Reasons forPsychological or Psycho-Educational Assessment

Hearing that a psychological or psycho-educational evaluationor assessment would be a useful step for you or a loved one may leave youfeeling unsure, confused, or overwhelmed.  There are frequently manyunknowns associated with this process, including what an evaluation will entailor what the term even means.   In short, a psychological orpsycho-educational evaluation is a diagnostic process that aims to identify andunderstand both the areas of strength one possesses as well as possible rootcauses associated with the difficulties that may be interfering with greaterlevels of success and well-being.  Veryoften, there are many potential explanations for a concerning behaviorpattern.  For example, if a child isstruggling in school, does this stem from differences with attention, alearning disability, or some other issue such as anxiety or depression?  If an older adult is exhibitingforgetfulness, is this simply an age-related memory change or could some otherchange in brain functioning or mood be involved?  Identifying and understanding what areas ofstrength are available and are contributing to a person’s successes as well aswhat other factors are may be associated with areas of difficulty is often keyto clarifying diagnoses and to helping construct a comprehensive, accuratetreatment plan that maximizes successful outcomes.

How do I know anevaluation may be needed?  Evaluationscan address a variety of areas of functioning, such as academic performance,attention and focus, emotional functioning, memory, and social functioning.  Observable signs that an evaluation may bewarranted include changes in motivation or energy, increased anxiety or worry,changes in school- or work-related performance, declining confidence andself-esteem, poor organization or time management, and/or difficulties withsocial interactions.   

What can anevaluation do for me and my family?  Theprimary goal of an evaluation is to have a better understanding of what factorsare contributing to a person’s struggles, which in turn can inform whattreatment path will be best.  Havingrecommended accommodations for school/work/home, and being guided to the rightprofessionals for subsequent intervention (as needed), are tangible, “hands-on”benefits of an assessment.  In addition,knowing why a difficult-to-manage orupsetting behavior is present can help parents, spouses, siblings, and otherrelatives and friends have a more compassionate and empathic view of a person,which in turn goes a very long way in strengthening support andencouragement.  

How do I getstarted?  The first step to anevaluation is a one-hour appointment in which the client and/or parents and relativesmeet with Dr. Barrow to discuss their concerns and goals for an assessment.  She will have questions about the client’sbackground and current behavior, and can then formulate a targeted andindividualized testing plan.

Contact Dr. Barrow at 832-328-0008 ordr.barrow.lifetrek@gmail.com with further questions or to schedule an initialevaluation!

Many of us look forward to the holidays and hope that there will be a time of happiness, friendliness, fellowship, love, and harmony. Yet often our anticipation and excitement turns into feelings of stress, anxiety, depression and/or family disharmony.

The stressfulness of holiday events may be a part of what happens in the holiday season, in terms of mood changes and anxiety. It may also be caused by overdrinking, overeating, overspending, over committing and fatigue. The demands of the season are many: shopping, cooking and travel, house guests, family reunions, parties, office parties and extra financial burden.

Given our country's economic woes, the holidays have the potential to create additional challenges this year. Few people seem to have extra resources to spend on gifts, parties and extravagances. Families are cutting back, employees are worrying about job security and seniors are concerned about their retirement. In an online poll conducted this summer on stress, the American Psychological Association (APA) found that nearly three-quarters of Americans say they experience stress at levels that exceed what they define as healthy.

“It is normal to feel overwhelmed during the holiday season. The pressure to have the perfect holiday can be extraordinary,” says Dr. Katherine Nordal, executive director for professional practice at APA. “It is important to put things in perspective and realize that the materialism of the holidays isn’t the real spirit of the season. The holidays are about family and togetherness, not tinsel and presents.”

Stress from the ailing economy and the increasing costs of gas, housing and healthcare can leave you especially vulnerable to increased anxiety during the holidays.  Sometimes people who are not generally depressed actually struggle with holiday depression.

Symptoms can include headaches, insomnia, uneasiness, anxiety, sadness, intestinal problems, and unnecessary conflict with family and friends.

However, it is important to view the current economic situation as an opportunity to enhance your psychological well-being. Remember, there are conscious steps you can take to prevent holiday stress and ensure a worry-free season.  Here are some tools to get through the holiday season happily....as well as ways to prevent problems and misery for yourself and your loved ones:

Tips to prevent holiday stress and depression

When stress is at its peak, it's hard to stop and regroup. Try to prevent stress and depression in the first place, especially if the holidays have taken an emotional toll on you in the past.

1. Acknowledge and embrace your emotions. The holidays can be particularly stressful if you have recently lost someone you love or have gone through a divorce, or if you are spending the holidays alone. Recognize that your feelings of sadness and loneliness are normal. Allow yourself to express your emotions openly. It's OK to take time to cry or express your feelings.  Don’t force yourself to be happy just because it’s a holiday.  Remember, the holidays do not automatically take away feelings of loneliness, sadness, frustration, anger, and fear.

2. Keep your expectations realistic. The holidays don't have to be perfect or just like last year. As families change and grow, traditions and rituals often change as well. Choose a few to hold on to, and be open to creating new ones. For example, if your adult children can't come to your house, find new ways to celebrate together, such as sharing pictures, emails or videos.  The main focus is to make happy memories, rather than continue traditions for tradition’s sake.  The more relaxed an event, the more likely everyone will want to keep it up, making future holidays easier and more enjoyable for everyone.

View inevitable missteps as opportunities to demonstrate flexibility and resilience. A lopsided tree or a burned brisket won’t ruin your holiday; rather, it will create a family memory. If your children’s wish list is outside your budget, talk to them about the family’s finances this year and remind them that the holidays aren’t about expensive gifts

Your family probably isn’t like the Cleavers, and your holiday probably won’t end up like a TV special. In real life, problems happen. Maybe you overcooked the turkey. Maybe your sister couldn’t make the drive up. Maybe you didn’t get through all the things on your “to do” list. Don’t sweat the small stuff. The holidays are a time to celebrate and give thanks for everyone and everything that you have.

3. Set aside differences. Try to accept family members and friends as they are, even if they don't live up to all of your expectations. Set aside grievances until a more appropriate time for discussion. And be understanding if others get upset or distressed when something goes awry. Chances are they're feeling the effects of holiday stress and depression, too.

Be responsible for how you behave. You certainly have no control over how your relatives behave. The most important part of avoiding holiday stress with our families is for each of us to feel mastery over and satisfaction with, our own behaviors, attitudes & feelings. If you know in your head and your heart that you've acted like the best parent, child, brother, sister, friend that you know how to be, you can walk away from any difficulty feeling good about yourself.

Be careful about resentments related to holidays past. Declare an amnesty with whichever family member or friend you are feeling past resentments. It is not helpful to intimidate your relative or to tell each resentment on your list of grievances. Don't let your relative do that to you, either. 

4. Focus on any positive behavior you see in others and let them know you see it and appreciate it.  The holidays are a time of family togetherness – and all the family drama that goes with it. When family members cram together under one roof, it is not uncommon for tempers to flare. Keep the peace in your household by setting a good example and always being on the look out for what people are doing successfully. And if that doesn’t work, walk away or find some other alternative to avoid getting caught up in someone's situation. 

5. Have an attitude of gratitude. Misery and gratitude cannot occupy the same space in our psychological house, and we have the power to choose between these emotional states.

6. Plan a budget and stick to it. Between gifts, travel, food and entertainment, it’s easy to overspend during the holidays if you aren’t careful. It takes about four months for the average credit-card user to pay off holiday-related bills.  Before you go gift and food shopping, figure out how much money you can afford to spend on a holiday. Then stick to your budget and don’t spend a penny more. The barrage of holiday advertising can make you forget what the holiday season is really about. When your holiday expense list is running longer than your budget, scale back.  Remind yourself that family time together makes a celebration great, not store-bought presents, elaborate decorations or gourmet food.

Try these and other alternatives. Donate to a charity in someone's name, give homemade gifts or start a family gift exchange.  For gift-giving, it may be helpful to decide how much money you can spend on each person, then put that amount of cash directly into an envelope with the person’s name on it. When the envelope is empty, your shopping ends. No exceptions.

7. Plan ahead. Set aside specific days for shopping, baking, visiting friends and other activities. Plan your menus and then make your shopping list. That'll help prevent last-minute scrambling to buy forgotten ingredients. And make sure to line up help for party prep and cleanup.

Focus on one thing at a time. Instead of trying to do everything at once, separate your tasks and tackle them one at a time. That way, you will be less likely to get sidetracked or have your mind wander. It also helps to have a list of all of your tasks so you can mark off each one as you complete it. Plus, you’ll feel a greater sense of accomplishment when you can see all the things you have finished.

Decide upon your priorities and stick to them. Organize your time. Be reasonable with your schedule. Do not overbook yourself into a state of exhaustion--this makes people cranky, irritable, and depressed.

8. Simplify. If you feel pulled in too many directions during the holiday season (places to go and people to see), cut back on all of your outings. For example, trying to juggle too many activities: office holiday parties, church events, Christmas caroling, tree-lighting ceremonies, pictures with Santa Claus, the Nutcracker ballet. Let each member of your family pick one or two activities that mean the most to them and save everything else for next year.

9. Learn to say no. Saying yes when you should say no can leave you feeling resentful and overwhelmed. Don’t let anyone pressure or guilt you into taking on more than you can handle. Friends and colleagues will understand if you can't participate in every project or activity. Simply decline, nicely but firmly, for activities and engagements that you don’t have the time or energy to undertake. If you can’t say no (for example, to your boss), cut something else out of your schedule, try to remove something else from your agenda to make up for the lost time to make sure that you don’t become overbooked.

