Category: Behavior

— Mindfulness-based cognitive therapy appears to be similar to maintenance antidepressant medication for preventing relapse or recurrence among patients successfully treated for depression, according to a report in the December issue of Archives of General Psychiatry, one of the JAMA/Archives journals.

"Relapse and recurrence after recovery from major depressive disorder are common and debilitating outcomes that carry enormous personal, familial and societal costs," the authors write as background information in the article. The current standard for preventing relapse is maintenance therapy with a single antidepressant. This regimen is generally effective if patients take their medications, but as many as 40 percent of them do not. "Alternatives to long-term antidepressant monotherapy, especially those that address mood outcomes in a broader context of well-being, may appeal to patients wary of continued intervention."

Zindel V. Segal, Ph.D., of the Centre for Addiction and Mental Health, Toronto, Ontario, Canada, and colleagues studied 160 patients age 18 to 65 who met criteria for major depressive disorder and had experienced at least two episodes of depression. After eight months of treatment, 84 (52.5 percent) achieved remission. Patients in remission were then randomly assigned to one of three treatment groups: 28 continued taking their medication; 30 had their medication slowly replaced by placebo; and 26 tapered their medication and then received mindfulness-based cognitive behavioral therapy.

In this therapy, patients learn to monitor and observe their thinking patterns when they feel sad, changing automatic reactions associated with depression (such as rumination and avoidance) into opportunities for useful reflection. "This is accomplished through daily homework exercises featuring (1) guided (taped) awareness exercises directed at increasing moment-by-moment nonjudgmental awareness of bodily sensations, thoughts, and feelings; (2) accepting difficulties with a stance of self-compassion; and (3) developing an 'action plan' composed of strategies for responding to early warning signs of relapse/recurrence," the authors write.

During the 18-month follow-up period, relapse occurred among 38 percent of those in the cognitive behavioral therapy group, 46 percent of those in the maintenance medication group and 60 percent of those in the placebo group, making both medication and behavioral therapy effective at preventing relapse.

About half (51 percent) of patients were classified as unstable remitters, defined as individuals who had symptom "flurries" or intermittently higher scores on depression rating scales despite having a low enough average score to qualify for remission. The other half (49 percent) were stable remitters with consistently low scores. Among unstable remitters, those taking maintenance medication or undergoing cognitive behavioral therapy were about 73 percent less likely to relapse than those taking placebo. Among stable remitters, there were no differences between the three groups.

"Our data highlight the importance of maintaining at least one active long-term treatment in recurrently depressed patients whose remission is unstable," the authors write. "For those unwilling or unable to tolerate maintenance antidepressant treatment, mindfulness-based cognitive therapy offers equal protection from relapse during an 18-month period." It is unclear exactly how mindfulness-based therapy works, but it may change neural pathways to support patterns that lead to recovery instead of to deeper depression, they note.

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Journal Reference:

1. Zindel V. Segal; Peter Bieling; Trevor Young; Glenda MacQueen; Robert Cooke; Lawrence Martin; Richard Bloch; Robert D. Levitan. Antidepressant Monotherapy vs Sequential Pharmacotherapy and Mindfulness-Based Cognitive Therapy, or Placebo, for Relapse Prophylaxis in Recurrent Depression. Archives of General Psychiatry, 2010; DOI: 10.1001/archgenpsychiatry.2010.168

 Quitting smoking is certainly healthy for the body, but doctors and scientists haven't been sure whether quitting makes people happier, especially since conventional wisdom says many smokers use cigarettes to ease anxiety and depression. In a new study, researchers tracked the symptoms of depression in people who were trying to quit and found that they were never happier than when they were being successful, for however long that was.

Based on their results, the authors of the article published online Nov. 24 in the journal Nicotine & Tobacco Research recommend that smokers embrace quitting as a step toward improving mental as well as physical health, said Christopher Kahler, corresponding author and research professor of community health at the Warren Alpert Medical School of Brown University. Quitting is not, as some smokers may fear, a grim psychological sacrifice to be made for the sake of longevity.

