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Post-earthquake psychological functioning in adults with attention-deficit / hyperactivity disorder: Positive effects of micronutrients on resilience
Abstract
The September, 2010, 7.1 magnitude earthquake in Christchurch, New Zealand, provided an opportunity to study the after-effects of a major earthquake where death and injury were absent. It created a natural experiment into the protective effects on well-being of taking EMPowerplus (EMP+), a micronutrient supplement, in a group of 33 adults diagnosed with ADHD who had been assessed prior to the earthquake. Fortuitously, 16 were currently taking the supplement as part of on-going research at the time of the quake, while 17 were not (they had completed their trial of EMP+ or were waiting to begin consumption). The Depression Anxiety and Stress Scale (DASS-42) which had been administered at varying times before the earthquake on recruitment into the micronutrient study was re-administered by telephone 7-10 and again 14-18 days post-earthquake to volunteer, earthquake-exposed participants. A modified Brinley plot analysis of the individual DASS-42 scores showed that the 16 participants on the nutritional supplement were more resilient to the effects of the earthquake than the 17 individuals not taking the supplement. This effect was particularly marked for Depression scores.
... The formula has been investigated in more than 20 peer-reviewed publications and has an established safety record (Popper 2014). Although there has been an increase in research showing the effectiveness and efficacy of EMP+ on the reduction of symptoms in adults with ADHD (Rucklidge and Harrison 2010;Rucklidge et al. 2014a), research in children with ADHD is currently limited to a few case studies and open-label trials (Popper 2001;Kaplan et al. 2002Kaplan et al. , 2004. Further, product safety, through assessment of blood biochemistry, was not directly investigated in previous trials. ...
... The primary outcome measures defined a priori were the ADHD rating scales, the CGI, and the SDQ. The data were analyzed using a three way combination of 1) visual analysis techniques of individual participant change in the form of modified Brinley Plots ( Jacobson and Truax 1991;Rucklidge and Blampied 2011); 2) group mean analyses endorsed by the new statistics approach (Cumming 2012;Kline 2013), including 95% confidence intervals (CI) and effect sizes (ES); and 3) conventional null hypothesis repeated-measures t tests. ...
... Visual analysis was based on modified Brinley plots ( Jacobson and Truax 1991;Rucklidge and Blampied 2011). These plots (Fig. 2) are used to display individual change over time in order to identify systematic effects of an intervention. ...
Objective:
The purpose of this study was to investigate the clinical effect and safety of a broad spectrum, 36 ingredient micronutrient (vitamins and minerals) in treating children with attention-deficit/hyperactivity disorder (ADHD).
Methods:
This open-label, on-off-on-off (reversal design) study followed 14 participants (8-12 years of age) with ADHD, diagnosed using standardized instruments, for 6 months with no dropouts. Following baseline assessment, including hematology and biochemistry screening, participants began an 8 week treatment phase with micronutrients titrated up to maximum dose (15 capsules/day). Treatment was withdrawn for 4 weeks, reinstated for a further 8 weeks, and then withdrawn for 4 weeks. Primary outcomes included the Conners' Parent Rating Scale, the Clinical Global Impressions Scale (CGI), and the Strengths and Difficulties Questionnaire - Parent version (SDQ). Secondary outcomes were mood and global functioning.
Results:
Modified Brinley plots revealed a reduction in ADHD symptoms, improved mood, and improved overall functioning during intervention phases, and deterioration in ADHD symptoms, mood, and overall functioning during the withdrawal phases. Reliable change analyses, Cohen's d and percent superiority effect sizes, 95% confidence intervals and t tests confirmed clinically and statistically significant change between the intervention and withdrawal phases, with large effect sizes observed pre- to post-exposure of micronutrients (d = 1.2-2.2) on ADHD symptoms during intervention phases. Seventy-one percent of participants showed at least a 30% decrease in ADHD symptoms by the end of the second treatment phase, and 79% were identified as "much improved" or "very much improved" at the end of the second phase (5 months) based on the clinician-rated CGI when considering functioning generally. The SDQ showed that these benefits occurred across other areas of functioning including emotional symptoms, conduct problems, and prosocial behaviours. The children's self-reports confirmed the improvements. Excellent adherence to treatment occurred throughout, side effects were mild and transitory, and no safety issues were identified through blood analyses.
Conclusions:
This study demonstrates the clinical benefit, feasibility, and safety of broad-spectrum micronutrients in the treatment of childhood ADHD. Replications utilizing double-blind placebo-controlled studies are warranted. Trial is registered with the Australia and New Zealand Clinical Trial Registry: ACTRN12612000645853.