10. Stay healthy and don't abandon healthy habits or let the holidays become a reason for over-indulging.  Unnecessary weight gain and hangovers only adds to the strain and guilt and exacerbates depression and anxiety. Contrary to popular opinion, alcohol is a depressant. 

Watch what you eat. Have a healthy snack before holiday parties so that you don't go overboard on sweets, cheese or drinks. You’ll be less tempted to overeat on a full stomach. Continue to get plenty of sleep and physical activity. We all have a tendency to overindulge during the holidays with sweets, fats, carbohydrates and alcohol.

Unfortunately, the more fats and sugar you eat, the less energy you have, and you end up feeling even more stressed and run-down. To keep your energy up during the hustle and bustle of holiday preparation, try eating mini-meals throughout the day.

Exercise is one of the best ways to help your body beat stress. But when you’re running around with a “to do” list as long as Santa’s, hitting the gym is usually the last thing on your mind. Just as it is important to maintain your normal diet during the holidays, it is essential to keep up with your normal exercise routine.

If you can’t squeeze in that hour-long cardio class, take the dog on a quick jog around the block or throw the football around in the backyard with your nieces and nephews. Yoga is a great exercise for holiday stress relief: You can stretch your muscles and relax your mind at the same time.

11. Make time to take care of yourself.  Making some time for yourself may sound counter productive but spending just 15 minutes alone, without distractions, may refresh you enough to handle everything you need to do. All of us need some time to recharge our batteries—by slowing down you may actually have more energy to accomplish your goals while making you more fun to be around. Remember that you’re only one person and can only accomplish certain things. Sometimes self-care is the best thing you can do.

Find something that reduces stress by clearing your mind, slowing your breathing and restoring inner calm. Take a walk at night and stargaze, get a massage or take time out to listen to your favorite music or sip a cup of hot tea and/or read a book. A little alone time will help you recharge those batteries and help put the rest of your holiday stressors in perspective.

12. Reach out. If you feel lonely, depressed, or isolated, seek out community, religious or other social events. They can offer support and companionship. Traditionally, many holidays are about giving. Volunteering your time to help others also is a good way to lift your spirits and broaden your friendships.

Find a local charity, such as a soup kitchen or a shelter where you and/or your family can volunteer. Also, participating in a giving tree or adopt-a-family program, helping those who are underprivileged, volunteering to help with hospitalized children, the homeless, or the aged and disabled at the holidays can fill you with a sense of joy like nothing else, especially if you can’t be with your own family during the holidays. There are many, many opportunities for doing community service and this can be a powerful tool for beating back those holiday blues.

Talk about stress related to the holidays with your friends and family. Getting things out in the open can help you navigate your feelings and work toward a solution.

Seek professional help if you need it. Despite your best efforts, you may find yourself feeling persistently sad or anxious, plagued by physical complaints, unable to sleep, irritable and hopeless, and unable to face routine chores. If these feelings last for a while, you might be suffering from depression.  Talk to your doctor or consider talking with a professional such as a psychologist to help you develop coping strategies and better manage your stress. A psychologist has the skills and professional training to help people learn to manage stress and cope more effectively with life problems, using techniques based on best available research and their clinical skills and experience.

Take control of the holidays

To sum it up, the holidays are upon us with last minute stress.  But don't let this special time of year become something you dread. Make an early New Year’s resolution to simplify your life.  Remember the holidays are about family, friends and togetherness.  Remember not to expect your visions of dancing sugarplums, family and friends to be perfect.

Instead, take these recommended steps to prevent the stress and depression that can descend during the holidays. Learn to recognize your holiday triggers, such as financial pressures or personal demands, so you can combat them before they lead to a meltdown. With a little planning and some positive thinking, you can find peace and joy during the holidays.

If nothing else, please remember that, to a great degree, we have a lot of choices about our perceptions and the meanings we attach to what ever is going on around us.  You can only control what you think and what you do.  Focus your energy there. The choice is always yours. 

If your mood gets more negative than “the blues” and lasts for several days or weeks, seek professional help.

• ADHD
• Anxiety
• Autism
• Asperger’s
• Learning Differences
• Emotional Self-Regulation
• OCD
• Depression
• PTSD
• Addictions
• Anger / Rage
• Migraines / Headaches
• Sleep Issues
• Mild Traumatic Brain Injury

Brain Mapping

Everyone’s brain is unique.  In order to know what areas of the brain to train, we must first “map” your entire brain.   We can see what is going on in your brain and compare the data to that of a larger, non-symptomatic population.  With this information, we design a brain training plan personalized to you.

Brain Train Results

We often see noticeable improvements in clients within ten sessions. However, additional sessions may be recommended based on your needs. With sufficient training and learning, results can be lasting and often permanent. 

Medication / Other Therapies

Neurofeedback is used as both a stand-alone form of intervention, or as an adjunct to medication and other forms of therapy.  It often results in a reduced need for medication, or discontinuation of medication, depending on factors including the severity of the condition.

Effectiveness

Neurofeedback therapy was developed and researched by scientists and NASA engineers in the late 1960’s.  In the last thirty years, there have been more than 1,000 published journals supporting its effectiveness.  The
research continues to emerge. 

In 2000, Harvard neurologist Frank Duffy noted…"The literature … suggests that EBT (EEG Biofeedback Therapy) should play a major therapeutic role in many difficult areas. In my opinion, if any medication had demonstrated such a wide spectrum of efficacy it would be universally accepted and widely used.”

Start Today

At LifeTrek, our trained clinician is here to get you started.  Are you or your child ready to unleash your potential brain power? Call 832-328-0008 to schedule FREE 30-minute phone consultation with Neurotherpist Chau Nguyen, LMSW.

• ADHD
• Anxiety
• Autism
• Asperger’s
• Learning Differences
• Emotional Self-Regulation
• OCD
• Depression
• PTSD
• Addictions
• Anger / Rage
• Migraines / Headaches
• Sleep Issues
• Mild Traumatic Brain Injury

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"This is the first study that shows that taking stimulants for ADHD improves long-term school performance," said lead researcher Dr. William Barbaresi, a pediatrician at the Mayo Clinic in Rochester, Minn. "This includes reading achievement, being absent from school and being retained in a grade -- stimulant treatment was associated with better outcomes," he said.

Based on the findings, stimulant medication needs to be considered for every child with ADHD, Barbaresi believes.

"We can make that recommendation now on the basis of long-term improvement in the ways children's lives turn out, not just on the desire to control ADHD behavior symptoms," he said.

A companion study by the same group of researchers finds that children with ADHD are at heightened risk of lowered reading scores, absenteeism, repeating a grade, and dropping out of school.

Both papers are published in the September edition of the Journal of Development & Behavioral Pediatrics.

Experts estimate that in the United States almost 2 million children -- or about 3 percent to 5 percent of young children in the country -- have ADHD. ADHD affects a child's ability to focus and to control impulsive behaviors.

In the first study, Barbaresi's team followed more than 5,700 children from birth until they were 18 years old. Among these children, 277 boys and 93 girls were diagnosed with ADHD.

The Mayo team found that treatment with prescription stimulants, such as Ritalin, was associated with improved long-term academic success of children with ADHD.

Children taking stimulants usually began taking them in elementary school and continued on the medication for almost three years -- about 30.4 months.

By age 13, those taking medication had improved reading scores compared with children with ADHD who didn't receive the drugs, the researchers found. Furthermore, those children taking the highest doses had the most improved reading scores, Barbaresi's group added.

Children treated with medication also were less likely to be absent from school, and the longer they took the drugs, the less absenteeism was seen. In addition, children with ADHD who received stimulants were 1.8 times less likely to be held back a grade than children with ADHD who were not receiving the treatment.

In the second study, Barbaresi's team found that school outcomes for the average child with ADHD were significantly worse compared with children without the condition.

"Reading tests among children with ADHD are almost 30 points lower, children with ADHD are absent for a significantly greater number of days, and children with ADHD are almost three times more likely to drop out of school and be retained a grade," Barbaresi said.

These poor outcomes were equally likely for boys and girls with ADHD, Barbaresi said.

"We can't simply focus on the symptoms of ADHD," Barbaresi said. "We really need to be focusing on the risk for poor outcomes in school and in other aspects of the child's life," he said. "That's why we have to recognize these children and make sure they get appropriate treatment."

The studies were funded by grants from the U.S. Public Health Service, the U.S. National Institutes of Health, the Mayo Clinic, and McNeil Consumer and Specialty Pharmaceuticals, maker of the ADHD stimulant Concerta.

One expert hailed the findings.

"This study reinforces the value and long-term benefit of treatment with stimulant medication," said Dr. Andrew Adesman, chief of developmental and behavioral pediatrics at Schneider Children's Hospital in New York City. "It also highlights the risks that ADHD patients face and indicates that those risks can be mitigated by effective treatment," he said.

Another expert had a more mixed reaction to the studies.

"This study provides reassuring evidence that medication is not just blunting hyperactivity or enhancing alertness but actually doing so in a way that protects the capacity to learn," noted Dr. David Katz, director of the Prevention Research Center at Yale University School of Medicine in New Haven, Conn.

But drugs may not be the total answer, he added.

"Ritalin works but is not a desirable alternative to recess, which could perhaps work, too, in some cases at least," Katz said. "We need more attention to the underlying reasons for the rising prevalence of ADHD. Is it lack of physical activity; the highly processed modern diet; the over-stimulation of a multimedia environment; or all of the above?" he wondered.

