People Who Have Alcoholism Run in the Family Release More Dopamine in Expectation of Alcohol

Interesting findings that should be included in future treatments of alcohol use disorders. Forming situations where alcohol use isn’t expected could allow people to avoid a bad structure of incentives.

People with a family history of alcohol use disorder (AUD) release more dopamine in the brain’s main reward center in response to the expectation of alcohol than people diagnosed with the disorder, or healthy people without any family history of AUD, reports a new study in Biological Psychiatry: Cognitive Neuroscience and Neuroimaging.

“This exaggerated reward center stimulation by expectation of alcohol may put the [individuals with family history] at greater risk of alcohol use disorder, and could be a risk factor in itself,” said first author Lawrence Kegeles, MD, PhD, of Columbia University.

The study examined a range of risk for AUD, including 34 healthy participants with no family history of AUD, 16 healthy participants with a family history of the disorder (referred to as the family-history positive, or FHP, group), and 15 participants diagnosed with AUD. Dr. Kegeles and colleagues used PET brain scanning to measure the amount of dopamine release in areas of the brain important for reward and addiction. The participants underwent the brain scans after receiving either an alcohol drink — a cocktail of vodka, tonic, and cranberry — or a placebo drink without the vodka. Although the participants didn’t know the order in which they would receive the drinks, if they received the placebo drink first they were cued into expecting the alcohol drink next.

All three groups had similar dopamine release-levels in response to the alcohol, suggesting that alcohol-induced dopamine release is normal in AUD. However, “we found that the FHP participants had a much more pronounced response to the placebo drink than the other groups, indicating that expectation of alcohol caused the FHP group to release more reward center dopamine,” said Dr. Kegeles. The release of dopamine into the reward center is thought to reinforce alcohol consumption and possibly contribute to risk of AUD.

Cannabidiol an Effective Treatment for Seizures in Patients With a Severe Type of Epilepsy

Seizures represent dysfunctional brain activity, and the mental process compromised by them is obviously negative. This research is also probably something of a milestone in treatment of seizures — many of today’s medications aren’t that effective and/or come with gruesome side effects.

Cannabidiol (CBD), a compound derived from the cannabis plant that does not produce a “high” and has been an increasing focus of medical research, was shown in a new large-scale, randomized, controlled trial to significantly reduce the number of dangerous seizures in patients with a severe form of epilepsy called Lennox-Gastaut syndrome.

In the new study comparing two doses of CBD to a placebo, the researchers reported a 41.9 percent reduction in “drop seizures” — a type of seizure that results in severe loss of muscle control and balance — in patients taking a 20 mg/kg/d CBD regimen, a 37.2 percent reduction in those on a 10 mg/kg/d CBD regimen, and a 17.2 percent reduction in a group given a placebo.

The phase III trial was led by principal investigator and study first co-author Orrin Devinsky, MD, a professor of neurology, neurosurgery, and psychiatry at NYU School of Medicine and director of NYU Langone’s Comprehensive Epilepsy Center, and was published online May 17 in The New England Journal of Medicine.

“This new study adds rigorous evidence of cannabidiol’s effectiveness in reducing seizure burden in a severe form of epilepsy and, importantly, is the first study of its kind to offer more information on proper dosing,” says Dr. Devinsky. “These are real medications with real side effects, and as providers we need to know all we can about a potential treatment in order to provide safe and effective care to our patients.

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“This landmark study provides data and evidence that Epidiolex can be an effective and safe treatment for seizures seen in patients with Lennox Gastaut Syndrome, a very difficult to control epilepsy syndrome,” adds study co-first author, Anup Patel, MD, chief of Neurology at Nationwide Children’s Hospital.

A study led by Dr. Devinsky published in last May’s New England Journal of Medicine showed a 39 percent drop in seizure frequency in patients with a different rare form of epilepsy, Dravet syndrome. Those findings represented the first large-scale, randomized clinical trial for the compound. Open label CBD studies led by Dr. Devinsky also have shown positive results for treatment-resistant epilepsies.

In April, a U.S. Food and Drug Administration advisory panel unanimously voted to recommend approval of a new drug application for Epidiolex cannabidiol oral solution, following a meeting where researchers, including Dr. Devinsky, presented their findings. The FDA will decide whether to approve the medication in late June.

