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Author Archives: Robert Pollack

Robert Pollack

About Robert Pollack

Board Certified Psychiatrist in practice over 42 years. Currently focused on Genomic Assessments as part of our treatment assessments and Transcranial Magnetic Stimulation (TMS) therapy along with general adult psychiatry. Currently serve on adjunct faculties of UCF, FSU, USF and Uof F. We currently accept most Insurances.

Sources of Parent-Offspring Resemblance for Major Depression

Question: How do effects of genetics and rearing each contribute to the transmission of risk for major depression from parents to children?

 

Findings: In this population register–based study of 2 269 552 offspring of intact, adoptive, not-lived-with father, stepfather, and triparental families from the general Swedish population, the effects of genes and rearing were approximately equal for parent-offspring resemblance for major depression. Genetic and rearing effects acted additively on offspring risk for major depression.

Meaning: Genetic and rearing effects are important in the cross-generational transmission of major depression.

Importance  Twin studies have assessed sibling resemblance for major depression (MD) but cannot address sources of resemblance across generations.

Objective  To clarify the relative importance of genetic and rearing effects on the parent-offspring resemblance for MD.

Design  This Swedish population register–based study examined parents and children from the following 5 family types: intact (2 041 816 offspring), adoptive (14 104 offspring), not-lived-with (NLW) father (116 601 offspring), stepfather (67 826 offspring), and triparental (29 205 offspring). The 5 family types permitted quantification of parent-offspring resemblance for genes plus rearing, genes-only, and rearing-only associations. Treated MD was assessed from national primary care, specialist care, and inpatient registries. Data were collected from January 1, 1960, through December 31, 2016.

Exposure  Diagnosis of MD vs no diagnosis in parents.

Main Outcomes and Measures  Registration for MD.

Results  The study population included 2 269 552 offspring (51.5% male and 48.5% female; median age, 42; range, 26-56 years). The weighted tetrachoric correlations for MD across family types and across mothers and fathers were r = 0.17 (95% CI, 0.16-0.17) for genes plus rearing, r = 0.08 (95% CI, 0.06-0.09) for genes-only, and r = 0.08 (95% CI, 0.07-0.09) for rearing-only parent-child associations. Only the genes plus rearing association differed significantly between mothers (weighted tetrachoric correlation, r = 0.18; 95% CI, 0.18-0.18) and fathers (weighted tetrachoric correlation, r = 0.15; 95% CI, 0.15-0.16). In triparental families, the parent-offspring correlations for MD were estimated at r = 0.19 (95% CI, 0.17-0.22) for mothers in the genes plus rearing association, r = 0.10 (95% CI, 0.07-0.13) for NLW fathers in the genes-only association, and r = 0.08 (95% CI, 0.05-0.11) for stepfathers in the rearing-only association. In adoptive families, the effect of affected biological and affected adoptive parents on adoptee risk for MD was additive. In intact families, parental MD diagnosed by specialists in hospital or outpatient settings and primary care physicians affected equally the risk for MD in offspring.

Conclusions and Relevance  The parent-offspring resemblance for treated MD arises from genetic factors and rearing experiences to an approximately equal extent. Both forms of cross-generational transmission act additively on the risk for MD in the offspring.

[Read the Original Research Article Here]

December 28, 2017
Robert Pollack

About Robert Pollack

Board Certified Psychiatrist in practice over 42 years. Currently focused on Genomic Assessments as part of our treatment assessments and Transcranial Magnetic Stimulation (TMS) therapy along with general adult psychiatry. Currently serve on adjunct faculties of UCF, FSU, USF and Uof F. We currently accept most Insurances.

More evidence links high-potency marijuana use to first-episode psychosis

Publish date: December 14, 2017
Randy Dotinga Clinical Psychiatry News

 

SAN DIEGO– High-potency marijuana use appears to be associated with an increased risk of a first psychotic episode, based on a case-control study conducted in Europe.

 

“Daily users of a strong type of cannabis face a significant increase in the probability of developing a psychotic disorder,” reported Marta Di Forti, MD, PhD, MRC, lead author of a study whose preliminary results were presented at the International Congress on Schizophrenia Research.

 

Dr. Di Forti spawned a media boomlet in 2015 when she and her colleagues raised the prospect of a possible association between so-called “skunk” marijuana and first psychotic episodes. In their study of subjects in London with first-time psychotic episodes and matched population controls, those who had psychotic episodes were three times (adjusted odds ratio: 2.92; 95% confidence interval, 1.52-3.45; = .001) as likely as controls to have used “skunk” marijuana (Lancet Psychiatry. 2015 Mar;2[3]:233-8).