1. No Name Calling.

2. No violence.

3. No fighting for longer than 15 minutes. If discussion lasts for longer then 15 minutes, it is not going to be resolved. Reschedule for another day and time.

4. Don't say never, always or you.

5. Say I feel, I need, I want, when I hear you say...I think or feel.

6. Don't go to bed angry.

7. Don't just say "I'm sorry"; include "please forgive me".

8. Use percentages to express how much each person wants to go to different activities, movies; for example, "I want to got to Taco Bell 10%" means it really doesn't matter. "I want to go 90%" means it matters a lot to you. (You need to be honest...don't say I want... 100% all the time).

9. Do not argue when hungry, angry, tired, or late at night.

10. Discuss only one topic at a time. It is not helpful to bring up old problems at the same time as discussing new problems.

11. Talk about how you feel hurt and why; anger is a secondary emotion.

12. Each partner needs to take no more than 50% of the responsibility for the communication problem. A relationship is a mutual agreement between 2 people and it does not come easily, it takes practice, work, and time.

“There are times when I’m overwhelmed with feelings of loneliness,” admits Max Allison of San Rafael, CA. “Even if I’ve been on some dates, overall I still feel very alone.”

Max isn’t the only one feeling this way. In fact, many single people feel lonely as they search for partners. “You can feel lonely when you are by yourself and have no one to connect with or when you are with others who are emotionally unavailable,” explains Rosalene Glickman, author of Optimal Thinking: How to Be Your Best Self.

To deal with your feelings effectively, she suggests asking yourself a few questions:

• What am I thinking or doing to create these feelings of loneliness?
• What is the best way to reach out and connect with a specific person/people today?
• What are the most loving actions I can take for another person/others today?

Your list is a plan of action. Learn to avoid those behaviors or thoughts that create or exacerbate your loneliness. Engaging in the positive activities will help, and they’ll keep you moving forward instead of wallowing.

There are other ways to keep your loneliness in check, such as:

• Get involved. “Service is one way to maintain positive connections with people,” says Susanne Alexander, author of Can We Dance? Learning the Steps for a Fulfilling Relationship. “Single Volunteers Inc. is a good organization to try, as is involvement with a religious congregation with a service mission.”
• Engage friends. “The best way I know to beat the lonelies is to hang out with my close friends,” says Dave Ruud of Madison, WI. “Spending time with my buddies always makes me feel like I’m a part of a team. We help each other out.”
• Have fun. “People don’t knock on our doors to find us, but they will spot us if we’re doing what we love,” explains Lewisburg, PA-based Rev. Ann Keeler Evans. “We’ll be surrounded by people who are interesting and interested in us. A person doing what he or she loves is someone whom everyone wants to meet. Your future beloved will find you fascinating because you will find your life fascinating.”
• Write it down. “When I start feeling lonely, I get out my journal and start writing,” says Tyleen Rodriguez of Tucson, AZ. “It helps me process my thoughts, follow my progress and plan for the future. Getting those feelings out of my system makes them go away faster.”

There’s also relief to be found in prayer. “During prayer, an optimal connection is initiated with the ultimate cosmic source,” Glickman says. “This powerful connection provides the religious person with an optimal venue to vent painful feelings, reflect on personal needs, and ask for them to be fulfilled.”

Here’s another way to look at it: “Prayer is wonderful because it will remind you of what you already know and possess,” says Debbie Mandel, author of Turn On Your Inner Light: Fitness for Body, Mind and Soul, “that God loves you the way you are and that you are never alone.”  This may be just the kind of comfort you need when those lonely moments come over you.

Chet has known Dave since they were in elementary school together, but lately their friendship has been strained. Dave's drinking on weekends has turned him into a completely different person. Dave used to get good grades and play sports, but since he started drinking he hasn't been finishing assignments and he has quit the soccer team.

When Chet saw Dave pound five beers in 30 minutes at two different parties, he realized how serious Dave's problem was. He knows what Dave is doing: binge drinking.

What Is Binge Drinking?

Binge drinking used to mean drinking heavily over several days. Now, however, the term refers to the heavy consumption of alcohol over a short period of time (just as binge eating means a specific period of uncontrolled overeating).

Today the generally accepted definition of binge drinking in the United States is the consumption of five or more drinks in a row by men — or four or more drinks in a row by women — at least once in the previous 2 weeks. Heavy binge drinking includes three or more such episodes in 2 weeks.

Why Do People Binge Drink?

Liquor stores, bars, and alcoholic beverage companies make drinking seem attractive and fun. It's easy for a high school student to get caught up in a social scene with lots of peer pressure. Inevitably, one of the biggest areas of peer pressure is drinking.

Other reasons why people drink include:

• They're curious — they want to know what it's like to drink alcohol.
• They believe that it will make them feel good, not realizing it could just as easily make them sick and hung-over.
• They may look at alcohol as a way to reduce stress, even though it can end up creating more stress.
• They want to feel older.

What Are the Risks of Binge Drinking?

Many people don't think about the negative side of drinking. Although they think about the possibility of getting drunk, they may not give much consideration to being hung-over or throwing up.

You may know from experience that excessive drinking can lead to difficulty concentrating, memory lapses, mood changes, and other problems that affect your day-to-day life. But binge drinking carries more serious and longer-lasting risks as well.

Alcohol Poisoning

Alcohol poisoning is the most life-threatening consequence of binge drinking. When someone drinks too much and gets alcohol poisoning, it affects the body's involuntary reflexes — including breathing and the gag reflex. If the gag reflex isn't working properly, a person can choke to death on his or her vomit.

Other signs someone may have alcohol poisoning include:

• extreme confusion
• inability to be awakened
• vomiting
• seizures
• slow or irregular breathing
• low body temperature
• bluish or pale skin

If you think someone has alcohol poisoning, call 911 immediately.

Impaired Judgment

Binge drinking impairs judgment, so drinkers are more likely to take risks they might not take when they're sober. They may drive drunk and injure themselves or others. Driving isn't the only motor skill that's impaired, though. Walking is also more difficult while intoxicated. In 2000, roughly one third of pedestrians 16 and older who were killed in traffic accidents were intoxicated.

People who are drunk also take other risks they might not normally take when they're sober. For example, people who have impaired judgment may have unprotected sex, putting them at greater risk of a sexually transmitted disease (STD) or unplanned pregnancy.

Physical Health

Studies show that people who binge-drink throughout high school are more likely to be overweight and have high blood pressure by the time they are 24. Just one regular beer contains about 150 calories, which adds up to a lot of calories if someone drinks four or five beers a night.

Mental Health

Binge drinkers have a harder time in school and they're more likely to drop out. Drinking disrupts sleep patterns, which can make it harder to stay awake and concentrate during the day. This can lead to struggles with studying and poor academic performance.

People who binge-drink may find that their friends drift away — which is what happened with Chet and Dave. Drinking can affect personality; people might become angry or moody while drinking, for example.

Alcoholism

Some studies have shown that people who binge-drink heavily — those who have three or more episodes of binge drinking in 2 weeks — have some of the symptoms of alcoholism.

Getting Help

If you think you or a friend have a binge-drinking problem, get help as soon as possible. The best approach is to talk to an adult you trust — if you can't approach your parents, talk to your doctor, school counselor, clergy member, aunt, or uncle.

It can be hard for some people to talk to adults about these issues, so an alternative could be a trusted friend or older sibling who is easy to talk to. Drinking too much can be the result of social pressures, and sometimes it helps to know there are others who have gone through the same thing. If you're worried, don't hesitate to ask someone for help. A supportive friend or adult could help you to avoid pressure situations, stop drinking, or find counseling.

How does grief affect faith? Perhaps a more useful question is how does faith affect grief? Losing a loved one in death is not easy. The experience can shake you mentally, physically, and spiritually. During the mourning process, it is not uncommon to rethink your beliefs about God and your relationship with God.

Part of this rethinking process includes adjustment to the loss of what has seemed to be an "absolute relationship." Most people do not plan for those who are close to them to die. Married couples, for example, tend to plan for their future together. Depending on their age, couples normally plan on raising children, buying a house, retiring, etc. In this sense, a close relationship may seem to most of us to be something that will never end. When these relationships do come to an end it can be a struggle to adjust to life without the one who was supposed to be there forever.

Part of this experience can be the concern about whether another absolute relationship, our relationship with God, might also end. For some people this concern may not be put into words or even fully understood. Yet this feeling can cause a real faith crisis for the bereaved person. Fear of abandonment by God often becomes a serious concern.

Faith does not have to be destroyed through the grief experience. In fact, faith can actually become stronger. People dealing with grief often report they find themselves feeling closer to God as they process their grief. In order for positive spiritual growth to occur, it may be necessary to seek some assistance in processing what has taken place and how your faith has been impacted by the grief experience.

Envisioning God on Your Side

Dealing with the death of a loved one is a time when being aware of God's presence is especially important. For some people it is a time when God actually seems more distant. How can you go about finding assurance of God's compassion for you?

One way is to envision God being on your side. Creating a mental picture of God can do this. Set aside some time, perhaps five to ten minutes at first, and try to imagine God's face. Select a time when no one else is going to be around so you won't be disturbed. As you concentrate on this image study God's facial expression. Look for the caring and concern on God's face. Imagine the gentle feeling of God's presence. Become aware that God is not critical of you but is genuinely concerned for you.