"The assumption has often been that people might smoke because it has antidepressant properties and that if they quit it might unmask a depressive episode," said Kahler. "What's surprising is that at the time when you measure smokers' mood, even if they've only succeeded for a little while, they are already reporting less symptoms of depression."

Moving mood

Kahler and colleagues from Brown, The Miriam Hospital, and the University of Southern California studied a group of 236 men and women seeking to quit smoking, who also happened to be heavy social drinkers. They received nicotine patches and counseling on quitting and then agreed to a quit date; some also were given specific advice to reduce drinking. Participants took a standardized test of symptoms of depression a week before the quit date and then two, eight, 16, and 28 weeks after that date.

All but 29 participants exhibited one of four different quitting behaviors: 99 subjects never abstained; 44 were only abstinent at the two-week assessment; 33 managed to remain smoke-free at the two- and eight-week checkups; 33 managed to stay off cigarettes for the entire study length.

The most illustrative — and somewhat tragic — subjects were the ones who only quit temporarily. Their moods were clearly brightest at the checkups when they were abstinent. After going back to smoking, their mood darkened, in some cases to higher levels of sadness than before. The strong correlation in time between increased happiness and abstinence is a tell-tale sign that the two go hand-in-hand, said Kahler, who is based at Brown's Center for Alcohol and Addiction Studies (CAAS).

Subjects who never quit remained the unhappiest of all throughout the study. The ones who quit and stuck with abstinence were the happiest to begin with and remained at the same strong level of happiness throughout.

Kahler said he is confident that the results can be generalized to most people, even though the smokers in this study also drank at relatively high levels. One reason is that the results correlate well with a study he did in 2002 of smokers who all had had past episodes of depression but who did not necessarily drink. Another is that the changes in happiness measured in this study did not correlate in time with a reduction in drinking, only with a reduction — and resumption — of smoking.

Looking at the data, Kahler said, it is difficult to believe that smoking serves as an effective way to medicate negative feelings and depression, even if some people report using tobacco for that reason. In fact, he said, the opposite seems more likely — that quitting smoking eases depressive symptoms.

"If they quit smoking their depressive symptoms go down and if they relapse, their mood goes back to where they were," he said. "An effective antidepressant should look like that."

In addition to Kahler, other authors on the study were Nichea Spillane of Brown's CAAS, Andrew Busch of the Centers for Behavioral and Preventive Medicine at The Miriam Hospital and Brown, and Adam Leventhal of the Keck School of Medicine at USC. The National Institute on Drug Abuse funded the study.

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Journal Reference:

1. C. W. Kahler, N. S. Spillane, A. M. Busch, A. M. Leventhal. Time-Varying Smoking Abstinence Predicts Lower Depressive Symptoms Following Smoking Cessation Treatment. Nicotine & Tobacco Research, 2010; DOI: 10.1093/ntr/ntq213

So, he or she has cheated on you for the umpteenth time and their only excuse is: "I just can't help it." According to researchers at Binghamton University, they may be right. The propensity for infidelity could very well be in their DNA.

In a first of its kind study, a team of investigators led by Justin Garcia, a SUNY Doctoral Diversity Fellow in the laboratory of evolutionary anthropology and health at Binghamton University, State University of New York, has taken a broad look at sexual behavior, matching choices with genes and has come up with a new theory on what makes humans 'tick' when it comes to sexual activity. The biggest culprit seems to be the dopamine receptor D4 polymorphism, or DRD4 gene. Already linked to sensation-seeking behavior such as alcohol use and gambling, DRD4 is known to influence the brain's chemistry and subsequently, an individual's behavior.

"We already know that while many people experience sexual activity, the circumstances, meaning and behavior is different for each person," said Garcia. "Some will experience sex with committed romantic partners, others in uncommitted one-night stands. Many will experience multiple types of sexual relationships, some even occurring at the same time, while others will exchange sex for resources or money. What we didn't know was how we are motivated to engage in one form and not another, particularly when it comes to promiscuity and infidelity."

