Benzodiazepines are a type of medication which fall under the sedative-hypnotic class, and work by enhancing the activity of the neurotransmitter GABA. While benzos are most well-known for their sedating and anxiolytic effects, they have been used in the treatment of those with seizures, alcohol withdrawal, for anesthesia purposes, as well as for insomnia and mental health issues like anxiety (particularly in the short term).

Interestingly from a historical perspective, benzos were also the original treatment for PTSD, and were thought to be beneficial in treating PTSD symptoms rapidly, particularly anxiety and trouble sleeping. While statistics range from 30% to upwards of 74% of those with PTSD being treated with benzodiazepines of some kind, there is growing evidence that suggests that these medications are not effective in treating the core symptoms of PTSD (i.e. hyperarousal, dissociation, and avoidance). 

In addition, studies have also suggested that use of benzodiazepines for those with PTSD may be in fact be harmful with risks that far outweigh the benefits. The studies below suggest that we should be very cautious in prescribing benzos for PTSD due to the high rates of comorbid substance use disorders (a serious risk given the tolerance/withdrawal associated with these meds), in addition to suggestions that benzos may in fact worsen overall severity of PTSD, depression and treatment outcomes for those who are affected.
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To learn more, check out these articles:
https://www.ncbi.nlm.nih.gov/pubmed/26164054
http://www.ptsd.va.gov/…/newsl…/research-quarterly/v23n4.pdf

If you've heard of the medication gabapentin before, you'll recall that it is most often used in the treatment of seizures as well as neuropathic pain.

However, addiction medicine specialists have been beginning to use the medication in the management of patients with alcohol use disorder, due to growing evidence that gabapentin, when used at moderate-high doses and compared to placebo, increases abstinence rate and days free of heavy drinking. In addition, studies also demonstrate that gabapentin can reduce withdrawal symptoms and aid in long-term recovery by reducing anxiety, insomnia, and cravings. 

The most common side effect of the medication is sedation and drowsiness. Doses tend to commonly range from 900-1800mg per day in TID divided dosing, but can be as high as 3600mg a day.
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To find out more, check out one of the RCTs that examined the utility of gabapentin for alcohol use disorder:
http://jamanetwork.com/journals/jamainternalmedicine/article-abstract/1764009

Could Instagram be used to help monitor one's mental health or in screening for depression? A recent study suggests this may just be in our future ...

The study, conducted by researchers at Harvard University and the University of Vermont, analyzed over 43,000 photos posted on Instagram by 166 volunteers. The volunteers were also asked to complete surveys that looked at their social media use, as well as history of mood disorder diagnoses and symptoms of depression.

The results indicated that certain features, such as colour, brightness, and number of faces, of one's online photos may be possible markers for or indicators of depression.

"Those who were depressed tended to post photos with increased hue, decreased brightness, and decreased color saturation. Overall, their photos were “bluer, grayer, and darker.” They also tended to post more frequently and use more Instagram filters, the most popular one for depressed participants being Inkwell, which turns a photo black and white. The most popular filter for volunteers who weren’t depressed was Valencia."
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To learn more about the study, click here:
https://arxiv.org/ftp/arxiv/papers/1608/1608.03282.pdf
http://fortune.com/2016/08/22/instagram-diagnose-depression/

Researchers at Duke University have made a significant advancement in understanding ‪‎OCD‬, as they announced last Friday that they have identified a receptor in the ‪‎brain‬ that may cause the disorder. Though their research was originally conducted in mice, it opens doors for the development of new more targeted and likely more effective medications and treatments ...

"When comparing regular mice to mice that lacked the Sapap3 gene, researchers discovered that the mice without it often had an overactive direct pathway, seemingly explaining why they are so prone to repeating the same actions over and over. When scientists did even more digging, they realize that a specific chemical receptor, called mGluR5, was consistently active in the brains of the mice who lacked Sapap3. This finding suggests that mGluR5 may control the hyperactivity of the brain circuits that coordinate action, thus possibly explaining why so many people with OCD have both obsessive thoughts and obsessive actions."