If this exercise is difficult for you, try writing God a letter. The letter is between you and God so no one else needs to read it. Because your letter is confidential, you are free to write whatever you want.

Write your letter in any style you prefer. The following outline may be helpful.

Praise
You may continue to feel God is active in your life even though you are grieving. If so, you might want to say 'thanks'. If you don't feel particularly grateful, don't feel obligated to write what you don't really feel.

Forgiveness
It's not unusual to ask God for forgiveness. Feelings of guilt are common in grief. You may even find yourself feeling responsible for things that happened in your relationship with the one that has died. This is an opportunity to get this feeling of guilt off your chest.

Petition                                                                                               This is simply asking God to help you. This is not a selfish act. Asking God for help is really a demonstration of your awareness of your own limitations. No one needs to struggle with life alone. Your requests to God can be for other people; even your deceased loved one.

Inspiration                                                                                            Ask God to keep you going. Tell God in your letter if you feel let down. There is no need to feel embarrassed about this request. Everyone needs God to give them a "pick me up" from time to time.

Our prayer is that you will find assurance of God's compassion for you.

Many people overthink because they're trying to solve problems or get over life traumas, says Stephen Lepore, a public-health researcher at Temple University .

But other methods are more effective. Writing one's deepest feelings about stressful experiences can improve health "and take the sting out. It acts like a buffer."

People who worry too much also can try these methods recommended by Yale University psychologist Susan Nolen-Hoeksema:

• Seek out new friends who prefer to help solve problems rather than indulge in mutual hand-wringing.

• Meditate or pray regularly.

• Schedule limited "overthink" sessions; don't do it any other time.

• Work on forgiveness and lowering unrealistically high expectations.

Adoption is a lifelong, intergenerational process that unites the triad of birth families, adoptees, and adoptive families forever. Adoption, especially of adolescents, can lead to both great joy and tremendous pain. Recognizing the core issues in adoption is one intervention that can assist triad members and professionals working in adoption better to understand each other and the residual effects of the adoption experience.

Adoption triggers seven lifelong or core issues for all triad members, regardless of the circumstances of the adoption or the characteristics of the participants:

1. Loss

2. Rejection

3. Guilt and Shame

4. Grief

5. Identity

6. Intimacy

7. Mastery/control

(Silverstein and Kaplan 1982).

Clearly, the specific experiences of triad members vary, but there is a commonality of affective experiences which persists throughout the individual's or family's life cycle development. The recognition of these similarities permits dialogue among triad members and allows those professionals with whom they interface to intervene in proactive as well as curative ways.

The presence of these issues does not indicate, however, that either the individual or the institution of adoption is pathological or pseudopathological. Rather, these are expected issues that evolve logically out of the nature of adoption. Before the recent advent of open and cooperative practices, adoption- had been practiced as a win/lose or adversarial process. In such an approach, birth families lose their child in order for the adoptive family to gain a child. The adoptee was transposed from one family to another with time-limited and, at times, shortsighted consideration of the child's long-term needs. Indeed, the emphasis has been on the needs of the adults--on the needs of the birthfamily not to parent and on the needs of the adoptive family to parent. The ramifications of this attitude can be seen in the number of difficulties experienced by adoptees and their families over their lifetimes.

Many of the issues inherent in the adoption experience converge when the adoptee reaches adolescence. At this time three factors intersect: an acute awareness of the significance of being adopted; a drive toward emancipation; and a biopsychosocial striving toward the development of an integrated identity.

It is not our intent here to question adoption, but rather to challenge some adoption assumptions, specifically, the persistent notion that adoption is not different from other forms of parenting and the accompanying disregard for the pain and struggles inherent in adoption.

However, identifying and integrating these core issues into pre-adoption education, post-placement supervision, and all post-legalized services, including treatment, universalizes and validates triad members' experiences, decreasing their isolation and feelings of helplessness.

Loss

Adoption is created through loss; without loss there would be no adoption. Loss, then, is at the hub of the wheel. All birth parents, adoptive parents, and adoptees share in having experienced at least one major, life-altering loss before becoming involved in adoption. In adoption, in order to gain anything, one must first lose--a family, a child, a dream. It is these losses and the way they are accepted and, hopefully, resolved which set the tone for the lifelong process of adoption.

Adoption is a fundamental, life-altering event. It transposes people from one location in the human mosaic into totally new configuration. Adoptive parents, whether through infertility, failed pregnancy, stillbirth, or the death of a child have suffered one of life's greatest blows prior to adopting. They have lost their dream child. No matter how well resolved the loss of bearing a child appears to be, it continues to affect the adoptive family at a variety of points throughout the families love cycle (Berman and Bufferd 1986). This fact is particularly evident during the adoptee's adolescence when the issues of burgeoning sexuality and impending emancipation may rekindle the loss issue.

Birthparents lose, perhaps forever, the child to whom they are genetically connected. Subsequently, they undergo multiple losses associated with the loss of role, the loss of contact, and perhaps the loss of the other birth parent, which reshape the entire course of their lives.

Adoptees suffer their first loss at the initial separation from the birthfamily. Awareness of their adopted status is inevitable. Even if the loss is beyond conscious awareness, recognition, or vocabulary, it affects the adoptee on a very profound level. Any subsequent loss, or the perceived threat of separation, becomes more formidable for adoptees than their non-adopted peers.

The losses in adoption and the role they play in all triad members lives have largely been ignored. The grief process in adoption, so necessary for healthy functioning, is further complicated by the fact that there is no end to the losses, no closure to the loss experience. Loss in adoption is not a single occurrence. There is the initial, identifiable loss and innumerable secondary sub-losses. Loss becomes an evolving process, creating a theme of loss in both the individual's and family's development. Those losses affect all subsequent development.

Loss is always a part of triad members' lives. A loss in adoption is never totally forgotten. It remains either in conscious awareness or is pushed into the unconscious, only to be reawakened by later loss. It is crucial for triad members, their significant others, and the professional with whom they interface, to recognize these losses and the effect loss has on their lives.

Rejection

Feelings of loss are exacerbated by keen feelings of rejection. One way individuals seek to cope with a loss is to personalize it. Triad members attempt to decipher what they did or did not do that led to the loss. Triad members become sensitive to the slightest hint of rejection, causing them either to avoid situations where they might be rejected or to provoke rejection in order to validate their earlier negative self-perceptions.

Adoptees seldom are able to view their placement into adoption by the birthparents as anything other than total rejection. Adoptees even at young ages grasp the concept that to be "chosen" means first that one was "un-chosen," reinforcing adoptees' lowered self-concept. Society promulgates the idea that the "good" adoptee is the one who is not curious and accepts adoption without question. At the other extreme of the continuum is the "bad" adoptee who is constantly questioning, thereby creating feelings of rejection in the adoptive parents.

Birthparents frequently condemn themselves for being irresponsible, as does society. Adoptive parents may inadvertently create fantasies for the adoptee about the birthfamily that reinforce these feelings of rejection. For example, adoptive parents may block an adolescent adoptee's interest in searching for birthparents by stating that the birthparents may have married and had other children. The implication is clear that the birthparents would consider contact with the adoptee an unwelcome intrusion.

Adoptive parents may sense that their bodies have rejected them if they are infertile. This impression may lead the infertile couple, for example, to feel betrayed or rejected by God. When they come to adoption, the adopters, possibly unconsciously, anticipate the birthparents' rejection and criticism of their parenting. Adoptive parents struggle with issues of entitlement, wondering if perhaps they were never meant to be parents, especially to this child. The adopting family, then, may watch for the adoptee to reject them, interpreting many benign, childish actions as rejection. To avoid that ultimate rejection, some adoptive parents expel or bind adolescent adoptees prior to the accomplishment of appropriate emancipation tasks.

Guilt/Shame

The sense of deserving such rejection leads triad members to experience tremendous guilt and shame. They commonly believe that there is something intrinsically wrong with them or their deeds that caused the losses to occur. Most triad members have internalized, romantic images of the American family that remain unfulfilled because there is no positive, realistic view of the adoptive family in our society.

For many triad members, the shame of being involved in adoption per se exists passively, often without recognition. The shame of an unplanned pregnancy, or the crisis of infertility, or the shame of having been given up remains unspoken, often as an unconscious motivator.

Adoptees suggest that something about their very being caused the adoption. The self-accusation is intensified by the secrecy often present in past and present adoption practices. These factors combine to lead the adoptee to conclude that the feelings of guilt and shame are indeed valid.

Adoptive parents, when they are diagnosed as infertile, frequently believe that they must have committed a grave sin to have received such a harsh sentence. They are ashamed of themselves, of their defective bodies, of their inability to bear children.

Birthparents feel tremendous guilt and shame for having been intimate and sexual; for the very act of conception, they find themselves guilty.

Grief

Every loss in adoption must be grieved. The losses in adoption, however, are difficult to mourn in a society where adoption is seen as a problem-solving event filled with joy. There are no rituals to bury the unborn children; no rites to mark off the loss of role of caretaking parents; no ceremonies for lost dreams or unknown families. Grief washes over triad members' lives, particularly at times of subsequent loss or developmental transitions.

Triad members can be assisted at any point in the adoption experience by learning about and discussing the five stages of grief: denial, anger, bargaining, depression, and acceptance (Kubler-Ross 1969).

