Mental health and the community

ABC TV's Australian Story program on Monday 5 March reported the heart-breaking story of Adam Salter, a man with a history of psychosis, who was shot and killed by police in November 2009 following a call made by his father that he was trying to stab himself.

Full details of the story can be found here.

The police involved on the day and in follow-up investigations of the matter were criticsed by the deputy state coroner of NSW at an inquest into Mr Salter's death in 2011.

Mental health advocates have described Mr Salter's medical and psychological treatment as a "failure of care".

While this is an extreme example of how mental health issues are not always dealt with well within the community, it is not an isolated incident. It has been well documented that mental health continues to carry a stigma within the community and does not always receive the same level of care and attention as physical illnesses. In Mr Salter's case, he was admitted to a mental health facility during a psychotic episode in 2008 as an involuntary patient and discharged without follow-up by the community mental health team and without his family being advised of his high risk of relapse. He is not alone. A Mental Health Council of Australia report, Consumer and Carer Experiences of Stigma from Mental Health and Other Professionals, which reports the results of a study of 400 mental health patients and 200 carers, found that 29% of patients reported feeling shunned or avoided by health professionals. Fourty-four percent of the carers believed that doctors behave differently towards patients when they find out that they have a history of mental health issues. Close to three quarters (73%) of the respondents said they had experienced stigma or discrimination in the last 12 months because of their mental illness.

Mental illness is not uncommon. One in five Australians suffer from a mental illness. The impact of mental illness is felt by the sufferer, their family, friends, workplaces and the broader community. It is important that mental health is treated seriously and that appropriate care is provided, including follow-up, appropriate referrals, case management and consultation with the family. An important component is community education.

We here at ANTS certainly recognise the importance of mental health and of educating the community. We run Mental Health First Aid Training programs to help increase knowledge about common mental health problems and to teach people and organisations to deal with mental health crises.

To learn more about our programs and our services more generally, contact us. We look forward to hearing from you.

Neuroplasticity in children

Neuroplasticity in children

The neuroplasticity of children’s brains has been well established. Children’s brains are able to reorganise themselves so that for instance if a young child suffers a brain injury to a part of the brain responsible for language another part of the brain will take over that function. The same does not occur in adulthood, and depending on which part of the brain is damaged, the adult may lose all or some language functions, while the child’s will be relatively spared.

Plasticity is greatest in the first few years of life because it is during this time that the brain is ‘wiring’ itself, working out which connections (or synapses) within the brain should be strengthened and which should be pruned. Anyone who has been exposed to a foreign language as a young child can attest to the effortless learning that occurs during this period, especially compared to the much more effortful process of learning a language as an adult.

The neuroplasticity of children’s brains has led to significant debate in the neuropsychological field about whether the outcomes of brain injury are better for children than adults. The example given above of the brain reorganising itself has been put forward as evidence supporting this view. However, there are several reasons why, depending on the severity of the injury, children actually tend to have worse outcomes than adults following brain injury.

Ironically, one reason is related to the process of brain wiring and forming synapses that contributes to neuroplasticity. During childhood there are certain ‘critical periods’ for development during which if a child is exposed to a certain experience or information they will benefit most from it. Some critical periods are essential (for example aspects of perception); and if a child does not receive the right stimulus during this period they will not develop the ability, for others learning is possible after the critical period but more difficult. Children who suffer brain injury may spend long periods of time recovering and not have the opportunity to be exposed to the appropriate experience or information during these critical periods.

Another reason is that different aspects of cognition develop at different rates. During infancy and early childhood basic processes such as perception and attention undergo rapid development whereas in later childhood and adolescence higher order linguistic and spatial functions are primary. Executive functions develop in late adolescence and early adulthood. The cognitive processes are hierarchical, so the higher order processes depend on the lower level ones. If a brain injury occurs in early childhood this may not only affect the processes developing at the time of the injury but also the development of higher level processes later in childhood.

Rehabilitation that occurs as soon as is possible after the injury is the best way to minimise the impact of the injury, for children and adults. The first step in any brain rehabilitation program is a thorough neuropsychological assessment.

If you’d like more information about Advanced Neuropsychological Treatment Services assessment and rehabilitation services please contact us.

References

Sparrow, S.S., & Davis, S. (2000). Recent advances in the assessment of intelligence and cognition. Journal of Child Psychology and Psychiatry, 41(1), 117-131.

Anderson, V., Northam, E., Hendy, J., & Wrennall, J. (2001). Developmental neuropsychology: A clinical approach. East Sussex: Psychology Press.

Plasticity in brains of middle age and older adults

Following on from our last post about brain neuroplasticity, this blog focuses on the ability of the brains of middle aged and older adults (ages 50 +) to change in response to environmental input.

