The Science of Mental Illness for Middle School Students

13 07 2013

If you are a teacher, check out this NIH Curriculum Supplement for Middle School students entitled: The Science of Mental Illness. In this supplement students gain insight into the biological basis of mental illnesses and how scientific evidence and research can help us understand its causes and lead to treatments and, ultimately, cures. As you can see below, it includes six interesting lessons.

Major Concept for Students
1. The Brain: Control Central The brain is the organ that controls feelings, behaviors, and thoughts, and changes in the brain’s activity result in long- or short-term changes to these.
2. What’s Wrong? Mental illnesses such as depression are diseases of the brain.
3. Mental Illness: Could It Happen to Me? Though everyone is at risk, factors such as genetics, environment, and social influences determine a person’s propensity to develop a mental illness.
4. Treatment Works! Medications and psychotherapies are among the effective treatments for most mental illnesses.
5. In Their Own Words Mental illnesses affect many aspects of a person’s life, but they can be treated so that the individual can function effectively.
6. You’re the Expert Now Learning the facts about mental illness can dispel misconceptions.

“Please hear this: There are not ‘schizophrenics’, there are people with schizophrenia.”

10 07 2012

Here is another fascinating story of a person with a health condition and disability. In this video by TED, Elyn Saks , a mental health law scholar and writer,  speaks for the rights of mentally ill people. In 2007, deep into her career, Saks dropped a bombshell–her autobiography, The Center Cannot Hold. In it, she reveals the depth of her own schizophrenia, now controlled by drugs and therapy. Clear-eyed and honest about her own condition, the book lent her new ammunition in the quest to protect the rights and dignity of the mentally ill. Thank you Namma for recommending this interesting lecture!

To watch and hear this lecture click HERE 

New medicinal concepts for psychiatric disorders

14 04 2012

In his recent editorial, Professor Jaak Panksepp illustrates how neuroscientists can significantly improve our understanding and treating depression and other psychiatric disorders.  For more information please click here.

The Role of Infections in Mental Illness

28 03 2012

This time I am “hosting” the Director of the National Institute of Mental Health Thomas Insel. I find this line of research very important and promising.

“In a visit to a mental asylum in 1912 you would have seen many patients with “general paresis.” The word “paresis” is Latin for weakness. General paresis was a form of psychosis with delusions, hallucinations, and memory problems often of rapid onset and thought to be due to a general constitutional weakness. At least that was the explanation until 1913, when general paresis was shown to be caused by syphilitic infection of the brain. The first treatments were awarded a Nobel Prize in 1917. The advent of antibiotics 30 years later led to the virtual eradication of neuro-syphilis, as the disorder came to be called, in this country.

The idea that mental or behavioral disorders could be due to infection is, therefore, not new but it remains surprisingly difficult to accept. When I was in training in the 1970’s, peptic ulcer disease was the prototype of a “biopsychosocial” disorder, with stress and a Type A personality considered the causes and psychodynamic therapy recommended as the treatment. Although helicobacter pylori was identified as the cause of peptic ulcer disease by Australians Robin Warren and Barry Marshall in the 1980’s, there was very little awareness (within the mental health community) that the disorder could be cured with antibiotics until Warren and Marshall received the Nobel Prize in 2005.

We may be looking at a similar reluctance to accept an infectious cause of pediatric sudden onset obsessive compulsive disorder (OCD) – in a debate that has been ongoing for almost two decades. In the early l990s, pediatrician Dr. Susan Swedo identified a subgroup of children whose OCD symptom onset didn’t fit the typical pattern. Instead of emerging gradually over weeks or months, they experienced ferocious bouts of compulsive behaviors and other symptoms “overnight and out of the blue.” As a pediatrician, Swedo’s familiarity with the ways of infectious agents and autoimmune mechanisms, together with her careful observations in the child psychiatry clinic of the NIMH Intramural Research Program, sparked the surprising hypothesis that a strep infection could trigger OCD symptoms via an autoimmune process.

This proved more complicated than syphilis or helicobacter. Part of the problem has been that strep is very common in childhood, making it methodologically difficult to prove a causal connection between the microbe and the OCD symptoms. The onset has not always been linked precisely with a strep infection and the critical increase in antibodies to strep has not been evident consistently. Nevertheless, immune-based treatments have proven successful, leading to the growing acceptance of the concept of Pediatric Autoimmune Neuropsychiatric Disorder Associated with Streptococcus (PANDAS).

Fortunately, the field is moving toward consensus on some of the larger issues, such as a broader concept of “acute and dramatic” onset of the same profile of psychiatric symptoms identified in PANDAS – but of unknown cause. There is also consensus on the need to establish a centralized registry to facilitate data analysis, so that causes and appropriate treatments can eventually be pinpointed.

