Monday, September 18, 2023

By Don Sapatkin

Good Monday morning, and welcome back (to me) from a Canada canoe trip that will be remembered for its broken flashlights (headlamp and spare), leeches (at least a dozen, but salt works well) and a black bear outside my tent (I played dead inside). It was a great vacation!

In today’s Daily: Schizophrenia may be a lot more prevalent than we thought. MDMA moves closer to approval to treat PTSD. A look at the impact of childhood poverty in rural Northern California, quite different from the city. An Ole Miss defensive tackle says his request for a mental health break was denied by the coach — and is suing for $40 million. And the head-scratcher of the week: Buyers of firearms at the height of the pandemic had much higher rates of suicidal thoughts, self-harm behaviors and intimate partner violence than other gun owners, a study found.

Schizophrenia and related disorders far more common than previously believed, new study finds

Schizophrenia-related disorders are two to three times more common among adults than previous estimates, according to a government-funded study that sought to measure the prevalence of serious mental illnesses. Estimates for some other mental disorders were also higher than previously believed.

The study estimated that 1.8% of  Americans aged 18 to 65 – 3.7 million in all – had a history of schizophrenia spectrum disorders (schizophrenia, schizoaffective disorder and schizophreniform disorder) and about 2.5 million (1.2%) met the criteria for the disorders in the past year.

The schizophrenia estimate “is especially important,” Heather Ringeisen, the project’s principal investigator and vice president for health of populations at RTI International, said in a press release. “People with a schizophrenia spectrum disorder experience high levels of disability that present significant challenges in all aspects of their life.” A team of researchers at RTI, a nonprofit research organization, conducted the study in collaboration with several major universities and treatment centers. It has not been published in a peer-reviewed medical journal.

The schizophrenia estimate “is a huge deal,” wrote one of the collaborators, Elizabeth Sinclair Hancq, director of research for the Treatment Advocacy Center, in a commentary for MindSite News. The new estimates make schizophrenia spectrum disorders “more common than Type 1 diabetes, multiple sclerosis, and ALS combined,” she wrote.

Past estimates of schizophrenia in the U.S. have been surprisingly squishy and left out significant parts of the population. This one differed in two significant ways: It included institutionalized populations with high rates of mental disorders, such as people in prison and treatment centers. And it was based on clinical interviews with nearly 5,700 participants, virtually or in-person, rather than the more typical self-report measures or nonclinical interviews.

Other notable findings:

  • The two most common mental disorders were major depression (31.4 million adults, or 15.5%) and generalized anxiety disorder (20.2 million, or 10%), both much higher than previous studies have found. Interviews for this report took place between October 2020 and October 2022.
  • Among substance use disorders, 6.7% (13.4 million) had alcohol use disorder in the previous year, 3.8% (7.7 million) had cannabis use disorder, 1.6% (3.2 million) had stimulant use disorder and 0.5% (1 million) had opioid use disorder. These were lower than earlier research had found.
  • One in 20 adults (11 million, or 5.5%) had co-occurring mental and substance use disorders (at least one of each in the previous year).
  • Among those with a mental disorder, 60.8% visited a mental health provider at least once in the past year. For people with substance use disorders, only 12.2% were treated at least once.

Study finds MDMA + psychotherapy highly effective for treating PTSD, moving the psychedelic closer to approval

A clinical trial using the psychedelic drug MDMA plus psychotherapy greatly reduced symptoms of post-traumatic stress disorder (PTSD) in a racially and ethnically diverse group of people.

The findings, in the third and final phase of testing normally required for regulatory approval, set the stage for an application to the FDA and could lead to MDMA reaching the market next year.

The study, published in Nature Medicine, confirms results from earlier research, and got widespread press coverage, including in the New York Times. If approved, MDMA, also known as ecstasy, would be the first new treatment for the often-debilitating disease in more than two decades. An estimated 5% of American adults have PTSD in any given year but current treatments help only about half of them.

The study’s 104 participants included childhood trauma victims, sexual assault survivors and combat veterans who had been diagnosed with moderate to severe PTSD and lived with the condition for an average of 16 years. Many also suffered from depression, alcohol use disorder and histories of suicidal thoughts. Each participant took part in three 90-minute talk therapy sessions before taking MDMA or a placebo in three cycles, spaced one month apart. Each treatment lasted eight hours and was paired with and followed by talk therapy sessions.