This is particularly good news because of all individuals who were told their brain was fixed, none were given this message more so that people in this age group!

Initial evidence that brain training works!

The data came from the Iowa Healthy and Active Minds Study and investigated the efficacy of attention-based visual 'brain training' exercises. Brain training exercises are typically computer based programs which present activities that aim to restore or improve cognitive functioning in various areas, usually: attention, memory, communication and planning/organisation. They can be used as part of a program of cognitive remediation for people who have sustained brain damage, or to miminise cognitive decline that occurs naturally with age.

Participants in the experimental groups underwent brain training exercises with different levels of supervision and follow up. The training came in the form of a game that challenged participants to visually process multiple things on the screen at once. A control group underwent crossword puzzle training sessions. Progress was measured by assessing particiants' "useful field of view", what they are able to attend to out of the corner of their eye, which is known to shrink with age.

Initial findings showed improvements in the useful field of view and performance on other cognitive tests of the experimental groups compared to the control group. This distinction indicates that it is the content of the training itself that is having the effect, rather than general stimulation.

The findings add to what scientists are beginning to learn: brain training has the potential to strengthen neural connections in the brain and may help to keep people of all ages mentally sharp! There are a broad range of online options for brain training exercises for those of us trying to keep our brains active and 'plastic'.

If you have sustained a brain injury and are looking for a specific treatment program, please contact us to find out more about our cognitive remediation services.

And stay tuned for more information about neuroplasticity...

What do you mean my brain is plastic?

It's strange but true, our brains are like plastic!

What this means is that our brains can be 'moulded'. As we learn, think, grow and gain new experiences our brains change and reorganise themselves. The fancy scientific term for this is "neuroplasticity".

While the neuroplasticity of children's brains has been well established, until fairly recently it was thought that adult's brains were fixed or hard-wired and unable to be moulded. Hence cliches like "you can't teach an old dog new tricks".

Well, luckily for anyone over the age of 18, it it turns out that you can!

The next series of blogs focuses on research and case studies that demonstrate that our brains have the ability to adapt to our environment and that we can keep on learning and improving throughout out lives. Another big thanks to ANTS-er Karen who is on top of all the fascinating neuro news!

Brain adapts when a limb is damaged

A fascinating study undertaken by Prof Lutz Jancke and colleagues at the University of Zurich in Switzerland has shown that when a limb is damaged and immobilised the thickness in the cerebral cortex (brain matter) associated with that part of the body reduces.

In a study that is the first of its kind, 10 right-handed people who had broken their dominant (right) arms had MRI brain scans within 48 hours of their accidents before their arms where placed in plaster/slings and again 16 days later while immobilised. The researchers also measured signals sent from brain to the right arm and the dexterity of their non-dominant left hand.

They found that the thickness of the motor cortex (brain cells that control movement) on the left side of the brain (which controls the right arm) decreased significantly in response to the arm's lack of use, and the signals from that part of the brain to the hand reduced. Whereas the dexterity of the left hand increased, as did the thickness of the part of the brain controlling movement in the left hand - in this case particularly the pre-motor cortex, which is involved in planning complex movements.

Dr Penelope McNulty of Neuroscience Research Australia said about the study:

"It just shows how dynamic the brain remodelling really can be. As far as I'm aware, this is one of the first studies to show that inactivity produces plasticity in the human brain."

This study has implications for the treatment of many conditions where there is loss of use of a part of the body, such as strokes.

It also reinforces that when it comes to the brain you need to use it or lose it!

We'd love to hear from you! Maybe you have a story about how your brain has changed, or maybe you'd like to know more about how to make the most of your exceptional brain. You can post a comment below or contact us here.

Nature v's Nurture? New Evidence regarding Intelligence

Nature v's Nurture

For decades, scientists, educators and psychologists have debated the contribution of our genes v's our environment to our intellectual functioning.

New research has quantified the contribution of both.

In a longitudinal study of almost 2,000 people, professors at the University of Edinburgh, University of Aberdeen and University of Queensland determined that genes are responsible for 40% of our lifetime intelligence, with the other 60% being determined by the environment.

The study commenced 80 years ago when intelligence tests were administered to almost all children born in Scotland in 1921 and 1936. Professor Deary from the University of Edinburgh tracked down 2,000 of these individuals who agreed to be re-tested and to supply gene samples for DNA analysis. They were aged from 65 to 79 years at the time of re-testing. Researchers examined the test scores and more than half a million genetic markers.

They found that intelligence was remarkably stable across the lifespan, but there were also examples of people whose functioning improved or worsened over time. The study of genetic markers allowed Professor Deary, Professor Visscher and colleagues to create an estimate of to what extent genetic differences affect how intelligence changes across a lifetime.