Gathering a detailed history of the sexual behavior and intimate relationships of 181 young adults along with samples of their DNA, Garcia and his team of investigators were able to determine that individual differences in sexual behavior could indeed be influenced by individual genetic variation.

"What we found was that individuals with a certain variant of the DRD4 gene were more likely to have a history of uncommitted sex, including one-night stands and acts of infidelity," said Garcia. "The motivation seems to stem from a system of pleasure and reward, which is where the release of dopamine comes in. In cases of uncommitted sex, the risks are high, the rewards substantial and the motivation variable — all elements that ensure a dopamine 'rush.'"

According to Garcia, these results provide some of the first biological evidence that at first glance, seems to be somewhat of a contradiction: that individuals could be looking for a serious committed long-term relationship, but have a history of one-night stands. At the same time, the data also suggests it is also reasonable that someone could be wildly in love with their partner, commit infidelity, and yet still be deeply attached and care for their partner. It all came back to a DRD4 variation in these individuals. Individual differences in the internal drive for a dopamine 'rush' can function independently from the drive for commitment.

"The study doesn't let transgressors off the hook," said Garcia. "These relationships are associative, which means that not everyone with this genotype will have one-night stands or commit infidelity. Indeed, many people without this genotype still have one-night stands and commit infidelity. The study merely suggests that a much higher proportion of those with this genetic type are likely to engage in these behaviors."

Garcia also cautions that the consequences of risky sexual behavior can indeed be extreme.

"One-night stands can be risky, both physically and psychologically," said Garcia. "And betrayal can be one of the most devastating things to happen to a couple. These genes do not give anyone an excuse, but they do provide a window into how our biology shapes our propensities for a wide variety of behaviors."

At this point, very little is known about how genetics and neurobiology influence one's sexuality propensities and tendencies but Garcia is hopeful that this study will add to the growing base of knowledge — in particular, how genes might predispose individuals to pursue sensation seeking across all sorts of domains — from substance use to sexuality. This study also provides further support for the notion that the biological foundations for sexual desire may often operate independently from, although absolutely linked to, deep feelings of romantic attachment.

As Garcia points out, he and his team of study co-authors have only just begun to explore the issue and plan on conducting a series of follow-up and related studies.

"We want to run a larger sample of men and women to replicate these findings and check for several other possible genetic markers," said Garcia.

"We will also be conducting a number of behavioral and biological studies to better understand what kinds of associated factors motivate uncommitted sexual behavior. Most importantly, we want to explore the receiving end of infidelity by looking at how people respond to cases of uncommitted sex and infidelity."

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Journal Reference:

1. Justin R. Garcia, James MacKillop, Edward L. Aller, Ann M. Merriwether, David Sloan Wilson, J. Koji Lum. Associations between Dopamine D4 Receptor Gene Variation with Both Infidelity and Sexual Promiscuity. PLoS ONE, 2010; 5 (11): e14162 DOI: 10.1371/journal.pone.0014162

Pity the female fruit fly. Being a looker is simply not enough. To get a date, much less a proposal, you have to act like a girl, even smell like one. Otherwise, you might just have a fight on your hands.

Like most animals, fruit flies must distinguish between a potential mate and a potential competitor. When a male fruit fly suspects he's encountered a female, he'll court; when he senses the other is a male, he'll fight. What triggers these sex-specific responses?

According to new research by scientists at Harvard Medical School, the answer lies with both pheromonal profiles and behavioral patterns. The researchers investigated the effects of taste and action by manipulating a gene that governs both the sex specificity of a fruit fly's body-surface hydrocarbons, or pheromones, and the sex-linked behavioral cues that issue through the dense nerve-cell network that constitutes the fly's brain.

"These findings underscore the importance of behavioral feedback in the manifestation of aggression," says Edward Kravitz, the George Packer Berry Professor of Neurobiology at Harvard Medical School.

The research is published in the November 23 issue of PLoS Biology.