... This research was initiated in the aftermath of a severe earthquake sequence that began in September 2010 in the Canterbury (Aotearoa/New Zealand) region, ultimately destroying much of the city of Christchurch. After the initial earthquake, Rucklidge and Blampied (2011), exploiting a natural experiment where the timing of the earthquake relative to participation in a clinical trial fortuitously created control and treatment groups, reported that trial participants who happened to be taking micronutrients at the time of the September 4, 2010, earthquake (magnitude 7.1) recovered more quickly in the first two weeks postearthquake than the people who were not taking the nutrients. ...
... The inaugural studies followed the natural disasters of an earthquake (Rucklidge & Blampied, 2011;Rucklidge et al., 2012) and a flood (Kaplan, Rucklidge, Romijn, & Dolph, 2015), each of which badly affected a city and its adjacent region, in two developed countries (Aotearoa New Zealand and Canada). The circumstances under which these studies were conducted permitted methodologically sound research, particularly RCTs, although there were limitations, as might be expected of research in the aftermath of disaster, including only modest Ns, few male participants, and a relatively homogenous ethnicity among participants. ...
Natural (e.g., earthquake, flood, wildfires) and human-made (e.g., terrorism, civil strife) disasters are inevitable, can cause extensive disruption, and produce chronic and disabling psychological injuries leading to formal diagnoses (e.g., post-traumatic stress disorder [PTSD]). Following natural disasters of earthquake (Christchurch, Aotearoa/New Zealand, 2010–11) and flood (Calgary, Canada, 2013), controlled research showed statistically and clinically significant reductions in psychological distress for survivors who consumed minerals and vitamins (micronutrients) in the following months. Following a mass shooting in Christchurch (March 15, 2019), where a gunman entered mosques during Friday prayers and killed and injured many people, micronutrients were offered to survivors as a clinical service based on translational science principles and adapted to be culturally appropriate. In this first translational science study in the area of nutrition and disasters, clinical results were reported for 24 clients who completed the Impact of Event Scale – Revised (IES-R), the Depression Anxiety Stress Scales (DASS), and the Modified-Clinical Global Impression (M-CGI-I). The findings clearly replicated prior controlled research. The IES-R Cohen’s d ESs were 1.1 (earthquake), 1.2 (flood), and 1.13 (massacre). Effect sizes (ESs) for the DASS subscales were also consistently positive across all three events. The M-CGI-I identified 58% of the survivors as “responders” (i.e., self-reported as “much” to “very much” improved), in line with those reported in the earthquake (42%) and flood (57%) randomized controlled trials, and PTSD risk reduced from 75% to 17%. Given ease of use and large ESs, this evidence supports the routine use of micronutrients by disaster survivors as part of governmental response.
... This research was initiated in the aftermath of a severe earthquake sequence that began in September 2010 in the Canterbury (Aotearoa/New Zealand) region, ultimately destroying much of the city of Christchurch. After the initial earthquake, Rucklidge and Blampied (2011), exploiting a natural experiment where the timing of the earthquake relative to participation in a clinical trial fortuitously created control and treatment groups, reported that trial participants who happened to be taking micronutrients at the time of the September 4, 2010, earthquake (magnitude 7.1) recovered more quickly in the first two weeks postearthquake than the people who were not taking the nutrients. ...
... The inaugural studies followed the natural disasters of an earthquake (Rucklidge & Blampied, 2011;Rucklidge et al., 2012) and a flood (Kaplan, Rucklidge, Romijn, & Dolph, 2015), each of which badly affected a city and its adjacent region, in two developed countries (Aotearoa New Zealand and Canada). The circumstances under which these studies were conducted permitted methodologically sound research, particularly RCTs, although there were limitations, as might be expected of research in the aftermath of disaster, including only modest Ns, few male participants, and a relatively homogenous ethnicity among participants. ...
... Subsequent research showed that enhancing the nutrition of adult earthquake survivors via vitamins and minerals (using a micronutrient formula called EMPowerplus, EMP+; Popper 2014) significantly reduced anxiety, depression and stress. Those with preexisting psychopathology (Attention-Deficit Hyperactivity Disorder; Rucklidge and Blampied 2011) and a general community sample participating in a randomized-controlled (RCT) all experienced benefits (Rucklidge et al. 2012;). This has been replicated an RCT of Canadian adults following a severe flood . ...
... Individual changes over baseline and treatment phases were analyzed using modified Brinley plots (Blampied 2017;Gordon et al. 2015;Jacobson and Truax 1991;Lothian et al. 2016;Rucklidge and Blampied 2011). In contrast to the original Brinley plot (Brinley 1965) which reported group mean data, in modified Brinley plots an individual's data at Time 1 (X-axis) and Time 2 (Y-axis) is plotted as a coordinate point. ...