While the outcomes show that both genes and environment play an important role in our intellectual functioning, genes are somewhat easier to study. Measuring detailed environmental factors is, according to Geneticist Professor Peter Visscher from the University of Queensland: "very very difficult". The researchers hope that this study will provide impetus for further research on the specific factors that are important for development of intelligence.

This research is critically important because intelligence is a predictor of many factors including lifespan, health and income. Understanding what influences our cognitive abilities may help us better manage conditions which affect the brain, such as dementia.

Molly goes into rehabilitation

Molly Meldrum has recently been transferred from hospital to a private rehabilitation centre, Epworth Rehabilitation Home.

Reportedly, the focus of his rehabilitation will be on improving his memory. Specifically, according to his brother, Brian, "getting things into the short term memory to the extent that they're passed onto the long term memory". There are ongoing reports that he is disoriented, has memory lapses, can only participate in limited conversation and that his recovery is likely to be gradual and prolonged.

Given his age and the likely severity of his traumatic brain injury, these outcomes are unsurprising. However, a rehabilitation program will ensure that Molly has the best possible recovery.

What is rehabilitation

Rehabilitation can be physical or cognitive, and in the case of traumatic brain injury, usually both. Our focus will be on cognitive rehabilitation.

Cognitive (thinking skills) rehabilitation has two components: restoration of functions that can be restored (remediation) and using intact skills to compensate for impaired skills (compensation). Processes that lend themselves well to restoration are things like unilateral visual inattention, where an individual does not attend properly to objects/information on one side. With practice and use of specific techniques to draw the patient's focus to the neglected side, this can often be restored.

Memory, particularly in cases of severe injury and with older patients, is often very difficult to restore. Compensation is the best option for treating memory problems. Common memory compensation techniques are using calendars, labelling objects, placing commonly used items in the same place each time, asking others to provide reminders and using techniques that optimise use of the memory process least impaired (e.g. if visual memory is better than verbal memory the use of charts/pictures can help).

The first step and the cornerstone of treatment for traumatic brain injury is a thorough neuropsychological assessment to identify level of functioning and pinpoint strengths and weaknesses. For more information about our assessment and treatment services, visit the ANTS website or contact us.

Molly Meldrum and TBI in the elderly

On 15 December 65 year-old Ian “Molly” Meldrum fell 3 metres downstairs whilst putting up Christmas decorations in his home, striking his head and fracturing his skull. He was hospitalised, sedated and placed on a ventilator to help him breathe. From the little information released by the media on his condition and recovery since the fall it appears that: Molly was unconscious for several days and possibly more than a week – although it is understood that he was in an induced coma for part of that time He regained consciousness after Christmas but remains disoriented and confused

• He is only able to respond to basic commands and is unable to carry on a conversation
• He can recognise close family members at times but this is inconsistent

These factors suggest that Molly sustained a traumatic brain injury (TBI) that was at least in the severe and possibly extremely severe, range.

Today’s ABC news report predicts that Molly has “a very, very long haul ahead of him”.

Research supports this assertion. Older age is an important predictor of worse outcome after TBI, even with relatively minor head injuries. A study by Mosenthal and colleagues (2002) found that elderly patients had twice the in-hospital mortality of younger TBI patients, the mortality rate increasing for each decade over 50 years. Elderly survivors of TBI are more likely to have a severe disability or be in a persistent vegetative state. The incidence of complications and poorer outcome after surgery are also worse for older patients.

The best predictors of a favourable outcome following TBI are younger age and lesser severity of TBI.
While this doesn't bode well for Molly, he does appear to be making some progress and all signs are that his functioning will continue to improve. It is also likely that he is getting the best possible care, which can make all the difference in ensuring the best possible recovery.

The thoughts of the ANTS team are with Molly and his family and we wish him a speedy recovery.

If you would like more information about TBI, cognitive rehabiliation or other ANTS services, please contact us.

References
Mosenthal, A.C., Lavery, R.F., Addis, M., et al. (2002). Isolated traumatic brain injury: Age is an independent predictor of mortality and early outcome. Journal of Trauma, 52(5), 907-911.
http://www.couriermail.com.au/news/molly-still-faces-an-uphill-battle/story-e6freon6-1226236078834
http://www.theaustralian.com.au/news/nation/meldrum-remains-in-intensive-care-faces-long-haul-to-recovery/story-e6frg6nf-1226236011605
http://www.heraldsun.com.au/news/more-news/molly-meldrum-recognises-brother/story-fn7x8me2-1226233539168
http://www.clinicalgeriatrics.com/articles/Traumatic-Brain-Injury-Elderly?page=0,8