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Showing posts with label Impulsivity. Show all posts
Showing posts with label Impulsivity. Show all posts

Monday, February 26, 2024

Hope for Suicide Prevention

Ellen Barry
The New York Times
Originally published 21 Feb 24

Here is an excerpt:

Research has demonstrated that suicide is most often an impulsive act, with a period of acute risk that passes in hours, or even minutes. Contrary to what many assume, people who survive suicide attempts often go on to do well: Nine out of 10 of them do not die by suicide.

Policymakers, it seems, are paying attention. I have been reporting on mental health for The New York Times for two years, and in today’s newsletter I will look at promising, evidence-based efforts to prevent suicide.

A single element

For generations, psychiatrists believed that, in the words of the British researcher Norman Kreitman, “anyone bent on self-destruction must eventually succeed.”

Then something strange and wonderful happened: Midway through the 1960s, the annual number of suicides in Britain began dropping — by 35 percent in the following years — even as tolls crept up in other parts of Europe.

No one could say why. Had medicine improved, so that more people survived poisoning? Were antidepressant medications bringing down levels of despair? Had life in Britain just gotten better?

The real explanation, Kreitman discovered, was none of these. The drop in suicides had come about almost by accident: As the United Kingdom phased out coal gas from its supply to household stoves, levels of carbon monoxide decreased. Suicide by gas accounted for almost half of the suicides in 1960.

It turns out that blocking access to a single lethal means — if it is the right one — can make a huge difference.

The strategy that arose from this realization is known as “means restriction” or “means safety,” and vast natural experiments have borne it out. When Sri Lanka restricted the import of toxic pesticides, which people had ingested in moments of crisis, its suicide rate dropped by half over the next decade.


Here is my summary

The article discusses new suicide prevention measures in the U.S., where suicide rates have risen 35% in recent decades. This contrasts with global trends of declining suicide rates.
  • It highlights how installing barriers on bridges, buildings, and other high structures can deter impulsive suicide attempts. Many communities are now considering such barriers.
  • Research shows most who survive a suicide attempt go on to live their lives and not die by suicide later. This suggests preventing access to lethal means in moments of crisis can save lives.
  • Restricting access to highly lethal means like guns and toxic pesticides has significantly reduced suicide rates when implemented in other countries.
  • In the U.S., red flag laws that temporarily remove guns from high-risk individuals have been associated with drops in firearm suicides.
  • Educating gun owners on safe storage habits is another promising approach, as is providing incentives for measures like locking devices or gun safes.
  • Even brief counseling for gun owners has proven effective in getting people to voluntarily store guns securely and prevent access during periods of risk.
In summary, the text highlights several evidence-based strategies for reducing access to lethal means during periods of acute suicide risk, thereby giving people a chance to recover and survive their suicidal crises.

Sunday, May 12, 2019

Looking at the Mueller report from a mental health perspective

 Bandy X. Lee, Leonard L. Glass and Edwin B. Fisher
The Boston Globe
Updated May 9, 2019

Here is an excerpt:

These episodes demonstrate not only a lack of control over emotions but preoccupation with threats to the self. There is no room for consideration of national plans or policies, or his own role in bringing about his predicament and how he might change, but instead a singular focus on how he is a victim of circumstance and his familiar whining about unfairness.

This mindset can easily turn into rage reactions; it is commonly found in violent offenders in the criminal justice system, who perpetually consider themselves victims under attack, even as they perpetrate violence against others, often without provocation. In this manner, a “victim mentality” and paranoia are symptoms that carry a high risk of violence.

“We noted, among other things, that the president stated on more than 30 occasions that he ‘does not recall’ or ‘remember’ or have an ‘independent recollection’ of information called for by the questions. Other answers were ‘incomplete or imprecise.’ ” (Vol. II, p. C-1)

This response is from a president who, in public rallies, rarely lacks certainty, no matter how false his assertions and claims that he has “the world’s greatest memory” and “one of the great memories of all time.” His lack of recall is particularly meaningful in the context of his unprecedented mendacity, which alone is dangerous and divisive for the country. Whether he truly does not remember or is totally fabricating, either is pathological and highly dangerous in someone who has command over the largest military in the world and over thousands of nuclear weapons.

The Mueller report details numerous lies by the president, perhaps most clearly regarding his handling of the disclosure of the meeting at Trump Tower (Vol II, p. 98ff). First he denied knowing about the meeting, then described it as only about adoption, then denied crafting his son’s response, and then, in his formal response to Mueller, conceded that it was he who dictated the press release. Lying per se is not especially remarkable. Coupled with the other characteristics noted here, however, lying becomes a part of a pervasive, compelling, reflexive pattern of distraught gut reactions for handling challenges by misleading, manipulating, and blocking others’ access to the truth. Rather than being seen as bona fide alternatives, challenges are perceived as personal threats and responded to in a dangerous, no-holds-barred manner.

The info is here.