To read more about the study click here:
http://www.bustle.com/…/173805-what-causes-ocd-scientists-m…
http://thescienceexplorer.com/…/researchers-find-switch-ocd…

For the original abstract click here:
http://www.biologicalpsychiatryjournal.com/…/S0006…/abstract

Health Canada announced early last week that they have approved a new ‪‎antipsychotic‬ medication for the treatment of ‪‎schizophrenia‬ in adults.

The medication is called Invega Trinza (aka paliperidone palmitate), a new version of the drug Invega Sustenna, which has already been out on the market for some time. Psychiatrists are hopeful regarding the impact Invega Trinza may have on the care of their patients and specifically their medication compliance and risk of relapse, as it is an injection that need only be administered four times a year, rather than on a monthly schedule in its old form.

"Adherence to medication is often a challenge for Canadians living with schizophrenia, with not taking medication as prescribed as the most common cause of relapse. Studies have shown that within the first five years of treatment, up to 80 per cent of people with schizophrenia had experienced one or more relapses. Each relapse can result in a reduced response to treatment, putting continued symptom control even further out of reach.

"Relapse prevention is a critical part of disease management and recovery-focused care for people living with schizophrenia," says Dr. Philip Tibbo, Director, Nova Scotia Early Psychosis Program in Halifax. "The unique dosing of INVEGA TRINZA can offer patients long-term symptom control. This could help to significantly reduce the risk of relapse over time." 
For more information about this new medication, check out the links below:

• http://www.newswire.ca/news-releases/health-canada-approves-first-treatment-for-schizophrenia-dosed-four-times-a-year-584505301.html
• http://windsorstar.com/news/local-news/new-schizophrenia-medication-taken-four-times-a-year

The gap between physical and mental healthcare is starting to be bridged thanks to a number of hospitals in the United States which are trying out a new pilot program. In the past, ‪psychiatrists‬ saw patients on medical units only as consultants, when called upon by other physicians after a mental health crisis emerged such as the development of ‪delirium‬ or when a patient becomes difficult to manage. However, with this new project, psychiatrists are an integral member of medical ward teams, including those in the ‪ICU‬.
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By including psychiatrists on these medical teams, they have the opportunity to round on all the patients on the unit, helping to identify and tackle mental or emotional health problems early on, provide bedside ‪psychotherapy‬ and support, and offering much needed input regarding medications and other modalities to use and avoid in order to prevent the development or worsening of ‪‎mental health‬ issues.

While the hospitals are currently studying the impact of this new program, early data has shown that by having psychiatrists on the medical wards length of stay in hospital can be shortened, and they further postulate that these new teams may even reduce the chance that patients may need to be readmitted.

For the full article, click here:
http://www.wsj.com/articles/hospitals-test-putting-psychiatrists-on-medical-wards-1461604767

If you've ever pulled an "all-nighter" whether when studying for exams or because you were up all night on call, you may remember not feeling or functioning at your best the next day secondary to the sleep deficit. In the article below, we learn of the impact ‪‎sleep‬ (or lack there of) can have on our brains and on our ‪‎mental health‬.
As you may have heard before and growing evidence is showing, sleep is quite important for those with mental illness. In addition when patients report sleep disturbances it may also help us identify conditions like ‪‎depression‬ and ‪‎bipolar‬ disorder. In this article, we learn of how being mindful of our patients' sleep when diagnosing and treating mental illnesses can be incredibly important and beneficial.

"Sleep abnormalities have indeed been identified in individuals prior to mental illness. For example we know that sleep disruption usually happens before an episode of depression. Furthermore, individuals identified as “at risk” of developing bipolar disorder and childhood-onset schizophrenia typically show problems with sleep before any clinical diagnosis of illness.

