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Mental Health Information Centre - Southern Africa

Stellenbosch University is conducting neuroimaging research in social anxiety disorder (SAD)

February 11th, 2016

Brain imaging research in the past has largely been focused on looking at regional differences in activity in the brain. So for example, researchers demonstrated that in the brains of people with SAD, there might be more activity in the amygdala (a part of the brain involved in anxiety) than would be expected in people without the disorder. While this work remains important, such regional differences only represent part of the picture!

Functional connectivity research is a recent method of brain analysis that allows scientists to examine how multiple, widespread connections in the brain result in these regional differences in activity. Groups of these connections form what are known as ‘neural networks’ and several of such networks have so far been detected. There is some evidence that one network in the brain (called the default mode network) may play a role in how social information is processed (social information includes our perceptions and thoughts about other people and how they perceive us).

We are interested in networks in the brains of SAD sufferers and whether they differ from those without the disorder. We want to investigate whether network differences can be linked to how people with SAD process social information. We also want to see the effect of treatment (using an established treatment for SAD – moclobemide) on these networks.

The project has been ongoing since 2015, and is progressing well. We need more participants with SAD however.

All participants undergo two types of brain scan (FDG PET/CT and fMRI) and a series of psychological tests. SAD volunteers then receive an 8-9 week course of moclobemide followed by repeat testing and scanning. Excluding the initial (screening) visit, SAD participants attend 8 study visits over the course of 9 weeks, while healthy volunteers (without SAD) attend 4 study visits over the course of 1-2 weeks. Participants are reimbursed for their food and travel costs.

Eligibility criteria:
• Between the ages of 18 and 55
• Fluent in English (the psychological tests are only available in English)
• Right-handed (left-handed people’s brains are different)
• Not pregnant or breastfeeding
• No dominant psychiatric conditions other than Social Anxiety Disorder (SAD participants)
• No significant psychiatric conditions at all (volunteers without SAD)
• Not currently on any medications for a psychiatric condition, or willing to temporarily interrupt medications to participate in the study.
• A few other medications might interfere with the study: the study doctor will check this provided you meet the other criteria.
• No previous or current medical conditions that directly affect the brain, (including previous head injury with loss of consciousness or brain surgery), no metal implants in the skull, no diabetes (affects the scan)
• Able to lie still in a scanner for up to an hour at a time

If you suspect you have SAD or have been diagnosed with SAD and are interested in taking part in the study; or if you are willing to volunteer as a healthy control (without SAD), please contact any of the following:
• Prof Christine Lochner (cl2@sun.ac.za ): Tel: 021 – 938 9179

Cognitive Training in Patients with Trichotillomania (Hair-Pulling Disorder)**

January 27th, 2016

Cognitive Training in Patients with Trichotillomania (Hair-Pulling Disorder)

Trichotillomania (hair-pulling disorder or HPD) is a condition in which patients engage in recurrent pulling of hair, resulting in hair loss. The negative impact of HPD should not be underestimated. For example, themes that emerged from reports from HPD patients focus on problematic triggering events, negative affect (isolation, embarrassment and shame, anger and frustration fear, guilt, humiliation and pain, body image issues) and control difficulty (self-disclosure, lack of information from the medical community and lack of control). Patients also live with the constant awareness of the impact their difficulty has on self and others in areas of social, occupational, academic and family functioning. Furthermore, patients may avoid accessing health care services due to feelings of shame, which contributes to delays in treatment seeking, incorrect diagnosis and reduced quality of life.

This intervention study will be conducted at the Psychology Department at Stikland Hospital, Bellville. Initially, 40 participants with a diagnosis of HPD will be recruited.

There will be an intervention called cognitive training. Cognitive training is a treatment method that focuses on improving cognitive functions (e.g. memory, attention, concentration, learning, planning). There is evidence to suggest that this method of cognitive training can increase working memory ability. An increase in working memory ability has shown positive effects on other impulse control difficulties (e.g. Attention Deficit Hyperactivity Disorder and Substance Abuse), thus there is reason to think that cognitive training may also be effective for treatment of HPD.
Thus, this study aims to assess whether cognitive training can reduce hair-pulling symptoms. To date, available treatments have not shown long-term reduction of symptoms.

