD, PhD, has identified mechanical changes in the human brain that seem to be connected to this state.

Using Dr. Deisseroth’s award-winning optogenetics technology (the use of laser lights to control a person’s brain activity), the team identified a rhythm that occurs in the posteromedial cortex section of the brain which may lead to dissociation. They also identified a protein that forms on the surface of neurons in the brain involved in generating this rhythm. The hope is that these findings will ultimately uncover new ways to prevent and treat dissociation.

Why it’s complicated – The researchers triggered neurons in one area of the brain to fire rhythmically. The dissociation symptoms that resulted were consistent with those that occur in epileptic individuals prior to having a seizure. But more work is needed to figure out how best to apply this knowledge.

 Learn more –  Read the full study by Vesuna S … Deisseroth K et al in Nature.

The perspectives –

  • NPR reports on this scientific breakthrough and how it may also lead to understanding other states of consciousness without the use of medication (say, ketamine).
  • A study in PLOS One paints a clearer picture of the experience of dissociation based on interviews with 12 patients. The findings offer real insights for clinicians.
  • Researchers publishing in the American Journal of Psychiatry look at how well brain measurements capture the severity of dissociation symptoms in people who experience trauma. They discovered that looking at the brain’s network connectivity in people who have experienced trauma may capture the most accurate picture.

The conversation –

  • @UCSF_Synapse tweets: “Though we still do not understand how consciousness is realized in the flesh, these experiments on dissociation provide one window on the phenomenon and how it changes forms in altered states. Read more and find out about the research on brain rhythm and dissociative states!”
  • @DrTamsinLee tweets: “Ketamine infusion for patients with #suicide ideation. Doses were increased to achieve disassociation. Disassociation was not an adverse effect. #science2stopsuicide”
  • @joarhalvorsen shares a Cambridge meta-analysis “indicating – contrary to popular clinical supposition – that baseline dissociation does not influence outcome of psychological treatments for PTSD.”

In practice – COVID-19 may be creating a new generation of trauma sufferers. More on psychedelic-assisted therapy in the clinical setting.

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Can Prazosin Further Aid in the Treatment of AUD Withdrawal?

What’s happening – Alcohol dependence, or alcohol use disorder (AUD), has long been a serious problem throughout the United States. With the COVID-19 pandemic triggering heavier drinking and substance abuse, more people with AUD are at risk of experiencing withdrawal symptoms as well as changes in mood, increased anxiety, and difficulty sleeping.

But the alpha-blocker prazosin, indicated to treat hypertension (and off label, to reduce alcohol cravings and PTSD-related sleep disturbance), may offer a powerful new way to address withdrawal symptoms and reduce cravings. A recent study of 100 individuals with alcohol dependence explored the drug’s effectiveness in reducing withdrawal symptoms and secondary outcomes of withdrawal.

The findings reveal that after 3 months of using prazosin (16 mg/day with 2-week titration), subjects with more severe withdrawal symptoms reported 7.07% heavy drinking days compared to 35.6% on placebo. In addition, patients experiencing serious withdrawal symptoms found that their depression, anxiety, and cravings for alcohol were significantly reduced while taking prazosin. The researchers concluded that there may be potential for further evaluating prazosin in select patient groups for the treatment of AUD. (Of note, the drug has also been studied for its benefits in relieving post-traumatic headache.)

Learn more – Read the full study by Sinha et al in the American Journal of Psychiatry.

 The perspectives –

  • The Addiction Policy Forum explores the study findings in a broader context and shares questions from NIAAA to help patients assess their own drinking habits.
  • A piece in the American Journal of Psychiatry looks at the benefits of using prazosin for managing severe withdrawal symptoms.
  • A recent Yale-led study looked at prazosin’s effect on stress and anxiety in relation to alcohol cravings. A related older animal model study in Alcohol and Alcoholism reported that prazosin may help to prevent the anxiety and stress that occurs when alcohol use is ceased.

 The conversation ­–

  • @psychopharmacol tweets: “M-A: Clonidine, an alpha‐2 agonist, significantly increased smoking abstinence [RR=1.39; 1.04-1.84]. The alpha‐1 antagonists prazosin and doxazosin decreased alcohol consumption but had no effect on abstinence or heavy drinking days”
  • @MilivojevicPhD reports: “Prazosin shows promise in normalizing stress-induced craving, anxiety, and autonomic and neuroendocrine response in early abstinence from alcohol!”
  • @ISAMAddiction tweets about a previous study, noting: “…Prozasin has an evidence base in treatment of nightmares in #PTSD, so this is an interesting study in a highly comorbid condition. Small (n=36) but some important learnings from this study, including optimal patient matching.”

In practice –More on alcohol-related dementia, alcohol and deaths of despair, and alcohol abuse by older adults. Plus, a primer on pharmacological options (MAT) for managing alcohol use disorder.

14 Mental and Behavioral Health Organizations Join Forces to Address Care Gaps

What’s happening – In response to the widespread impact COVID-19 has had on mental health in the United States, over a dozen national organizations have joined forces to form the Mental Health Coalition. The group’s mission is to advocate for important changes to the mental healthcare system to provide better policies and support. This coordinated response aims to specifically address the disproportionate impact the pandemic has had on people of color and of lower economic status, including treatment access.

(Update: The American Psychiatric Association issued a formal apology to BIPOC “for enabling discriminatory and prejudicial actions within the APA and racist practices in psychiatric treatment” on January 18 – the Martin Luther King, Jr, holiday – as part of its ongoing Task Force on Structural Racism)

Among the coalition participants are the: American Psychological Association, American Psychiatric Association, the National Alliance on Mental Illness, the National Association for Behavioral Healthcare, and Mental Health America, and others. The group has created A Unified Vision for Transforming Mental Health and Substance Abuse Care – essentially a blueprint meant to redefine the current system to help it to better meet the needs of the people it serves by focusing on prevention, intervention, and recovery, as well as more integrated programs.

 Learn more – Read the collaboration’s unified vision statement and follow their progress.

Why it’s complicated – More than half of all Americans are experiencing mental health struggles as a result of the COVID-19 pandemic, yet the current mental healthcare system is not adequately prepared to meet the needs that exist. (See our sister consumer site’s report on the shortage.)

The perspectives –

  • A statement from the NAMI highlights the need for the coalition to address racism and discrimination that lead to disparities in care and access.
  • A position paper in the Lancet recognizes the depth of the failings of our current mental health system amid rising cases of mental illness during COVID-19.
  • The WHO highlights the fact that many countries have broken mental health systems and calls for increased investments to strengthen services and meet the growing mental health needs.

 The conversation –

  • @vitalalabama (Early Intervention and Treatment Services) tweets: “We stand by @MentalHealthAm & others for a unified vision for transforming mental health & substance use care. Now more than ever there is a need for collective action to advance mental health & substance use disorder care in the United States.”
  • @OriginsOSU (Current Events with Historical Perspective) shares: “America’s mental healthcare infrastructure has long been unevenly distributed and inadequate. Covid-19 is making things much, much worse.”
  • @MentalHealthAm (Mental Health America) posted a blog on helping employed men through the pandemic.
  • @arianenoel (a consultant) shares: “Today on @MSNBC, @MentalHealthAm CEO @pgionfriddo shared how the pandemic has impacted the mental health of so many Americans. He also shared how the nation’s largest mental health orgs came together to create a unified vision for mental health.”

In practice  – Understand how psychiatric diagnosis is linked to higher COVID-19 mortality risk. How to manage patients with schizophrenia during the pandemic. A look at COVID stress on mental healthcare practitioners including views from Psych Congress.

Last Updated: Jun 16, 2021