Adoptees in their youth find it difficult to grieve their losses, although they are in many instances aware of them, even as young children. Youngsters removed from abusive homes are expected to feel only relief and gratitude, not loss and grief. Adults block children's expressions of pain or attempt to divert them. In addition, due to developmental unfolding of cognitive processes, adoptees do not fully appreciate the total impact of their losses into their adolescence or, for many, into adulthood. This delayed grief may lead to depression or acting out through substance abuse or aggressive behaviors.

Birthparents may undergo an initial, brief, intense period of grief at the time of the loss of the child, but are encouraged by well-meaning friends and family to move on in their lives and to believe that their child is better off. The grief, however, does not vanish, and, in fact, it has been reported that birthmothers may deny the experience for up to ten years (Campbell 1979).

Adoptive Parnets' grief over the inability to bear children is also blocked by family and friends who encourage the couple to adopt, as if children are interchangeable. The grief of the adoptive parents continues as the child grows up since the adoptee can never fully meet the fantasies and expectations of the adoptive parents.

Identity

Adoption may also threaten triad members' sense of identity. Triad members often express feelings related to confused identity and identity crises, particularly at times of unrelated loss.

Identity is defined both by what one is and what one is not. In adoption, birthparents are parents and are not. Adoptive parents who were not parents suddenly become parents. Adoptees born into one family, a family probably nameless to them now, lose an identity and then borrow one from the adopting family.

Adoption, for some, precludes a complete or integrated sense of self. Triad members may experience themselves as incomplete, deficient, or unfinished. They state that they lack feelings of well-being, integration, or solidity associated with a fully developed identity.

Adoptees lacking medical, genetic, religious, and historical information are plagued by questions such as: Who are they? Why were they born? Were they in fact merely a mistake, not meant to have been born, an accident? This lack of identity may lead adoptees, particularly in adolescent years, to seek out ways to belong in more extreme fashion than many of their non-adopted peers. Adolescent adoptees are over represented among those who join sub-cultures, run away, become pregnant, or totally reject their families.

For many couples in our society a sense of identity is tied to procreation. Adoptive parents may lose that sense of generativity, of being fled to the past and future, often created through procreation.

Adoptive parents and birthparents share a common experience of role confusion. They are handicapped by the lack of positive identity associated with being either a birthparent or adoptive parent (Kirk 1964). Neither set of parents can lay full claim to the adoptee and neither can gain distance from any problems that may arise.

Intimacy

The multiple, ongoing losses in adoption, coupled with feelings of rejection, shame, and grief as well as an incomplete sense of self, may impede the development of intimacy for triad members. One maladaptive way to avoid possible reenactment of previous losses is to avoid closeness and commitment.

Adoptive parents report that their adopted children seem to hold back a part of themselves in the relationship. Adoptive mothers indicate, for example, that even as an infant, the adoptee was "not cuddly.'' Many adoptees as teens state that they truly have never felt close to anyone. Some youngsters declare a lifetime emptiness related to a longing for the birthmother they may have never seen.

Due to these multiple losses for both adoptees and adoptive parents, there may also have been difficulties in early bonding and attachment. For children adopted at older ages, multiple disruptions in attachment and/or abuse may interfere with relationships in the new family (Fahlberg 1979 a,b).

The adoptee's intimacy issues are particularly evident in relationships with members of the opposite sex and revolve around questions about the adoptee's conception, biological and genetic concerns, and sexuality.

The adoptive parents' couple relationship may have been irreparably harmed by the intrusive nature of medical procedures and the scapegoating and blame that may have been part of the diagnosis of infertility. These residual effects may become the hallmark of the later relationship.

Birthparents may come to equate sex, intimacy, and pregnancy with pain leading them to avoid additional loss by shunning intimate relationships. Further, birthparents may question their ability to parent a child successfully. In many instances, the birthparents fear intimacy in relationships with opposite sex partners, family or subsequent children.

Mastery/Control

Adoption alters the course of one's life. This shift presents triad members with additional hurdles in their development, and may hinder growth, self-actualization, and the evolution of self-control.

Birthparents, adoptive parents, and adoptees are all forced to give up control. Adoption, for most, is a second choice. Birthparents did not grow up with romantic images of becoming accidentally pregnant or abusing their children and surrendering them for adoption. In contrast, the pregnancy or abuse is a crisis situation whose resolution becomes adoption. In order to solve the predicament, birthparents must surrender not only the child but also their volition, leading to feelings of victimization and powerlessness that may become themes in birthparents' lives.

Adoptees are keenly aware that they were not party to the decision that led to their adoption. They had no- control over the loss of the birthfamily or the choice of the adoptive family. The adoption proceeded with adults making life-altering choices for them. This unnatural change of course impinges on growth toward self-actualization and self-control. Adolescent adoptees, attempting to master the loss of control they have experienced in adoption, frequently engage in power struggles with adoptive parents and other authority figures. They may lack internalized self-control, leading to a lowered sense of self-responsibility. These patterns, frequently passive/aggressive in nature, may continue into adulthood.

For adoptive parents, the intricacies of the adoption process lead to feelings of helplessness. These feelings sometimes cause adoptive parents to view themselves as powerless, and perhaps entitled to be parents, leading to laxity in parenting. As an alternative response, some adoptive parents may seek to regain the lost control by becoming overprotective and controlling, leading to rigidity in the parent/adoptee relationship.

Summary

The experience of adoption, then can be one of loss, rejection, guilt/shame, grief, diminished identity, thwarted intimacy, and threats to self-control and to the accomplishment of mastery. These seven core or lifelong issues permeate the lives of triad members regardless of the circumstances of the adoption.

Identifying these core issues can assist triad members and professionals in establishing an open dialogue and alleviating some of the pain and isolation that so often characterize adoption. Triad members may need professional assistance in recognizing that they may have become trapped in the negative feelings generated by the adoption experience. Armed with this new awareness, they can choose to catapult themselves into growth and strength.

Triad members may repeatedly do and undo their adoption experiences in their minds and in their vacillating behaviors while striving toward mastery. They will benefit from identifying, exploring and ultimately accepting the role of the seven core issues in their lives.

The following tasks and questions will help triad members and professionals explore the seven core issues in adoption:

List the losses, large and small, that you have experienced in adoption.
Identify the feelings associated with these losses.
What experiences in adoption have led to feelings of rejection?
Do you ever see yourself rejecting others before they can reject you? When?
What guilt or shame do you feel about adoption?
What feelings do you experience when you talk about adoption?
Identify your behaviors at each of the five stages of the grief process. Have you accepted your losses?
How has adoption impacted your sense of who you are?

Researchers have known for years that psychological trauma that results in post-traumatic stress disorder (PTSD) or depression can change how a person responds to stress. Now, Cornell researchers report that rapes, sudden deaths of loved ones, life-threatening accidents and other such traumas may result in long-term changes even if the survivor doesn't develop a clinical disorder.

"The findings suggest that there may be persistent differences in the stress response in some trauma-exposed people, even if they do not exhibit PTSD or depression or both, and even if their trauma was years in the past," said Barbara Ganzel, a lecturer in human development in Cornell's College of Human Ecology.

Ganzel led a team of Cornell researchers, whose study is published in a the Journal of Traumatic Stress on the biology of trauma. They assessed a group of women before and after they took their medical admissions tests (MCATs), a stressful experience for most people. Measuring levels of a stress hormone in saliva (cortisol), they found that women who had experienced trauma earlier in life (but who did not have PTSD or major depression) had lower levels cortisol leading up to and after the MCAT exam.

In addition, they found that the women who had experienced trauma kept a negative mood after the test, compared with other women, whose moods lifted significantly after the exams.

Ganzel suspects that the stress response system in these women have compensated or changed over time. The trauma-exposed women showed lower rather than higher levels of cortisol, Ganzel theorized, because "stress initially boosts cortisol output but after the stressor is over, cortisol falls below normal. These data suggest that, in some people, it may fall below normal and stay there, or that it develops a chronic tendency to dip lower than normal under stress."

The other co-authors are John Eckenrode, Pilyoung Kim, Elaine Wethington, all in human development at Cornell; Eric Horowitz '07; and Elise Temple, formerly of Cornell and now at Dartmouth College.

The research was supported by the College of Human Ecology, the Family Life Development Center and the Laboratory for Developmental Cognitive Neuroscience at Cornell, as well as by the National Institute of Mental Health. Bottom of Form

Drawing from data in the nation’s largest real-world study of treatment-resistant depression, a team led by researchers at Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center reported in November’s Medical Care journal that African-Americans and Latinos didn’t respond as well as whites to medication for their depression.

The study suggests that the lower response rates may stem from differences in socioeconomic background -- rather than race or ethnicity per se. When some of the socioeconomic and health disparities present when subjects entered the study were taken into account, the researchers found the response to antidepressant medications was more similar among all groups.

Dr. Ira Lesser, a LA BioMed investigator who authored the report along with a team of researchers including LA BioMed investigator Daniel B. Castro, said these findings suggest African-Americans and Latinos from lower socioeconomic backgrounds may need more than medication to be treated successfully for depression.

"African Americans who suffer from depression had a much lower success rate with medication than whites, and Latinos did somewhat more poorly in response to medication," Dr. Lesser said. "We found that these two groups tended to be more disadvantaged socioeconomically, had more medical problems, less education and higher unemployment rates. As a result, they may need more treatment, including talk therapy, to overcome their depression."

Dr. Lesser and the team of researchers who authored the article, "Ethnicity/Race and Outcome in the Treatment of Depression," based their findings on data collected for the Sequenced Treatment Alternatives to Relieve Depression (STAR*D) study, the nation's largest real-world study of treatment-resistant depression.