Once referred to the study, the participant will be contacted telephonically and asked a few questions to make sure they are appropriate for inclusion to the study. Then a first contact session will be scheduled where the participant will complete working memory and impulse control tasks and questionnaires to assess their level of functioning before treatment. During the second contact session, the participant will be introduced to the internet-based cognitive training program, which he/she will use, at home, during the next 5 weeks. After completion of the training, a third contact session will be scheduled, during which the participant will complete working memory and impulse control tasks and questionnaires to assess change in hair-pulling symptoms and working memory. A fourth contact session will be scheduled 3 months after completion of the training to assess whether the changes were maintained over a longer period.

All participants will get the same tests. The only difference is that half of HPD patients will receive the real cognitive training program, and the other half will do the placebo training.

If you do qualify for participation, you will be asked to do the following things:
• To attend the 4 contact sessions scheduled with the principle investigator.
• To complete the internet-based cognitive training program – this entails 25 sessions, at home, over a period of 5 weeks.
• To do the training in a quiet environment where you can concentrate.
• To make use of an electronic device, preferably a computer or laptop, that has access to the internet (the whole 5 week program uses about 50Mb of data).

If you want more information or want to participate, please contact: Ms Derine Sandenbergh: (021) 940 4449 / 4504; Derine.Sandenbergh@westerncape.gov.za, or Prof Christine Lochner 021 – 938 9179, e-mail: cl2@sun.ac.za

Cognitive training in patients with obsessive-compulsive disorder (OCD)

January 27th, 2016

Cognitive training in patients with obsessive-compulsive disorder (OCD)

OCD is a condition that is known to be associated with problematic functioning of certain regions of the brain. One such problem relates to a concept called “working memory”. Working memory is linked to a person’s control over his/her thoughts and behaviour. There is research that suggests that greater activation of specific parts of the brain is associated with improved working memory, and thus improved self-control. This study involves a simple “brain game” (i.e. a “cognitive training” with the so-called n-back working memory task) that trains this specific part of the brain, to test whether this method can improve self-control in people with OCD.

What will your responsibilities be?

In order to participate, you need to have a Smartphone on which the study application will be loaded. If you do not, cognitive training would have to be provided by the UCT Department of Psychiatry and Mental Health on a loan phone which you will be responsible for. You will undergo a comprehensive screening interview with a clinical psychologist to see whether you qualify for participation. The interview also includes the assessment of OCD symptoms and severity.

The study aims to include 20 OCD patients and 20 healthy controls to compare. Nine participants have been recruited thus far, two have completed the 8-week Cognitive Training and two more are currently on their way to completing the Cognitive Training. Taking part in the study involves the following: a screening session, a neuropsychological testing session, a brain scan session, a 4 week follow-up, a post scan and post neuropsych/exit interview. Thus far the training has gone smoothly and participants seem to engage well with this novel manner of brain training. Patients who have already completed the study have expressed their interest in continuing using the application.

Will you benefit from taking part in this research?

Based on results from previous research in other psychiatric disorders, we know that it is highly likely that doing brain training in this way will alter the way your brain functions, in a healthy way, so that you can use more self-control to decrease obsessive thoughts and compulsive behaviour. If this can be proven, your participation will help to increase the number of possibly effective treatment options for patients with OCD.

We are still eagerly looking for participants. If you think you have OCD, or would like to take part as a healthy control, please contact one of the persons involved in the study, as indicated below.

Prof Christine Lochner 021 – 938 9179, e-mail: cl2@sun.ac.za or visit http://mentalhealthsa.org.za

We are looking forward to the results of this study and hopefully making a difference in the field of OCD!

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Major New Study Rewrites the Nature v. Nurture Debate About Schizophrenia

December 1st, 2015

One of the largest studies of postmortem human brain tissue found that environment affected brain changes associated with schizophrenia during early development but not during early adulthood when individuals appear to become ill

The Lieber Institute for Brain Development (LIBD) released today the results of a study that shed new insights on the nature versus nurture interplay in schizophrenia. Findings from one of the largest studies of postmortem human brain tissue suggest that environmental influences during the prenatal period cause brain changes associated with schizophrenia, but that environmental influences in early adulthood, when symptoms of the illness typically emerge, may not be as important as originally thought.

“Mapping DNA methylation across development, genotype and schizophrenia in the human frontal cortex”

The study and its relevant findings were published today in Nature Neuroscience. The published paper, titled “Mapping DNA methylation across development, genotype and schizophrenia in the human frontal cortex,” can be found online here.