María de la Paz Fernández and Yick-Bun Chan, post-doctoral researchers in the Kravitz lab, discovered these links to aggression when investigating whether a male fruit fly would ever attack a female. They focused on a particular gene called transformer, which is active in females but not in males. Through blocking transformer expression in a variety of different tissues in females, the researchers could specifically alter the "femaleness" or "maleness" of the pheromones, which in turn altered the patterns of aggressive behavior encoded in the fly's brain.

When they changed pheromone profiles so that females "tasted" like males, the researchers found that males would attack them. This indicated that pheromonal cues alone could label another fly as a competitor. But the researchers were surprised to discover that males also attacked "aggressive females" — flies that still looked, smelled and tasted female but had been genetically altered to display male-like patterns of behavior.

When the researchers turned the tables by triggering the expression of transformer in males so as to feminize both the pheromonal and behavioral profiles, control males showed no aggression toward the transformed males. Instead, they began to court them. These results show that it is possible to completely reverse normal behavioral responses by presenting males with unanticipated and conflicting sensory cues.

"Future studies will aim at unraveling the neuronal circuitry that governs this type of decision-making behavior, as such decisions are essential for survival," says Kravitz. "With the powerful genetic methods available in fly neurobiology, it should be possible to dissect the decision-making circuitry at far greater levels of detail than have heretofore been possible in other species."

"This study addresses a classic question in animal behavior: What motivates an individual to do X rather than Y, or vice versa," said Laurie Tompkins, Ph.D., who manages Kravitz's and other behavioral genetics grants at the National Institutes of Health. "Because the general principles of how behaviors are controlled are conserved among species, Kravitz's conclusions about how flies make simple choices may illuminate how humans and other animals make more complex decisions."

The study was supported by grants from the National Institute of General Medical Science and by a Pew Latin American Fellowship awarded to Fernández.

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Journal Reference:

1. María De La Paz Fernández et al. Pheromonal and Behavioral Cues Trigger Male-to-Female Aggression in Drosophila. PLoS Biology, 8(11): e1000541 DOI: 10.1371/journal.pbio.1000541

— A patient education program combining videos with one-on-one follow-up did not appear to reduce the risk of falls among all older hospital patients, but was associated with fewer falls among patients who were not cognitively impaired, according to a report posted online November 22 that will be published in the March 28 print issue of Archives of Internal Medicine.

"Falls are a leading patient safety incident event in general hospitals and are especially common in older patients," the authors write as background information in the article. About 30 percent of these falls result in injury, which could lead to lengthier hospital stays, the risk of institutionalization and potential legal complaints against the facility.

Terry P. Haines, Ph.D., of Monash University and Southern Health, Kingston Centre, Victoria, Australia, and colleagues conducted a randomized controlled trial assessing two forms of multimedia patient education designed to help prevent falls in the hospital. A total of 1,206 older patients at two Australian hospitals were randomly assigned to one of three groups between January 2008 and April 2009.

A group of 401 received the complete intervention, involving written materials, videos and one-on-one follow-up with a trained health professional at the patient's bedside. The program presented data about frequency and causes of falls, invited patients to reflect on their own risk and identify problem areas, then guided them toward developing goals and strategies for prevention. Another 424 patients received only the materials from the program and no individual follow-up, and a group of 381 received usual care, which varied by hospital but usually consisted of risk screening, use of alert items such as wrist bands and generic interventions such as checklists.

During the study period, 247 participants fell and 97 sustained injuries, including five fractures. Overall, the rate of falls per 1,000 days per patient did not differ significantly among the three groups (9.3 in the control group, 8.6 in the materials-only group and 7.6 in the complete intervention group).

However, among the 906 participants who did not have cognitive impairment, falls were less frequent among those in the complete program group (4 per 1,000 days per patient) than among those in the materials-only group (8.2 per 1,000 days per patient) or the control group (8.7 per 1,000 days per patient). Only 6 percent of patients who received the complete intervention fell, compared with 11 percent in the control group. Based on this data, the authors estimate that providing 33 patients with this intervention would prevent one from falling, and using it for 15 patients would prevent one fall.