“While the news gives hope for a new treatment option to the epilepsy community, more research remains imperative to better determine the effects of CBD and other similar cannabis-derived compounds on other forms of the disease and in more dosing regimens,” says Dr. Devinsky.

Study: Intensive Diet Program Reversed Type 2 Diabetes in 86% of Patients

This isn’t really that surprising, or it shouldn’t be that surprising anyway. Many modern ailments and afflictions are caused or linked to unhealthy diets, and so it makes some sense that it might be possible to reverse them using the opposite approach of healthier diets.

Type 2 diabetes isn’t necessarily for life, with a 2017 clinical trial providing some of the clearest evidence yet that the condition can be reversed, even in patients who have carried the disease for several years.

A clinical trial involving almost 300 people in the UK found an intensive weight management program put type 2 diabetes into remission for 86 percent of patients who lost 15 kilograms (33 lbs) or more.

“These findings are very exciting,” said diabetes researcher Roy Taylor from Newcastle University.

“They could revolutionise the way type 2 diabetes is treated.”

Taylor and fellow researchers studied 298 adults aged 20-65 years who had been diagnosed with type 2 diabetes within the previous six years to take part in the Diabetes Remission Clinical Trial (DiRECT).

Participants were randomly assigned to either an intensive weight management program or to regular diabetic care administered by their GP, acting as a control group.

For the 149 individuals placed in the weight management program, participants had to restrict themselves to a low calorie formula diet consisting of things like health shakes and soups, limiting them to consuming 825-853 calories per day for a period of three to five months.

After this, food was reintroduced to their diet slowly over two to eight weeks, and participants were given support to maintain their weight loss, including cognitive behavioural therapy and help with how to increase their level of physical activity.

Not an easy lifestyle change to adapt to, perhaps; but where there’s a will, there’s a way.

Drinking -Baking Soda- May be an Effective Approach to Combating Autoimmune Disease

If traditional medication isn’t working, drinking some baking soda may be a viable alternative. It sounds odd, but compared to a lot of pharmaceuticals out there, any possible side effects don’t seem like they’d be too bad.

A daily dose of baking soda may help reduce the destructive inflammation of autoimmune diseases like rheumatoid arthritis, scientists say.

They have some of the first evidence of how the cheap, over-the-counter antacid can encourage our spleen to promote instead an anti-inflammatory environment that could be therapeutic in the face of inflammatory disease, Medical College of Georgia scientists report in the Journal of Immunology.

They have shown that when rats or healthy people drink a solution of baking soda, or sodium bicarbonate, it becomes a trigger for the stomach to make more acid to digest the next meal and for little-studied mesothelial cells sitting on the spleen to tell the fist-sized organ that there’s no need to mount a protective immune response.

“It’s most likely a hamburger not a bacterial infection,” is basically the message, says Dr. Paul O’Connor, renal physiologist in the MCG Department of Physiology at Augusta University and the study’s corresponding author.

Mesothelial cells line body cavities, like the one that contains our digestive tract, and they also cover the exterior of our organs to quite literally keep them from rubbing together. About a decade ago, it was found that these cells also provide another level of protection. They have little fingers, called microvilli, that sense the environment, and warn the organs they cover that there is an invader and an immune response is needed.

Drinking baking soda, the MCG scientists think, tells the spleen — which is part of the immune system, acts like a big blood filter and is where some white blood cells, like macrophages, are stored — to go easy on the immune response. “Certainly drinking bicarbonate affects the spleen and we think it’s through the mesothelial cells,” O’Connor says.

44 Genomic Variations Linked to Major Depression in New Research

Genetic variations (variants) are the roughly 0.5% share of DNA that makes individuals unique, as about 99% of human DNA is shared across humans. The word genome represents the entire set of genetic material someone’s made of. With that being said, this research is important because major depressive disorder can be a really crippling affliction, and the more that’s known about it, the more effectively it can be treated or prevented.

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A new meta-analysis of more than 135,000 people with major depression and more than 344,000 controls has identified 44 genomic variants, or loci, that have a statistically significant association with depression.

Of these 44 loci, 30 are newly discovered while 14 had been identified in previous studies. In addition, the study identified 153 significant genes, and found that major depression shared six loci that are also associated with schizophrenia.

Results from the multinational, genome-wide association study were published April 26 in Nature Genetics.