Most participants correctly guessed whether they had received MDMA or placebo, a common problem in psychiatric research, particularly with psychedelics. The results showed both the power of the drug and of psychotherapy: Among those who got MDMA, 87% had a measurable reduction of symptoms, and 71% improved so much they no longer met the criteria for PTSD. But even in the placebo group, 69% improved and almost half – 48% – no longer met PTSD criteria.

“MDMA-assisted therapy offers a new, potentially lifesaving option when done thoughtfully and professionally,” senior author Berra Yazar-Klosinski told the Times. He is the chief scientific officer for Multidisciplinary Association for Psychedelic Studies – MAPS – the nonprofit that funded and conducted the research. Some independent experts were less enthusiastic, telling the Times that the difference in outcomes between the MDMA and placebo groups might not be enough for approval. Still, the Biden administration, and members of both parties in Congress, as well as the FDA, have been growing increasingly interested in the potential of psychedelics to treat the country’s mental health crisis.

In Northern California, rural students are also struggling with poverty, stress and trauma

By most standards, Linda Plumlee appeared to be the model of a successful high school student. She was president of the student body and captain of the cheerleading team at Modoc High School in rural Northern California. She was also exhausted, working two jobs outside of high school. At 18, she’d been essentially homeless for nearly two years – ever since she’d successfully petitioned a California judge to legally emancipate her from her mother so she could make her own medical decisions and have full control over applying for college and financial aid. Her mom responded by kicking her out. (Her father died young.)

The Los Angeles Times uses Plumlee’s story to look at the reality of rural child poverty − and how educators in Modoc County, among the poorest in the state, were trying to understand and grapple with it.

Nearly a decade ago, they realized that something was seriously wrong. Students were regularly becoming so disruptive and angry that they had to be pulled from classrooms. Suspensions were triple the state average. An informal, anonymous tally of adverse childhood experiences (ACEs) – things like abuse or neglect, a parent’s incarceration, divorce, death and mental illness in the home − estimated that a whopping 58% of children in the county had four or more ACEs, greatly increasing their risk of suicide, substance abuse, chronic health problems and unemployment later in life.

“It was very eye-opening,” Misti Norby, deputy superintendent of the Modoc County Office of Education, told the L.A. Times. “We now function on: We know they have trauma. Somewhere. Somehow.”

Plumlee hopes to challenge those odds. Last spring, she was accepted to attend college at UC Berkeley.

In other news…

People who bought firearms during the height of the pandemic had much worse mental health than other gun owners and people who don’t own firearms, according to a 2021 survey of 1,036 adults in the U.S. published in PLOS One. Pandemic buyers had significantly higher rates of suicidal thoughts, self-harm behaviors and intimate partner violence. They also were much more likely to hold extreme beliefs. First author Brian Hicks said in a University of Michigan press release that he had never seen such a dramatic divide based on a single question in his psychology research career.

Californians will vote on a $6.4 billion expansion of mental health services next spring after Gov. Gavin Newsom said that two newly approved bills – to be jointly known as Proposition 1 – represented “the most significant changes to California’s mental health system in more than 50 years” and should be up to the public to decide, the Associated Press reported. Together, the bills would expand services for substance abuse, prioritize care for people with serious mental illness, restrict how local governments can use a tax on millionaires, and fund 10,000 new treatment beds and supportive housing units with a $6.4 billion bond. But mental health and disability advocates were furious about a last-minute change in the bond measure that stripped language prohibiting the money being used for involuntary confinements, CalMatters reported.

Defensive tackle DeSanto Rollins is suing the University of Mississippi and head coach Lane Kiffin for kicking him off the team after he requested a mental health break, the Clarion Ledger reported. The suit, filed in federal district court, seeks $10 million in compensatory damages and $30 million in punitive damages. It charges that Rollins suffered physical injuries that “substantially limited his ability to perform major life activities,” and caused severe depression and anxiety. It also alleges that Kiffin and the coaching staff “forced him to participate in football practice” following his injuries, and charges Kiffin with discrimination on the basis of race (Rollins is Black, Kiffin white) and disability. The university said it had not received the suit.

The number of prescription pain pills shipped in the U.S. plunged nearly 45% between 2011 and 2019, even as opioid-related overdose deaths rose to record levels as users increasingly turned to heroin and illegal fentanyl, the Washington Post reported. The industry transaction data, collected by the Drug Enforcement Administration, was released to attorneys suing industry players involved with opioids. supports what’s known about the trajectory of the nation’s opioid crisis.

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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Type of work:

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...