"Many of the strategies pursued by patients as a result of participating in the complete program focused on (1) working more effectively with staff members caring for them; (2) identifying environmental hazards; and (3) using appropriate aids, equipment and clothing," the authors conclude. "These proposed strategies form a plausible mechanism of action for reducing falls among these patients and highlight the importance of behavioral elements in the causes of falls in this setting."

Among patients who were cognitively impaired, those receiving the full intervention had a higher rate of falls resulting in injuries than those in the control group (7.5 vs. 2.9 per 1,000 days per patient), and a similar proportion of patients who fell overall (26 percent vs. 24 percent). "Cognitive impairment can limit the ability of patients to adhere to the planned safety-promoting behaviors and is a reason why an education program might not be beneficial among these patients," the authors write. "Further research is warranted to examine the efficacy of the complete program targeted at cognitively intact patients and used within the context of a broader falls-prevention program that uses other strategies to reduce falls among cognitively impaired patients."

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Journal Reference:

1. Terry P. Haines, PhD; Anne-Marie Hill, MS; Keith D. Hill, PhD; Steven McPhail, BS; David Oliver, MD; Sandra Brauer, PhD; Tammy Hoffmann, PhD; Christopher Beer, MBBS. Patient Education to Prevent Falls Among Older Hospital Inpatients A Randomized Controlled Trial. Arch Intern Med., November 22, 2010 DOI: 10.1001/archinternmed.2010.444

Late-preterm babies — those born between 34 and 36 weeks — are at an increased risk for cognitive and emotional problems, regardless of maternal IQ or demographics, according to new research published by Michigan State University researchers in the current edition of the journal Pediatrics.

While late-preterm births (full-term pregnancies last at least 37 weeks) have been associated with such problems before, the study represents one of the most rigorous looks at the issue by accounting for other potential causes, said the study's lead author, Nicole Talge, a postdoctoral research associate in MSU's Department of Epidemiology.

"Previous studies reveal that babies born a little early are at-risk for short-term medical problems and possibly long-term behavioral and cognitive problems," Talge said. "We wanted to look at a diverse population of children and take into account important factors such as maternal IQ and birth weight for gestational age; do the previously reported associations still hold up?

"We found late-preterm babies are between two and three times more likely at age 6 to have lower IQs as well as higher levels of attention problems and symptoms of anxious, withdrawn behavior."

Talge stressed that not all babies born late-preterm experience problems and that further research is needed into exactly what is contributing to the increase.

As part of the National Institutes of Health-funded study, researchers analyzed a cohort developed by Naomi Breslau, a professor in MSU's Department of Epidemiology. Data on babies born between 1983 and 1985 in both urban and suburban settings in southeast Michigan were analyzed and compared with data collected when the children were 6 years old.

For each late-preterm baby analyzed, a full-term counterpart was randomly identified as part of a control group, taking into account birth weight for gestational age.

"Children born late-preterm exhibited lower levels of cognitive performance and higher levels of behavioral problems at the age of 6 even after accounting for socioeconomic factors and maternal IQs," Talge said. "We want to find out what explains these associations: Why are some late-preterm babies at risk and others are not? Could it be the presence of obstetric complications, neonatal complications, postnatal factors such as feeding choice or some combination of these factors?

"We are looking into these possibilities in follow-up investigations."

In addition, the increased risk was found at age 6; since children are still developing at that age it is important to see if and how these associations persist later in life.

It's important to find these answers as more children are being born late-preterm: The rate of such delivery has risen 20 percent since 1990. While there is debate as to why that is occurring, Talge said, the impact it is having needs to be addressed.

Other researchers taking part in the study include Claudia Holzman, Joseph Gardiner and Jianling Wang from MSU's Department of Epidemiology, part of the College of Human Medicine, and Victoria Lucia from William Beaumont Hospital in Royal Oak.