The study was an unprecedented global effort by over 200 scientists who work with the Psychiatric Genomics Consortium. Co-leaders of the study are Patrick F. Sullivan, MD, FRANZCP, Yeargen Distinguished Professor of Psychiatry and Genetics and Director of the Center for Psychiatric Genomics at the University of North Carolina School of Medicine; and Naomi Wray, PhD, Professorial Research Fellow at the University of Queensland in Australia.

“This study is a game-changer,” Sullivan said. “Figuring out the genetic basis of major depression has been really hard. A huge number of researchers across the world collaborated to make this paper, and we now have a deeper look than ever before into the basis of this awful and impairing human malady. With more work, we should be able to develop tools important for treatment and even prevention of major depression.”

“We show that we all carry genetic variants for depression, but those with a higher burden are more susceptible,” Wray said. “We know that many life experiences also contribute to risk of depression, but identifying the genetic factors opens new doors for research into the biological drivers.”

“This pioneering study is incredibly important, for two reasons,” said Josh Gordon, MD, PHD, Director of the U.S. National Institute of Mental Health. Dr. Gordon was not an author on this paper.

“First, it reaffirms the value of large-scale collaborations, particularly in identifying the complex genetics underlying psychiatric illness. Second, it confirms the genetic roots for depression, offering important biological clues that we hope will lead to new and better treatments.”

“Major depression represents one of the world’s most serious public health problems,” said Steven E. Hyman, MD, former director of the U.S. National Institute of Mental Health who is now Director of the Stanley Center for Psychiatric Research at the Broad Institute of MIT and Harvard. Dr. Hyman was not an author on this paper. “Despite decades of effort there have been, until now, only scant insights into its biological mechanisms. This unfortunate state of affairs has severely impeded treatment development, leaving the many people who suffer from depression with limited options. This landmark study represents a major step toward elucidating the biological underpinnings of depression,” Hyman said.

Other findings of the study include:

  • The results can be used for improved therapies — targets of known antidepressant medications were enriched in the genetic findings
  • The genetic basis of depression overlaps importantly with other psychiatric disorders like bipolar disorder and schizophrenia
  • Intriguingly, the genetic basis of depressive disorder also overlaps with that for obesity and multiple measures of sleep quality, including daytime sleepiness, insomnia and tiredness

Better Care of Sickest Patients Saves Hospitals Money, Largest Study of Its Kind Finds

It’s significant due to the amount of unnecessary suffering caused by hospitals treating their sickest patients inadequately. This study is important because it shows that hospitals have an incentive — saving money — to treat their worst patients better.

Palliative care — which better aligns medical treatments with patients’ goals and wishes, aggressively treats distressing symptoms, and improves care coordination, — is associated with shorter hospital stays and lower costs, and shows its greatest effect among the sickest patients, according to a study published Monday, April 30, in JAMA Internal Medicine. The meta-analysis was conducted in collaboration between scientists at the Icahn School of Medicine at Mount Sinai and Trinity College Dublin.

The investigation represents the largest and most rigorous study to date to demonstrate that palliative care — which has been previously shown to improve care quality, extend survival, and improve family well-being — is associated with reduced hospital stays and associated cost savings, particularly for patients with the most complex conditions. The study found:

  • Hospitals saved on average $3,237 per patient, over the course of a hospital stay, when palliative care was added to their routine care as compared to those who didn’t receive palliative care.
  • Palliative care was associated with a cost savings — per hospital stay — of $4,251 per patient with cancer and $2,105 for those with non-cancer diagnoses.
  • Savings were greatest for patients with the highest number of co-existing illnesses.

“People with serious and complex medical illness account heavily for healthcare spending, yet often experience poor outcomes,” says the lead study author, Peter May, MD, Research Fellow in Health Economics, Centre for Health Policy and Management, Trinity College Dublin. “The news that palliative care can significantly improve patient experience by reducing unnecessary, unwanted, and burdensome procedures, while ensuring that patients are cared for in the setting of their choice, is highly encouraging. It suggests that we can improve outcomes and curb costs even for those with serious illness.”

The Amazing Treatment for Drug Addiction (Medication-Assisted Treatment) Too Rarely Used

Drug addictions need to be treated as health problems instead of as crimes, and in any case, it’d be valuable to direct more resources towards helping people with addictions. That could be rather than using the resources on a senseless or harmful pursuit such as building even more nuclear weapons systems that threaten to cause disasters.