Over a seven-year period, STAR*D enrolled 4,041 outpatients, ages 18-75 years, from 41 clinical sites around the country, including more than 350 patients from Harbor-UCLA Medical Center . Participants represented a broad range of ethnic and socioeconomic groups. All participants were diagnosed with non-psychotic major depressive disorder and were already seeking care at one of these sites.

Before STAR*D, other studies had suggested African Americans and Latinos responded more quickly than whites to the older antidepressants, and as quickly as whites to modern antidepressants.

Lesser said most previous studies excluded patients who had other diagnosis, including additional medical conditions and problems with alcohol. STAR*D was a much larger study than any before it, and it sought to re-create real-world conditions by including patients with other problems. Lesser said those two factors may explain why the STAR*D trial found the differences in the response to medication among African Americans and, to a lesser extent, Latinos.

"Clinicians need to be aware when they are treating African Americans and Latinos, particularly if they come from lower social economic groups, that these patients may need more than medication," he said. "This holds true for treating any patient who does not respond to an initial trial of medication."

The lifetime prevalence of major depression in the United States is estimated to be 16.2 percent, with considerable social and role impairment evident in the majority of patients. Previous studies found only minor differences in depression rates among African Americans, Latinos and whites. But various studies have found patients from lower social economic groups often have less access to mental health care, are less likely to be prescribed and to fill prescriptions for new antidepressants and are less likely to receive care beyond medications when compared to whites.

The journal article is entitled "Ethnicity/Race and Outcome in the Treatment of Depression."

Adapted from materials provided by Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center .

Females seem to be unequally disposed to the harmful effects of stress and to addiction compared with males. Recent studies show that:

• Estrogen can increase the possibility that females will start to take, and continue taking, cocaine.
• Females appear to have a genetic predisposition toward reproducing the physiological reward produced by cocaine, suggesting sex chromosomes may influence habit formation.
• Mothers with post-traumatic stress disorder (PTSD) may uniquely pass on biological risk factors to their offspring, according to work with the descendents of Holocaust survivors.
• Stress can damage an area of the brain with a controlling effect on mood.
• Females without a growth-factor gene can become more depressed than males.

"The comparisons between male and female responses to pain, depression, injury, and addiction are manifold," says Bruce McEwen, PhD, at Rockefeller University in New York City. "Neuroscientific proof of these differences can have profound impacts on everything from over-the-counter pharmaceuticals to government reimbursements for health care."

In three experiments with rats, Jill Becker, PhD, of the University of Michigan, found in each case that females showed an increased vulnerability to cocaine addiction.

In the study, a pool of 150 male and female rats of various predetermined hormone levels (some males were castrated, some females had their ovaries removed) were exposed to various combinations of estrogen, progesterone, or a peanut oil control. The rats were allowed to self-administer cocaine for a three-week period, during which time doses increased every seven days.

Becker found that female rats were more likely to use cocaine when circulating estrogen was high, but also that progesterone could counter the effects of estrogen. Further, she found that the administration of estrogen had no effects on self-administration in male rats.

"The factors that cause some people to try drugs despite all of society's warnings about their dangers are complex, but we know that among the factors are gender, personality type, and prior stress experiences," Becker says. "Women tend to try cocaine earlier in life, susceptible individuals become addicted faster, and, once addicted, they suffer worse damage to their brains, hearts, and livers as a result of their cocaine use, compared with men."

The study attributed this tendency to activity in the nucleus accumbens and the striatum -- two areas in the brain where neurons producing the brain chemical dopamine transmit signals related to reward and motivation. Estrogen's activation of this brain region appears to be critical in determining the brain's response to narcotics and why it might be different for men and women.

"Females acquire self-administration at lower doses of cocaine and escalate drug taking more rapidly than males, so they take more cocaine in relation to their body weight," Becker says. "They will also work harder for cocaine than males will."

Becker also found that stress in early life or even during the prenatal period can increase vulnerability to drug use and abuse. Preliminary findings indicate that the tendency to begin using cocaine is enhanced following prenatal stress, and that males and females are uniquely affected by stress in the womb. Further research will focus on the interaction of gender, stress response, hormonal fluctuations, and novelty-seeking. Such studies may help researchers understand women's susceptibility to cocaine use, abuse, and addiction.

In related work with rats, scientists found that females appear to have a genetic predisposition to reproduce the physiological reward produced by cocaine.

Jane Taylor, PhD, of Yale University, studied cocaine's effects on the signaling pathway for protein kinase A (PKA), the enzyme that helps transfer dopamine-transmitting signals inside cells.

In the experiment, rats were given access over a 24-hour period to either cocaine or a saline solution. Their degree of dependence was rated by counting the number of times rats would return to the dispenser when either the cocaine or saline had been removed. Taylor examined one group immediately after the 24-hour exposure period; she studied a second group after a 10-day delay. Taylor examined the rats' brains and measured levels of protein kinase A (PKA), which is a sign of the activation of pleasure circuits.

Compared to males, females had higher levels of markers for PKA in the striatum, indicating increased dopamine and therefore greater reinforcement of reward signals in the female rats' brains. Increased levels of markers for PKA were seen also in the pleasure-indicative nucleus accumbens of females more than males, particularly among controls and rats tested after the 10-day abstinence period. Cocaine also increased PKA marker levels when male rats, but not females, were tested immediately after exposure.

"Our data appear to be a unique demonstration of a role of gender in a complex behavior: habit formation. These habits do not appear to be hormone-dependent," says Taylor. "This has allowed us to make significant progress in understanding some of the distinct contributions of genetic and hormonal factors to behaviors that are argued to be associated with an increased vulnerability to addiction."

Further studies may follow the mice through different phases of the cycle of addiction, which could aid in the development of gender-specific treatments to prevent relapses in cocaine-dependent women.

Recent examination of risk factors associated with PTSD show that mothers may contribute uniquely to the possibility that their offspring will develop the disorder.

Working with the children of Holocaust survivors, Rachel Yehuda, PhD, at Mount Sinai Medical Center in New York City, studied biological risk factors by examining levels of the stress hormone cortisol.

The study assembled 49 subjects, none of whom had been diagnosed with PTSD. Twenty-three subjects had parents who were Holocaust survivors with PTSD. The parents of the remaining 26 subjects did not have PTSD, but in 10 cases, a parent had survived the Holocaust. The three groups were monitored for basal cortisol secretion over a 24-hour period, to account for any fluctuations in hormone release over the circadian cycle.

On average, the study team found lower cortisol levels in offspring who had at least one parent with PTSD. In previous research, low cortisol levels have been associated with an increased risk for developing PTSD; some researchers think it could serve as a marker for vulnerability to developing the disorder.

It also complements work showing that mothers with PTSD confer different risk on their offspring than fathers with PTSD.

In earlier research, Yehuda studied about 38 children whose mothers were pregnant and in New York's World Trade Center on the morning of Sept. 11, 2001. Half of these mothers developed PTSD and showed low levels of cortisol. Examining results from healthy-baby checks when the infants were a year old, she found a trimester effect: Babies of PTSD mothers born closest to the traumatic event had the lowest levels of cortisol, if mothers were in their third trimester on 9/11.

"The risk factor has something to do with effects that are uniquely maternally transmitted," says Yehuda. "Paternal PTSD contributes to other outcomes, but maybe not low cortisol." The maternal contribution to increased risk, she suggests, is "a real gender difference."

Other findings indicate that stress may damage a region of the brain that regulates mood, adding to previous findings that had indicated damage in the hippocampus, which can regulate levels of cortisol. By identifying the biological changes that result from stress, researchers hope to pin down the ways stress can trigger depression in some people, and, in particular, how this may affect women, who show increased sensitivity to stress.

Tracy Bale, PhD, of the University of Pennsylvania, studied the effects of stress on male mice that were 3 months old, the equivalent of human adults. In particular, she focused on the role of corticotrophin-releasing factor (CRF), an important element in the brain's stress-response pathway. In one group of mice, a gene aiding the transmission of CRF was knocked out.

Half of the mice in each group were then exposed to several different types of mild stress, in a random order, each day for three weeks. They were put in a cage with damp bedding overnight, for example, moved to several different cages in a short period of time, or restrained for 15 minutes.

When the responses of the mice were later tested when they were placed in a cage or on an elevated cross-shaped maze with no protective siding, Bale found that normal mice responded by becoming more active and alert, showing they had adapted to the chronic stress. They started exploring the new environment and were curious to look over the edge of the maze. In contrast, the genetically altered, stress-sensitive mice showed no change in behavior in the new setting, "as though they had shut down or their brains hadn't dealt with the stress they had experienced," she says.

Detailed examination of the brains of the mice showed that the stress-sensitive mice exposed to stress, but not normal mice exposed to the same conditions, lost cells in the raphe nucleus, which releases serotonin, an important brain chemical that is associated with depression.

Biologically identifiable changes, such as cell loss in the raphe nucleus, ultimately could provide ways to look for susceptibility to depression in people before disorders develop and help researchers pinpoint different reactions to stress in males and females.

"Finding a significant loss of cells following a period of mild stress in a brain region that is critical for regulating serotonin and mood is essential to our understanding of how stress is related to the onset of affective disorders, such as depression," Bale says.

"We've shown that changes in gene expression in this area are probably vital to coping with stress, and the absence of such changes in the stress-sensitive mice ma y suggest potential sex differences linking heightened stress responsivity to disease."

The next step, Bale says, will be to repeat this study, examining differences between male and female mice.

