Monday, January 23, 2023

By Don Sapatkin

Good Monday morning. In today’s Daily: How Matisse got out of an anxiety-fueled slump and created a new art form. Climate change’s effect on mental health goes beyond behavior – it may alter your brain. Can lithium in drinking water reduce the risk of suicide? And Canada’s new guidelines for alcohol say no amount is healthy.


An art exhibit examines Matisse’s late-career transformation

The Conversation, 1938, by Henri Matisse (San Francisco Museum of Modern Art: Bequest of Mr. James D. Zellerbach)

“How does an artist forge ahead after a creative slump? What does it take to maintain a creative drive over a lifetime,” journalist Diane Bernard asks in an incisive story for the BBC focused on “a gorgeous, provocative” new exhibition of Henri Matisse’s works.

The French master’s creative output dropped toward the end of 13 years of relative isolation. The Great Depression was just beginning, fascism was rising in Europe, and the 60-year-old Matisse sensed that his approach was in crisis, a feeling that grew as he internalized critics’ comments that he had lost his edge. Bernard sees a present-day parallel in a 2021 survey that found 64% of artists and creative workers experienced a drop in productivity during the pandemic. More than half attributed their decline to stress, anxiety, and depression about the state of the world. 

Matisse “broke free of his painting stagnation in the late 1920s, and transformed into a revived decorative artist” over the next decade, as shown in an exhibit of 143 works titled “Matisse in the 1930s” at the Museum of Art in Philadelphia. A significant section is devoted to a single painting: “The Dance II,” commissioned by Philadelphia art collector Alfred Barnes to fit under massive arched windows in his new museum outside the city. Working out the enormous challenges took three years – and helped Matisse enter what the celebrated artist and Chinese dissident Ai Weiwei describes as a “relatively free state of creativity.”

Bernard writes that Matisse “broke through the quarantine of his own mind to come out the other end with a revolutionary new style of creative expression. His new focus on simple lines and bold colors represents a complete departure from realism, speaking to emotions rather than just intellect.”


Researchers link “climate trauma” to changes in the brain

Six months after Northern California’s 2018 Camp Fire killed 85 people and destroyed 18,000 structures, psychological assessments of 725 California residents found that exposure to the blaze led to chronic mental health problems like post-traumatic stress disorder, depression and anxiety. The closer someone was to the “climate trauma,” the worse their symptoms. Even indirect exposure raised the risk for depression and anxiety, according to a study published two years ago.

Now, some of those same researchers have shown for the first time that climate-related stress can cause significant differences in cognition and underlying brain functioning a year after direct exposure. Their findings, published in PLOS Climate and covered by the science news site Study Finds, were based on measurements of electrical activity in the brain, cognitive tests and other mental health assessments in 75 original participants.

They were divided into three groups: those directly exposed to the fire, those who witnessed it but were not directly impacted, and a control group of participants several hundred miles away whose members might have heard about the fire but had no exposure. The direct-exposure group’s EEGs displayed increased activity in regions of the brain involved in cognitive control and the ability to cope with intrusive thoughts. The frontal cortices of those who re-experienced trauma compensated by working harder at cognitively demanding tasks, potentially increasing their risk of neurological problems elsewhere.

The first study found that childhood trauma exacerbated fire-related mental health problems; the second that factors like resilience and mindfulness seemed to reduce them. “Unchecked climate change projected for the latter half of this century may severely impact the mental wellbeing of the global population. We must find ways to foster individual resiliency,” wrote the authors from UC-San Diego, and California State University, Chico, located just 15 miles from the town of Paradise, which burned to the ground in 2018 but is now rising from the ashes.


Can lithium in drinking water reduce the risk of suicide?

That intriguing question is asked by medical journalist Suchandrima Bhowmik for a story in MDLinx, a news site for health care providers. The answer is unclear, but a growing body of evidence suggests that trace amounts of lithium in drinking water could decrease suicide rates, which have risen 35% over two decades.

Unlike most medicines, lithium – a standard treatment for bipolar disorder – can be found on the periodic table of elements that we studied in school. It occurs naturally in rocks and minerals and breaks down over time, allowing it to enter soil and standing water and ultimately showing up in drinking water in different concentrations depending on geology. Chile’s Atacama region has among the world’s highest concentrations in surface water – and significantly lower suicide rates than other regions. A meta-analysis that combined data from multiple studies in Europe, Asia and North America found similar inverse relationships, according to a perspective article published last year. Other large analyses also associate higher lithium concentrations with lower suicide rates. One commentary published last year considered the use of lithium in water by comparing it with the fluoridation of public drinking water which has reaped huge benefits since 1945.