This rapprochement recently took form in criteria for a broadened syndrome of acute onset OCD, published last month by Swedo, James Leckman at Yale and Joel Rose at Johns Hopkins. Their proposed Pediatric Acute-onset Neuropsychiatric Syndrome (PANS) builds on and subsumes PANDAS. It embraces youth who experience acute onset of OCD or anorexia symptoms, mixed with a varying profile of other neuropsychiatric symptoms – cause unspecified.

Meanwhile, to strengthen evidence in support of immune-based treatment for the subset of youth whose illness is strep-related, Swedo, Leckman, and Madeleine Cunningham of the University of Oklahoma, and colleagues, are collaborating on a multi-site, double blind, placebo-controlled trialExternal Link: Please review our disclaimer. It is testing intravenous immunoglobulin (IVIG) for OCD symptoms in PANDAS. IVIG, an infusion of normal antibodies, restores normal immune function by neutralizing errant antibodies. A similar pilot study testing IVIG and another immune-based treatment more than a decade ago found that all treated children with PANDAS improved, with more than half completely cured or experiencing only subclinical symptoms after one year.

Despite doubt in some quarters, hints of possible involvement of infectious agents and/or autoimmune processes in other serious brain disorders, such as autism, have spurred interest in PANDAS as a model for a type of illness process that may be more informative than widely assumed.

MRI scans of a PANDAS patient, showing reduced inflammation in the caudate nucleus(area circled just to the left of black area in center of brain), part of the basal ganglia, following IVIG treatment. Evidence suggests that this brain structure is targeted by errant anti-brain antibodies, triggered by a strep infection, in PANDAS”.


Swedo, SE, Leckman JF, Rose, NR. From Research Subgroup to Clinical Syndrome: Modifying the PANDAS criteria to describe PANS (Pediatric Acute-onset Neuropsychiatric Syndrome). Feb 2012, Pediatrics & Therapeutics.

The Psychiatric rehabilitation law in Israel

28 02 2012

In the past decades there have been substantial changes in the Israeli mental health field in general, and in the community based psychiatric rehabilitation in particular. These changes occurred both in policy making level and in practice level. Since 2001 the Israeli Ministry of Health has been in the process of developing community based psychiatric rehabilitation services as part of the implementation of the Rehabilitation in the Community of People with a Psychiatric Disability Law or “Psychiatric Rehabilitation Law”.

This law combines the rights of people with disability and the rights to dignity and liberty– in the psychiatric rehabilitation field prospective. The main goal of this law is “to work diligently for the rehabilitation and social inclusion of people with a psychiatric disability in order to allow them to achieve the maxim amount of independence and quality of life, while keeping their dignity according to the Basic Law: Human Dignity and Liberty” (2000).  Furthermore, this law emphasizes the importance of social inclusion of people with psychiatric disabilities as part of the rehabilitation process; and stated that all Israelis with a psychiatric disability will enjoy the right for community based psychiatric rehabilitation services provided by the country.

Nonetheless, while there are many developments in research and practice in this field in Israel, there are still many barriers that slow down the positive progresses in this field: the medical model approach is still dominant in policy and in budgets; the shift from the “protected” rehabilitation approach that encourages low functioning and social exclusion to “empowered” approach that encourages high functioning and social inclusion is slow; the passage from paternalistic attitude from many sectors in the system to a more self-definition attitude for the consumers and therapeutic practices and social attitude that maintain mental illness stigma and discrimination are still common; and still many people do not have access to psychiatric rehabilitation services.

For more information read these recent papers by Aviram, Ginat and Roe and by Drake, Hogan, Slade and Thornicroft.

For questions, clarifications and any other inquiries about this issue please feel free to contact me.

Have a great day!


Eating disorders

25 02 2012

Eating disorders… do we fully understand the reasons for these disorders? Do we fully acknowledge the dire consequences of anorexia, bulimia, and binge eating disorder? Do we really know how many people cope/suffer from these conditions? Are there enough professionals that know how to assist people with eating disorders to cope with the disorders symptoms? Are there enough resources for research, treatment and rehabilitation in this field? Well my friends, the answer for these questions is absolutely NO!

As part of my professional work I have been facing, more than once, with the lack of services for people with eating disorders in Israel. Personally, I had to deal with the tragedy of a very early dead due to an eating disorder (outside of Israel).

I call policy makers to recognise how prevalence and dangerous these health conditions are, and to allocate [much] more resources to reasearch and practice in this field.  Fortunately, Dr. Thomas R. Insel,  Director of the [American] National Institute of Mental Health (NIMH) is aware of the situation and is seeking to improve it.