Bale is a shareholder in Neurocrine Biosciences, which is developing drugs for treating insomnia, anxiety, depression, irritable bowel syndrome, pain, and CNS-related disorders.

Previous work has shown that anxiety and depression are more often diagnosed in females and that stress is a predisposing factor in the development of these mood disorders. Tara Perrot-Sinal, PhD, at Dalhousie University, in Halifax, Canada, studied differences in stress responding between male and female rats using a number of models, including reactions to the natural stress of predator odor.

In one experiment, Perrot-Sinal restrained rodents, resulting in the release of stress hormones. The process demonstrated that levels of a protein that is important for normal brain cell function, brain-derived neurotrophic factor (BDNF), was reduced after stress in both males and females.

However, she also found that BDNF levels in nonstressed males were different than in females in two areas of the hippocampus, a brain region important for responses to stress. This indicates that males and females start out with differing levels of BDNF and therefore could be at differential risk of developing pathologies involving this brain region following exposure to stress. Previous work suggests that alterations in BDNF may contribute to depression-related behaviors, but also that they may be involved in the therapeutic effect of antidepressants.

"Most stress experienced by humans today is psychological in nature, and therefore we need to mimic that in our animal models," Perrot-Sinal said.

Psychological stress can be triggered in rats by exposing them to the smell of a cat. Perrot-Sinal's team used this scenario to highlight several gender differences in response to stress. Her findings included the tendency for females to show more caution than males when exposed to acute cat odor-whether the animals had been stressed previously or not. Female rats also failed to show stress hormone responses upon exposure to the smell of cats, unlike males.

Her most recent work shows differences between males and females in the serotonin system following cat odor stress. The serotonin system is targeted by many antidepressants. Further research will include assessing how these gender differences in stress responding are related to the development of depression-like behavior and related diseases in female subjects.

Adapted from materials provided by Society For Neuroscience .

TUESDAY, Nov. 6  -- Alzheimer's disease may progress faster in patients with high blood pressure or a type of irregular heartbeat called atrial fibrillation, a new study found.

"The main point of these findings is that vascular factors do affect the rate of progression in Alzheimer's, so treatment of these factors could reduce the rate of decline," said study author Dr. Michelle Mielke, an assistant professor of psychiatry at Johns Hopkins University School of Medicine.   "There are some dementia medications out there that are effective for some people [with Alzheimer's] but, for some people, they aren't effective or can't be tolerated," added Mielke. "Perhaps this is another way of reducing [their] decline. Even if you can give people a few more months with a better quality of life and keep them more cognizant than in the past, I think that then it is worth it."

The study is published in the Nov. 6 issue of Neurology.   An estimated 4.5 million Americans have Alzheimer's disease, according to the National Institute on Aging, but that number is expected to increase dramatically as the population grows older. Experts believe that about half of people 85 and older may have the disease.

Mielke and her colleagues studied a group of 135 women and men 65 and older from Cache County, Utah. The study participants had developed dementia that was characterized as "possible or probable AD" [Alzheimer's disease] without concurrent vascular dementia, the study said.   Those patients at the time of diagnosis who had systolic blood pressure greater than 160 or atrial fibrillation deteriorated more rapidly, based on standard tests of functioning and mental status, than those who didn't have the conditions, the study found.

Age also played a role in the progression of Alzheimer's for patients who had certain vascular conditions, the study said. The disease progressed more rapidly in older participants with high blood pressure, angina or a history of a heart attack, the study authors said.

But the researchers also found some unexpected results -- a history of diabetes or heart bypass at the time of diagnosis was associated with slower progression of Alzheimer's, the study said.   Mielke said the researchers aren't sure what the association between diabetes and slower Alzheimer's progression means. They speculated that patients who'd undergone heart bypass surgery may have benefited from their heart's increased ability to pump oxygen-rich blood to the brain. Other factors that may have helped bypass patients include better overall health, better diets, and closer monitoring by physicians, she added.

The study did not specifically look at the impact of treating vascular conditions such as high blood pressure on Alzheimer's patients. But the results did show that patients who had been treated with high blood pressure drugs prior to their Alzheimer's diagnosis did decline more slowly, according to one rating scale, the researchers said.

Earlier this year, French researchers reported that Alzheimer's patients with vascular disease who received standard medications -- such as statins, anti-clotting agents, insulin and anti-hypertensive drugs -- did better cognitively over a 36-month period than those who didn't receive such treatment.

Dr. Lon Schneider, a professor of psychiatry and behavioral science at the University of Southern California Keck School of Medicine, said the work of Mielke and her colleagues is "confirming and affirming that vascular factors have a significant role to play in Alzheimer's disease in moderating the onset and the course of the illness. It suggests a large portion of treatment and preventive treatment should be focused on cardiovascular disease."

Dr. William Thies, vice president for medical and scientific relations for the Alzheimer's Association, said both the French study and the work of Mielke's team "certainly do support the idea that aggressive therapy for vascular disease throughout your whole life span is probably a good idea, and that doesn't change once you have Alzheimer's disease either."

More information :   To learn more about Alzheimer's disease, visit the U.S. National Institute on Aging.

Children with attention-deficit/hyperactivity disorder (ADHD) can perform better at school if placed on long-term drug therapy, a new study suggests.

"This is the first study that shows that taking stimulants for ADHD improves long-term school performance," said lead researcher Dr. William Barbaresi, a pediatrician at the Mayo Clinic in Rochester, Minn. "This includes reading achievement, being absent from school and being retained in a grade -- stimulant treatment was associated with better outcomes," he said.

Based on the findings, stimulant medication needs to be considered for every child with ADHD, Barbaresi believes.

"We can make that recommendation now on the basis of long-term improvement in the ways children's lives turn out, not just on the desire to control ADHD behavior symptoms," he said.

A companion study by the same group of researchers finds that children with ADHD are at heightened risk of lowered reading scores, absenteeism, repeating a grade, and dropping out of school.

Both papers are published in the September edition of the Journal of Development & Behavioral Pediatrics.

Experts estimate that in the United States almost 2 million children -- or about 3 percent to 5 percent of young children in the country -- have ADHD. ADHD affects a child's ability to focus and to control impulsive behaviors.

In the first study, Barbaresi's team followed more than 5,700 children from birth until they were 18 years old. Among these children, 277 boys and 93 girls were diagnosed with ADHD.

The Mayo team found that treatment with prescription stimulants, such as Ritalin, was associated with improved long-term academic success of children with ADHD.

Children taking stimulants usually began taking them in elementary school and continued on the medication for almost three years -- about 30.4 months.

By age 13, those taking medication had improved reading scores compared with children with ADHD who didn't receive the drugs, the researchers found. Furthermore, those children taking the highest doses had the most improved reading scores, Barbaresi's group added.

Children treated with medication also were less likely to be absent from school, and the longer they took the drugs, the less absenteeism was seen. In addition, children with ADHD who received stimulants were 1.8 times less likely to be held back a grade than children with ADHD who were not receiving the treatment.

In the second study, Barbaresi's team found that school outcomes for the average child with ADHD were significantly worse compared with children without the condition.

"Reading tests among children with ADHD are almost 30 points lower, children with ADHD are absent for a significantly greater number of days, and children with ADHD are almost three times more likely to drop out of school and be retained a grade," Barbaresi said.

These poor outcomes were equally likely for boys and girls with ADHD, Barbaresi said.

"We can't simply focus on the symptoms of ADHD," Barbaresi said. "We really need to be focusing on the risk for poor outcomes in school and in other aspects of the child's life," he said.

"That's why we have to recognize these children and make sure they get appropriate treatment."

The studies were funded by grants from the U.S. Public Health Service, the U.S. National Institutes of Health, the Mayo Clinic, and McNeil Consumer and Specialty Pharmaceuticals, maker of the ADHD stimulant Concerta.

One expert hailed the findings.

"This study reinforces the value and long-term benefit of treatment with stimulant medication," said Dr. Andrew Adesman, chief of developmental and behavioral pediatrics at Schneider Children's Hospital in New York City. "It also highlights the risks that ADHD patients face and indicates that those risks can be mitigated by effective treatment," he said.

Another expert had a more mixed reaction to the studies.

"This study provides reassuring evidence that medication is not just blunting hyperactivity or enhancing alertness but actually doing so in a way that protects the capacity to learn," noted Dr. David Katz, director of the Prevention Research Center at Yale University School of Medicine in New Haven, Conn.

But drugs may not be the total answer, he added.

"Ritalin works but is not a desirable alternative to recess, which could perhaps work, too, in some cases at least," Katz said. "We need more attention to the underlying reasons for the rising prevalence of ADHD. Is it lack of physical activity; the highly processed modern diet; the over-stimulation of a multimedia environment; or all of the above?" he wondered.

  Even moderate consumption reduced brain volume, study found

While it might help your heart, drinking even moderately could shrink your brain, U.S. researchers say.

"A small amount of alcohol is beneficial for the heart," noted lead researcher Carol Ann Paul, "but there is a continuous negative correlation between alcohol consumption and total brain volume. It seems that there is not a beneficial effect of even small amounts of alcohol on brain volume."

Paul was scheduled to present her findings at this week's annual meeting of the American Academy of Neurology, in Boston .

In the study, Paul and colleagues looked at MRI brain scans of 1,839 people ages 34 to 88. The people were classified as non-drinkers, former drinkers, low drinkers (those who drank one to seven drinks per week), moderate drinkers (eight to 14 drinks per week), or high drinkers (more than 14 drinks per week).