Association is not causation, of course, although large numbers of associations can be suggestive. Medical research suggests lithium improves mood disorders by affecting cellular pathways and the expression of multiple genes. Still, the evidence remains limited, and some studies failed to find a clear benefit. Medicinal lithium does have adverse effects, mostly related to dosage, although chronic use over decades may lead to renal failure. As the MDLinx story and virtually every research article says, “further research is needed.”


New audits to target nursing homes’ overuse of schizophrenia drugs 

For decades, evidence has been emerging that some nursing homes overprescribe powerful psychotropic drugs – especially antipsychotics – in order to keep residents calm and easy to deal with. In response, the federal government will soon begin auditing nursing facilities to check their patterns of diagnosis and prescribing. The results will factor in ratings that could impact payments to the facilities and their financial survival, the Wall Street Journal reported.

“People in nursing homes deserve safe, high-quality care, and we are redoubling our oversight efforts to make sure that facilities are not prescribing unnecessary medications,” said Chiquita Brooks-LaSure, administrator of the Centers for Medicare and Medicaid Services (CMS). 

An inspector general’s report two months ago found that 80% of Medicare’s long-term residents were prescribed these medications, which can cause serious, sometimes deadly, side effects. A 2011 report about nursing home abuse of antipsychotics led to a crackdown on prescriptions for residents not diagnosed with schizophrenia. But some skilled nursing facilities found a loophole: They began diagnosing patients with schizophrenia, even in the clear absence of symptoms like delusions and hallucinations. The number of residents with unsupported diagnoses nearly doubled, although most were concentrated in a small number of facilities. About 100 nationwide reported that 20% or more of their residents had schizophrenia, a disease that affects less than 1% of the general population.

Nursing homes where auditors find unusual patterns may see a drop in their ratings on the Medicare Compare website. CMS may also publicly post inspection reports even if nursing homes dispute the findings.


In other news…

“I’m a veterinarian,” said Dr. Kwane Stewart, approaching a homeless man on LA’s Skid Row. “I walk the area and find pets like yours and give free

medical care.” Stewart, the “Street Vet,” has visited homeless camps in Orange, San Diego and Los Angeles about twice a month for 12 years.Studies estimate that 5% to 10% of homeless people own pets, easing their loneliness and improving their mental health. “These people out here who own pets – they’re looking for a normal life, they’re trying to get on their feet, they value companionship and they need it.”


Yale University announced sweeping policy changes that will permit students grappling with mental health problems to take leaves of absence and return to classes when they feel ready –without being pushed to withdraw or facing a formidable reinstatement application process. Such policies have drawn increasing fire from students and alumni, according to the Washington Post, which had previously reported that students were pressured to withdraw when the university learned about their mental health problems.


“No amount or kind of alcohol is good for your health.” So says Canada’s official new guidelines for alcohol consumption, which recommend drinking as little as possible, according to the New York Times. The guidelines reflect a major shift based on a growing body of evidence that even small amounts of alcohol can have negative health consequences. The risks  

range from low for people who consume two or fewer drinks per week to “increasingly high,” for people downing seven or more drinks per week.


During the pandemic, the federal government eased prescribing restrictions for buprenorphine, a synthetic opioid used to treat people with opioid addiction. Now a new study finds that this policy shift did not lead to more buprenorphine overdose deaths. The findings, published in JAMA Network Open, should allay concerns about keeping the loosened guidelines in place when the pandemic ends, CBS News reported. Similar findings have been made about methadone, another treatment for opioid use disorder. Providers, researchers and treatment advocates have been pushing the government to make the pandemic rules permanent.


If you or someone you know is in crisis or experiencing suicidal thoughts, call or text 988 to reach the 988 Suicide & Crisis Lifeline and connect in English or Spanish. If you’re a veteran press 1. If you’re deaf or hard of hearing dial 711, then 988. Services are free and available 24/7.


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Don Sapatkin

Don Sapatkin is an independent journalist who reports on science and health care. His primary focus for nearly two decades has been public health, especially policy, access to care, health disparities...