Wednesday, June 1, 2016

Don't make Important Decisions When You are Hungry

The Stomach-Derived Hormone Ghrelin Increases Impulsive Behavior

Rozita H Anderberg, Caroline Hansson, Maya Fenande and others
Neuropsychopharmacology (2016) 41, 1199–1209
doi:10.1038/npp.2015.297; published online 21 October 2015

Abstract

Impulsivity, defined as impaired decision making, is associated with many psychiatric and behavioral disorders, such as attention-deficit/hyperactivity disorder as well as eating disorders. Recent data indicate that there is a strong positive correlation between food reward behavior and impulsivity, but the mechanisms behind this relationship remain unknown. Here we hypothesize that ghrelin, an orexigenic hormone produced by the stomach and known to increase food reward behavior, also increases impulsivity. In order to assess the impact of ghrelin on impulsivity, rats were trained in three complementary tests of impulsive behavior and choice: differential reinforcement of low rate (DRL), go/no-go, and delay discounting. Ghrelin injection into the lateral ventricle increased impulsive behavior, as indicated by reduced efficiency of performance in the DRL test, and increased lever pressing during the no-go periods of the go/no-go test. Central ghrelin stimulation also increased impulsive choice, as evidenced by the reduced choice for large rewards when delivered with a delay in the delay discounting test. In order to determine whether signaling at the central ghrelin receptors is necessary for maintenance of normal levels of impulsive behavior, DRL performance was assessed following ghrelin receptor blockade with central infusion of a ghrelin receptor antagonist. Central ghrelin receptor blockade reduced impulsive behavior, as reflected by increased efficiency of performance in the DRL task. To further investigate the neurobiological substrate underlying the impulsivity effect of ghrelin, we microinjected ghrelin into the ventral tegmental area, an area harboring dopaminergic cell bodies. Ghrelin receptor stimulation within the VTA was sufficient to increase impulsive behavior. We further evaluated the impact of ghrelin on dopamine-related gene expression and dopamine turnover in brain areas key in impulsive behavior control. This study provides the first demonstration that the stomach-produced hormone ghrelin increases impulsivity and also indicates that ghrelin can change two major components of impulsivity—motor and choice impulsivity.

The article is here.

Monday, March 12, 2012

Risk and Reward Are Processed Differently in Decisions Made Under Stress

By Mara Mather and Nichole R. Lighthall
Current Directions in Psychological Science
February 2012, vol. 21, no. 1, pp 36-41.

Abstract

Years of research have shown that stress influences cognition. Most of this research has focused on how stress affects memory and the hippocampus. However, stress also affects other regions involved in cognitive and emotional processing, including the prefrontal cortex, striatum, and insula. New research examining the impact of stress on decision processes reveals two consistent findings. First, acute stress enhances selection of previously rewarding outcomes but impairs avoidance of previously negative outcomes, possibly due to stress-induced changes in dopamine in reward-processing brain regions. Second, stress amplifies gender differences in strategies used during risky decisions, as males take more risk and females take less risk under stress. These gender differences in behavior are associated with differences in activity in the insula and dorsal striatum, brain regions involved in computing risk and preparing to take action.

Beginning of the article:

The word stress describes experiences that are emotionally or physiologically challenging (McEwen, 2007). Stressful experiences elicit sympathetic-nervous-system responses and stimulate the release of stress hormones (e.g., cortisol in humans; Sapolsky, 2004) that mobilize the body's resources to respond to a challenge. The physiological effects of a stressful experience such as making a speech are evident not only during the event, but also in the next hour or so (Dickerson & Kemeny, 2004). When stressors are constantly present or anxiety about potential stressors is high, stress levels may become chronically elevated. Beyond the physiological effects of stress, a substantial literature indicates that both acute and chronic stress affect cognitive function.

Until recently, most studies examining stress and cognition have focused on stress effects on memory; effects on other aspects of cognition, including decision making, have received less attention. However, it is crucial to understand whether and how stress may alter decision making, as important decisions are often made under stress. For example, decisions about finances, health care, and social relationships are frequently accompanied by stress or cause stress. Early work on stress and decision making determined that stressors like time pressure and noise impaired decision making, resulting in decision making that is hurried, unsystematic, and lacking full consideration of options (Janis & Mann, 1977).

More recent work focuses on how stress influences how people respond to the risks and rewards of decisions. Acute stress potentiates dopaminergic reward pathways in the brain (Ungless, Argilli, & Bonci, 2010), which may intensify the allure of potential gains associated with decision options. The core brain-body feedback loops involved in the stress response also are involved in assessing risk and reward (Bechara & Damasio, 2005). As part of this brain-body feedback system, the insula helps represent somatic states and signals the probability of aversive outcomes during risky decisions (Clark et al., 2008). Both physical and psychological stress activate the insula, but differently for males and females (Naliboff et al., 2003; Wang et al., 2007).

In the following sections, we review recent evidence for two distinct effects of stress. First, stress enhances learning about positive choice outcomes and impairs learning about negative choice outcomes. This effect appears to be similar across gender and age groups. Second, stress affects decision strategies differently for males and females, with behavior diverging under stress when decision making involves immediate risk taking.

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This article is pertinent to ethical decision-making while experiencing stress and anxiety.

Special thanks to Ken Pope for this information.