Such findings raise the possibility that sleep and circadian rhythm disruption may be an important factor in the early diagnosis of individuals with mental illness. This is hugely important, as early diagnosis offers the possibility of early help. It is also plausible that treating the actual sleep problems will have a positive impact upon the level of mental illness. A recent study managed to reduce sleep disruptions using cognitive behavioural therapy in patients with schizophrenia who showed persecutory delusions and found that a better night’s sleep was associated with a decrease in paranoid thinking along with a reduction in anxiety and depression. So the emerging data suggests treating sleep problems can be an effective means to reduce symptoms."

For the full article, click here: https://www.weforum.org/agenda/2015/11/how-sleep-and-mental-health-are-linked-in-the-brain/?utm_content=buffer0592b&utm_medium=social&utm_source=twitter.com&utm_campaign=buffer

For many individuals, having a heart attack is a life-defining event. It can also be life-changing, but not just in the fact that for some it offers a frightening reminder that one should employ a healthier lifestyle, but rather we're now learning that for some, heart attacks can also have a profound impact on one's mental well-being...

Recent studies have found that the prevalence of ‪depression‬ post-MI are markedly higher than that of the general population, and range between 20-40% with a higher prevalence among women and those with a past history of a mood disorder. Researchers are also concerned that experiencing depression may also impair one's recovery following the heart attack, and as such put these individuals at an increased risk of additional cardiac events in the future.

"“People who are depressed are at much higher risk of having another cardiac event, which could potentially kill them,” Jacobs says. Those diagnosed with major depression or who have symptoms indicating they have major depression after a heart attack – including that it impairs their ability to function – face almost twice the risk of having a future heart attack and are one and a half times more likely to die prematurely, Davidson says.

But while ‪‎cardiologists‬ typically inquire about other risk factors, they routinely fail to screen patients for depression after a heart attack. Previous research finds about 7 in 10 cardiologists failed to inquire about depression in more than half of their cardiac patients, even though depression is more common following cardiac events and procedures. “We really need to address this issue in a more systematic way,” says Coulter, who has done research on treating depression to reduce cardiac risk and improve outcomes."

For the full story, click here: http://health.usnews.com/health-news/patient-advice/articles/2016-02-25/depression-can-threaten-recovery-after-a-heart-attack

Catch up on all the news related to mental health and psychiatry from last week!

Surfacing data has identified a growing trend of prescribing ‪‎antidepressants‬ and ‪antipsychotics‬ to toddlers and ‪children‬ under the age of 2. For many physicians and experts in the field, the use of psychotropics to address violent or withdrawn behaviour in our youth is worrisome, particularly due to the fact that these medications were originally designed for adults and have not been researched on young children to determine efficacy and risks on young people with rapidly developing brains.

The data also raises the question of whether as a society we are pathologizing certain child behaviours that are variants of normal or are seeking a quick fix rather than being willing to spend the time and money to explore the more deeply rooted causes of the child's mood and actions. It also brings to light the shortage of child psychiatrists and gaps in the training of our pediatricians which likely perpetuate the issue.

"In interviews, a dozen experts in child psychiatry and neurology said that they had never heard of a child younger than 3 receiving such medication, and struggled to explain it. They presumed that parents and doctors, probably desperate and well meaning, were trying to alleviate thrashing temper tantrums — the kind that get children kicked out of day care — or an overly depressed disposition, like being strikingly inhibited, nonverbal or lethargic.

“People are doing their very best with the tools available to them,” said Dr. Mary Margaret Gleason, a pediatrician and child psychiatrist at Tulane University School of Medicine. “There’s a sense of desperation with families of children who are suffering, and the tool that most providers have is the prescription pad.”

But Dr. Gleason said that children with ages measured in months had brains whose neurological inner workings were developing too rapidly, and in still unknown ways, to risk using medications that can profoundly influence that growth. She said the medications had never been subject to formal clinical trials in infants and toddlers largely because of those dangers."

For the full story, click here: http://www.nytimes.com/2015/12/11/us/psychiatric-drugs-are-being-prescribed-to-infants.html?ref=todayspaper&_r=1