 

In the new study, Dr. Di Forti and her colleagues analyzed 1,200 first-incident cases of psychosis that were captured between the years 2010 and 2013 by the European Network of National Schizophrenia Networks Studying Gene-Environment Interactions project (EU-GEI). The researchers compared the cases to 1,300 population-based controls in five unidentified European countries and found that daily users of high-potency marijuana had the highest adjusted odds ratio (4.5-8, statistical significance not available) of a psychotic episode (Schizophr Bull. 2017 Mar:43:S30. doi: 10.1093/schbul/sbx021.078). “This effect is significant even after controlling for other drugs of abuse such as stimulants, tobacco and alcohol, and main sociodemographic confounders,” the researchers wrote in their abstract.

 

“The biology of cannabis-associated psychosis is still unclear,” Dr. Di Forti said in an interview. “Nevertheless, we know that THC (tetrahydrocannabinol) binds with two receptors called CB1 and CB2. They’re part of the endocannabinoid system, which from uterus onward protects our central nervous systems from insults. It activates on demand if the brain goes on hypoxia or we experience a brain injury.”

 

“CB1 activation leads to changes in the transmission of both GABA and glutamate. Downstream, they affect the dopamine system, which is biologically linked to psychosis.”

 

Dr. Di Forti dismissed the idea that people at risk for psychosis are drawn to high-potency marijuana. “Using genetic data, we’ve showed that cannabis users – both cases and controls – did not have a higher genetic load for schizophrenia than those who never used (marijuana),” she said (Lancet Psychiatry. 2015 May;2[5]:381-2).

 

The findings point to the importance of asking patients – and students and children – about more than just whether they have ever used marijuana. History-taking for marijuana use needs to be comparable to that performed for alcohol use, she said. “I always ask my patients for details about their past and present use but also try to understand why they use (marijuana). When possible, once I know how frequently and what type (of marijuana) they use, I can negotiate some harm-reduction strategy.”

 

The study is funded by the U.K.’s Medical Research Council and a European Union grant. Dr. Di Forti reports no relevant disclosures.

 

[Read the Original Article Here]

December 19, 2017
Robert Pollack

About Robert Pollack

Board Certified Psychiatrist in practice over 42 years. Currently focused on Genomic Assessments as part of our treatment assessments and Transcranial Magnetic Stimulation (TMS) therapy along with general adult psychiatry. Currently serve on adjunct faculties of UCF, FSU, USF and Uof F. We currently accept most Insurances.

The Benefits of Combining Ketamine and TBS to Treat Depression.

A.F. Leuchter, R. Espinoza, N. Suthana, A. Hunter, I.A. Cook
University of California Los Angeles, USA
[0601] DOI: http://dx.doi.org/10.1016/j.brs.2017.01.438

 

Introduction: Repetitive Transcranial Magnetic Stimulation (rTMS) applied to dorsolateral prefrontal cortex (DLPFC) causes acute changes in neuronal excitability in this region as well as changes in functional connectivity of brain circuitry involving DLPFC. Theta burst stimulation (TBS) has particularly strong effects on cortical excitability: intermittent pulsing of left DLPFC (iTBS) increases excitability, while continuous pulsing of the right DLPFC (cTBS) reduces excitability. TBS modulation of cortical excitability is known to be dependent upon glutamatergic neurotransmission through the N-Methyl-D-aspartate receptor (NMDAR).

 

Methods: We used the NMDAR antagonist ketamine (KET) to probe glutamatergic mediation of functional connectivity changes seen with TBS. Excitability in, and neurophysiologic connectivity of, DLPFC during iTBS and cTBS was monitored using TMS-compatible quantitative electroencephalography (qEEG). Subjects were pretreated with KET or placebo (PBO) prior to administration of TBS. Baseline functional magnetic resonance imaging (fMRI) and Diffusion Tensor Imaging (DTI) were performed to examine functional and structural connectivity measures, with follow-up scans to examine changes associated with treatment.

 

Results: Both TBS and KET had robust effects on cortical excitability. TBS was associated with local changes in excitability involving DLPFC, while KET (but not placebo) was associated with more global changes in excitability. Pretreatment with KET modulated the excitability effects of iTBS in left DLPFC and the inhibitory effects of cTBS in right DLPFC. Changes in excitability were correlated with connectivity of DLPFC, anterior cingulate cortex, medial frontal cortex, and orbitofrontal cortex.

 

Discussion: Ketamine constitutes a useful neurochemical probe of the mechanisms underlying the physiologic effects of TBS on excitability, connectivity, and neuroplastic processes. Future studies should examine the potential clinical impact of combining these treatment modalities.

 

TMS Center of SWFL finds a combination of ketamine and TBS can be an effective treatment of Major Depressive Disorder in some patients.

 

[Read the Original Post on the Brain Stimulation Journal for Members of the Clinical TMS Society]

December 14, 2017
Robert Pollack

About Robert Pollack

Board Certified Psychiatrist in practice over 42 years. Currently focused on Genomic Assessments as part of our treatment assessments and Transcranial Magnetic Stimulation (TMS) therapy along with general adult psychiatry. Currently serve on adjunct faculties of UCF, FSU, USF and Uof F. We currently accept most Insurances.