The researchers found that the more alcohol people drank on a regular basis, the smaller their brain volume. People who had more than 14 drinks per week had an average 1.6 percent reduction in brain volume compared with people who never drank.

Paul's team found that brain volume decreased 0.25 percent for every increase in drinking category.

Brain shrinkage was slightly greater in female drinkers than in male drinkers and had the biggest impact on women who were in their 70s and were still heavy drinkers, the researchers found.

That's not a surprise, Paul said, because women's bodies tend to react differently to alcohol. "Women are more sensitive to alcohol [than men] and absorb it faster," she said.

Paul stressed that brain volume will decrease naturally throughout the life span. "There is a normal decline in brain volume. Some people seem to be unaffected by it, but some people are not," she said. "Alcohol seems to be accelerating this normal decline."

One expert believes the study shows a clear, negative effect of drinking on the brain.

"This study corroborates a building story about the detrimental effects of alcohol on brain structure and function," said Dr. James Garbutt, a professor of psychiatry at the University of North Carolina at Chapel Hill .

According to Garbutt, studies have also shown that alcohol has negative effects on brain functioning and cognition. "However, there haven't been studies that show how brain volume and cognition are related and whether alcohol has any effect," he said.

New findings on marijuana's damaging effect on the brain show the drug triggers temporary psychotic symptoms in some people, including hallucinations and paranoid delusions, doctors say.

British doctors took brain scans of 15 healthy volunteers given small doses of two of the active ingredients of cannabis, as well as a placebo.

One compound, cannabidiol, or CBD, made people more relaxed. But even small doses of another component, tetrahydrocannabinol, or THC, produced temporary psychotic symptoms in people, including hallucinations and paranoid delusions, doctors said.

The results, to be presented at an international mental health conference in London on Tuesday and Wednesday, provides physical evidence of the drug's damaging influence on the human brain.

"We've long suspected that cannabis is linked to psychoses, but we have never before had scans to show how the mechanism works," said Dr. Philip McGuire, a professor of psychiatry at King's College, London .

In analyzing MRI scans of the study's subjects, McGuire and his colleagues found that THC interfered with activity in the inferior frontal cortex, a region of the brain associated with paranoia.

"THC is switching off that regulator," McGuire said, effectively unleashing the paranoia usually kept under control by the frontal cortex.

In another study being presented at the conference, a two-day gathering of mental health experts discussing the connections between cannabis and mental health, scientists found that marijuana worsens psychotic symptoms of schizophrenics.

Doctors at Yale University in the U.S. tested the impact of THC on 150 healthy volunteers and 13 people with stable schizophrenia. Nearly half of the healthy subjects experienced psychotic symptoms when given the drug.

While the doctors expected to see marijuana improve the conditions of their schizophrenic subjects _ since their patients reported that the drug calmed them _ they found that the reverse was true.

"I was surprised by the results," said Dr. Deepak Cyril D'Souza, an associate professor of psychiatry at Yale University's School of Medicine. "In practice, we found that cannabis is very bad for people with schizophrenia," he said.

While D'Souza had intended to study marijuana's impact on schizophrenics in more patients, the study was stopped prematurely because the impact was so pronounced that it would have been unethical to test it on more people with schizophrenia.

"One of the great puzzles is why people with schizophrenia keep taking the stuff when it makes the paranoia worse," said Dr. Robin Murray, a professor of psychiatry at King's College.

Experts theorized that schizophrenics may mistakenly judge the drug's pleasurable effects to outweigh any negatives.

Understanding how marijuana affects the brain may ultimately lead experts to a better understanding of mental health in general.

"We don't know the basis of paranoia or anxiety," said McGuire.

"It is possible that we could use cannabis in controlled studies to understand psychoses better," he said. McGuire theorized that could one day lead to specific drugs targeting the responsible regions of the brain.

Many clinicians believe religion and spirituality have a positive effect on patients' health, and clinicians' beliefs also influence their clinical observations, according to the results of a study reported in the April 9 issue of the Archives of Internal Medicine.

"In spite of a substantial body of empirical data, professional disagreement persists regarding whether and how religion and spirituality (R/S; treated as a single concept) influences health," write Farr A. Curlin, MD, from The University of Chicago in Illinois , and colleagues. "This study examines the association between physicians' religious characteristics and their observations and interpretations of the influence of R/S on health."

The investigators mailed a cross-sectional survey to a stratified, random sample of 2000 practicing US clinicians from all specialties. This survey asked clinicians to estimate how often patients mention R/S issues, how much R/S affects health, and in what ways this effect is evident.

The response rate to the survey was 63%. Although 56% of clinicians believed that R/S had much or very much influence on health, only 6% believed that R/S often changed "hard" medical outcomes. In contrast, most clinicians believed that R/S often helps patients to cope (76%), puts patients in a positive frame of mind (75%), and provides emotional and practical support via the religious community (55%).

Compared with clinicians reporting low religiosity, those reporting high religiosity are more likely to report that patients often mention R/S issues (36% vs 11%; P < .001), believe that R/S strongly affects health (82% vs 16%; P < .001), and interpret the effect of R/S in positive rather than in negative ways.

"Patients are likely to encounter quite different opinions about the relationship between their R/S and their health, depending on the religious characteristics of their physicians," the authors write.

Study limitations include possible response bias and difficulty in measuring clinician religiosity.

"Limitations notwithstanding, these findings challenge any aspirations to a consensus interpretation of the relationship between R/S and health," the authors conclude. "Indeed, consensus is probably an unrealistic aim if disagreements are rooted in differences that go as deep as religion. These findings might rather lend support to the Association of American Medical Colleges' recommendation that physicians 'recognize that their own spirituality... might affect the ways they relate to, and provide care to, patients.'"

The Greenwall Foundation, the Robert Wood Johnson Clinical Scholars Program, and the National Center for Complementary and Alternative Medicine of the National Institutes of Health supported this study. The authors have disclosed no relevant financial relationships.

Clinical Context

According to the authors of the current study, controversy about how religion and religiosity help or harm patients' health remains, and, to complicate matters, clinicians' own spiritual beliefs and practices also may influence the way clinicians interpret their clinical experiences. The authors also discuss a previous study in which they found that religious clinicians are more likely than their secular colleagues to inquire about and discuss R/S issues with their patients. The authors define religion and spirituality as a single concept: R/S.

This is a cross-sectional national survey conducted on a stratified random sample of US clinicians belonging to the American Medical Association database to examine if and how the varying R/S beliefs of clinicians influence their approach to patient health.

Study Highlights

• The mailed 12-page survey was conducted on a random sample of 2000 clinicians aged 65 years or younger who were practicing in the following US regions: Midwest , South, Northeast, and West.
• The survey was administered 3 times by mail.
• The terms "religion" and "spirituality" were not defined within the survey, and respondents were asked to apply their own working definitions.
• The clinicians' religious characteristics ("intrinsic religiosity") were defined by the extent to which they embraced their religion as the "master motive" guiding their life.
• This was measured by a response of "agree" or "disagree" to 2 statements: "I try hard to carry my religious beliefs over to all my other dealings in life" and "My whole approach to life is based on my religion."
• Intrinsic religiosity was defined as low if clinicians disagreed with both statements, moderate if they agreed with 1 and disagreed with the other, and high if they agreed with both.
• Clinicians' religious affiliations were categorized as "none" (includes atheist, agnostic, and none), "Protestant, Catholic, Jewish, and other" (includes Buddhist, Hindu, Mormon, Muslim, and other).
• Clinicians were asked for responses to survey questions addressing whether illness increased patient awareness of R/S, how much influence R/S had on health, and whether R/S helped to prevent "hard" medical outcomes, helped patients cope, or had potential negative influences on health.
• Responses were coded in 3 categories —"often/always," "sometimes," and "rarely/never" — or as yes/no binary responses.
• The response rate of eligible clinicians was 63% (n = 1144).
• Mean age was 49 years, 26% were women, 58% were from the Midwest and South, 78% were white, 12% were Asian, and 2% were black.
• The primary specialties were internal medicine (32%), family medicine (14%), pediatrics and subspecialties (13%), and surgical specialties (9%).
• Two thirds of clinicians believed that the experience of illness often or always increased patients' awareness of and focus on R/S issues.
• 56% believed that R/S very much influenced health, and 54% believed that sometimes the supernatural intervened.
• 85% believed that the influence of R/S was generally positive.
• Only 6% believed that R/S influenced "hard" medical outcomes.
• 76% believed that R/S often helps patients to cope, and 74% believed that it gave patients positive states of mind.
• 55% believed that R/S provided emotional and positive support via the religious community.
• 2% to 7% identified harmful effects of R/S including guilt, anxiety, and patients declining medical therapy.
• Clinicians with high intrinsic religiosity were much more likely to report that their patients brought up R/S issues, to believe that R/S strongly influenced health, and to interpret R/S influence in a positive way.
• Protestant clinicians were more likely to report that their patients believed that God intervened in health, that R/S helped patients to cope, and that R/S sometimes prevented adverse medical outcomes.
• Clinicians who practiced in the South and Midwest (where the authors reported a higher proportion of high intrinsic religiosity responses) were more likely than those practicing in the West and Northwest to believe that R/S influenced health in strong and positive ways.

Pearls for Practice

• Most US clinicians believe that R/S has a substantial and generally positive effect on patients' health.
• Clinicians with higher intrinsic religiosity are more likely to include R/S in their patient encounters and to interpret R/S influence on patients in a positive way.