Findings outlined in the paper shed new light on the potential role of environmental influences on an individual’s risk of developing schizophrenia. The role of the environment in causing schizophrenia is a hotly debated topic, with many theories focusing on the stressful environment around the early adult period that typically heralds the onset of clinical symptoms of schizophrenia. In the study, results suggest that the prenatal period, not early adulthood, is when environmental influences cause brain changes involving DNA methylation that are associated with a greater risk of schizophrenia.

The environment can affect human biology, e.g. how your brain responds to experience, or how your body responds to exercise, by influencing the mechanisms that turn genes on and off. One of these mechanisms is called “epigenetics,” which involves changes in the chemical structure of DNA without changes in the inherited genetic code itself. DNA methylation is an epigenetic change that signals an environmental effect.

Study investigators analyzed the brain tissue of 526 subjects, including 191 individuals with schizophrenia and 335 normal subjects, to determine how DNA methylation changes in the transition from prenatal to postnatal life and how it changes during early adult life. These time periods both involve profound environmental changes, both biological and experiential. These periods also involve major changes in DNA methylation.

Unexpectedly, investigators found that changes in DNA methylation that are associated with schizophrenia and observable in the brain tissue of patients with the illness had no observable relationship to the environmental effects that might have played on the brain at the time when individuals first require treatment in early adult life – for example, when they first seem to manifest the illness. Instead, the changes were strongly linked to the early development period.

“This is the first time we have been able to take a molecular snapshot of when the environment affects the brains of patients with schizophrenia,” said Andrew Jaffe, Ph.D., the study’s lead investigator.

The results suggest that the epigenetic changes that leave a lasting mark in the brains of patients with schizophrenia harken back to early brain development – long before the first symptoms of the illness are recognized. In other words, the building of the brain early in life is key to understanding schizophrenia, and the events around the apparent onset of the illness “may be a red herring,” said Dr. Jaffe.

“This conclusion, while perhaps not the final verdict on the subject, is hard to resist given this remarkable evidence,” said Daniel R. Weinberger, M.D., director and CEO of the Lieber Institute for Brain Development and co-leader of the research team with Joel Kleinman, M.D., Ph.D., the Lieber Institute’s associate director of clinical sciences. “These results have potentially far-reaching implications for how we understand schizophrenia, how we develop experimental models of this illness in scientific laboratories, how we search for new ways to prevent the disorder from happening, and how we treat it once it does.”

About the Lieber Institute for Brain Development

The mission of the Lieber Institute for Brain Development and the Maltz Research Laboratories is to translate the understanding of basic genetic and molecular mechanisms of schizophrenia and related developmental brain disorders into clinical advances that change the lives of affected individuals. LIBD is an independent, not-for-profit 501(c)(3) organization and a Maryland tax-exempt medical research institute affiliated with the Johns Hopkins University School of Medicine.

http://www.businesswire.com/news/home/20151130006174/en/Major-Study-Rewrites-Nature-v.-Nurture-Debate

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Neuroimaging Research in Social Anxiety Disorder (SAD)

November 18th, 2015

The SU/UCT MRC Unit on Anxiety & Stress Disorders, Stellenbosch University and Tygerberg Hospital are currently engaged in Neuroimaging Research in Social Anxiety Disorder (SAD) and we are now looking for healthy controls.

In particular, we are now seeking 3 healthy controls that fit one of the following profiles:
1) Female, about 22 years old (in the range of 19-25 years), right handed, does not have a psychiatric condition, not taking any psychotropic medications.
2) Female, about 40 years old (in the range of 37-43 years), right handed, does not have a psychiatric condition, not taking any psychotropic medications.
3) Male, about 33 years old (in the range of 30-36 years), right handed, does not have a psychiatric condition, not taking any psychotropic medications.

For further information on the research, please contact:
Prof Christine Lochner (cl2@sun.ac.za ): Tel: 021 – 938 9179

Psychiatry in distress: How far has South Africa progressed in supporting mental health?

November 16th, 2015

Late last week, psychiatry professor Dan Stein, after winning a National Science and Technology Forum (NSTF) Award for research and output, said South Africa needed to invest more deeply into assisting patients with mental disorders.

Mental Health Topics

In partnership with:


University of Stellenbosch
South African Medical Research Council
University of Cape Town