The death toll from the opioids epidemic continues to soar – nearly 64,000 people died in 2016 alone.

Scientists are working to find creative tools to fight it, and President Donald Trump has called the overdose crisis a public health emergency. But he has not yet outlined any targeted solutions aside from calling for drug dealers to be given the death penalty.

A growing cadre of health professionals say we already have a science-backed treatment that works. It’s called medication-assisted treatment, or MAT, and it involves administering FDA-approved medications that help curb cravings and reduce the excruciating symptoms of withdrawal.

“Medications are an effective treatment for opioid addiction,” Kelly J. Clark, president of the American Society of Addiction Medicine, told Business Insider.

The problem is that very few people can get those medications.

Only about half of private-sector treatment programs for opioid use disorder currently offer access to MAT, and of those that offer it, only one third of patients actually receive the medication, according to a study published in the Journal of Addiction Medicine.

There are many reasons for this lack of access to medication. Some stem from a misconception about how the treatments – which can include buprenorphine, methadone, or naltrexone – work.

The stigma surrounding drug use and addiction plays a role, too. Still other issues include federal and state laws that restrict the availability of the medications.

“It’s more of an implementation problem than a basic science problem,” Clark said, “because we know what works.”

Medications do not ‘substitute one drug for another’

In someone with opioid use disorder, using the drugs is often not a pleasurable experience, but rather a practice that has become a necessary fact of life. Being without the drugs leads to painful symptoms that can include severe nausea, shaking, diarrhoea, and depression.

The need to use is simultaneously a physical and emotional compulsion – the lines between those kinds of pain are blurred.

One of the main misconceptions about medication-assisted treatment is that medications simply replace the drugs that hooked users – leading to more highs and fuelling a pattern of repeated use.

But that view is outdated and ill-informed, experts say. Instead, the drugs work by staunching cravings and reducing or preventing withdrawal and relapse.

Buprenorphine and methadone help suppress cravings, while naltrexone blocks the euphoric and sedative effects of opioids so users don’t experience a high.

“People ask me all the time, ‘well, aren’t they just substituting one drug for another?’ The answer is no. These are evidence-based treatments and they work,” Patrice A. Harris, the former president of the American Medical Association and a board certified psychiatrist, told Business Insider.

Several large studies suggest that as access to MAT rises, drug overdose deaths fall.

A study of heroin overdose deaths in Baltimore between 1995 and 2009 published in the American Journal of Public Health, for example, found a link between the increasing availability of methadone and buprenorphine and a roughly 50 percent decrease in the number of fatal overdoses.

“These treatments are life saving and they work,” Sarah Wakeman, the medical director of the substance use disorder initiative at Massachusetts General Hospital and an assistant professor at Harvard, told Business Insider.

From jail to court to rehab, medication-assisted treatment is hard to find

Despite the evidence demonstrating MAT’s effectiveness, it is surprisingly difficult to obtain.

One of the hardest-to-access forms of medication for recovery is methadone. In the US, the medication can only be accessed in specialised clinics; because of the way the treatment works, people on MAT must come to a facility to be injected daily.

But those facilities typically have negative reputations because of policies that restrict them to locations considered seedy or run-down.

And patients who come for treatment often have to push past active drug users – a big trigger for someone with substance use disorder – on their way to and from the clinic.

“You can access heroin pretty easily, yet we make it really hard to get a treatment that’s life-saving and allows you to live healthily,” Wakeman said.

On Friday, the US Food and Drug Adminstration issued a new set of guidelines aimed at underlining the important role MAT should play treating opioid use disorder.

“Unfortunately, far too few people who suffer from opioid use disorder are offered an adequate chance for treatment that uses safe and effective medications,”commissioner Scott Gottlieb said.

Other countries take a very different approach to medication-assisted treatment that makes the treatments easier to obtain. In Canada, for example, methadone is distributed in pharmacies.

Rehabilitation facilities and courts in the US often don’t offer medication-assisted treatment either. Instead, most operate on an abstinence-based model, in which patients must detox and then are offered counseling.

They’re encouraged to attend 12-step meetings like Narcotics Anonymous, which remains opposed to MAT despite the growing body of evidence behind it.