This study examined the effects of micronutrients on children with clinically elevated stress and anxiety 23–36 months after experiencing a natural disaster (a major earthquake). A single-case multiple-baseline design allocated 14 children (7 males, 7 females; aged 8–11 years; 10 with formal anxiety-disorder diagnoses) randomly to 1, 2 or 3 week baselines. Participants then took eight capsules/day of a micronutrient formula (EMPowerplus) during an 8-week open-label trial. Assessment instruments were the Children’s Global Assessment Scale (CGAS), the Screen for Child Anxiety-Related Emotional Disorders (SCARED), the Pediatric Emotional Distress Scale (PEDS), and the Revised Children’s Manifest Anxiety Scale (RCMAS). Symptom severity declined slightly in baseline for some children and declined much more during intervention for all children. Effect sizes at end of treatment were −1.40 (RCMAS), −1.92 (SCARED), +1.96 (CGAS), and −2.13 (PEDS). Modified Brinley plots revealed decreases in anxiety and improvements in overall functioning for 10 out of 11 completing participants. Side effects were mild and transient. The study provided evidence that treatment with a dietary supplement containing micronutrients reduced children’s post-disaster anxiety to a clinically significant degree. Future placebo-controlled randomized-controlled trials and treatment-comparison research is recommended to determine if this is true of anxiety in general.
... Recently, the use of broad-spectrum micronutrients (vitamins and minerals) has emerged as an effective treatment for a range of mental health problems, including stress, anxiety, depression, and neurodevelopmental problems (Adams et al., 2011;Gosney, Hammond, Shenkin, & Allsup, 2008;Kaplan, Rucklidge, Romijn, & Dolph, 2015;Rucklidge & Kaplan, 2013;Schlebusch et al., 2000;Stough et al., 2011). In the course of demonstrating positive effects of micronutrient treatment for attention-deficit/hyperactivity disorder (ADHD) in adults (Rucklidge, Frampton, Gorman, & Boggis, 2014) and children (Gordon, Rucklidge, Blampied, & Johnstone, 2015) and for counteracting the psychological effects of a natural disaster (a major earthquake; Rucklidge et al., 2012;Rucklidge & Blampied, 2011), we encountered many anecdotal reports of a positive effect on insomnia, hence the research reported here. ...
... Modified Brinley plots were used to analyze individual changes over time for the PIRS and for the secondary outcome measures of depression, anxiety, and stress (DASS). See Gordon et al. (2015), Jacobson and Truax (1991), and Rucklidge and Blampied (2011) for examples of these plots, termed modified Brinley plots because they show individual data rather than the group mean data presented by Brinley (1965) in his eponymously named plots. Modified Brinley plots show each individual participant's score in any particular phase relative to another phase as a coordinate pair, with the earlier and later data points as the x-axis and y-axis values, respectively. ...
Insomnia is a debilitating condition causing psychological distress and frequently comorbid with other mental health conditions. This study examined the effect of 8 weeks of treatment by broad spectrum micronutrients (vitamins and minerals) on insomnia using a multiple-baseline-across-participants open-label trial design. Seventeen adults were randomized to 1-, 2-, or 3-week baseline periods (14 completed). Self-report measures were the Consensus Sleep Diary–Morning (CSD-M), the Pittsburgh Insomnia Rating Scale (PIRS), and the Depression, Anxiety, Stress Scale (DASS). Baselines were generally stable. Treatment completers reported reliable and clinically significant change in insomnia severity (PIRS), in depression, stress, and anxiety (DASS), and on at least two aspects of sleep measured by the CDS-M. All completers were treatment-compliant, and side effects were minimal. Nutritional supplementation is shown to be a novel, beneficial treatment for insomnia in adults. Follow-up research using placebo-controlled designs as well as comparisons to cognitive-behavioral and other treatments is recommended.
... When the 7.1 magnitude earthquake hit on September 4, 2010, the Mental Health and Nutrition Research Group at the University of Canterbury was in the midst of conducting a clinical trial of a broad-spectrum mineral/ vitamin formula in adults with ADHD, but some individuals had completed the trial or not started the trial and therefore were not taking it on the day of the earthquake and the following weeks. Two weeks after the earthquake, those who were taking the formula at the time of the earthquake were significantly less anxious and stressed than those not taking it (Rucklidge and Blampied, 2011;. Subsequently, when the February 22, 2011 earthquake of 6.3 magnitude struck, this research group immediately implemented a randomised trial in the general population, comparing two doses of the same formula to a B Complex formula (Rucklidge et al., 2012) previously shown to be efficacious for the treatment of stress and anxiety (Carroll et al., 2000; Contents lists available at ScienceDirect journal homepage: www.elsevier.com/locate/psychres ...
... Group differences could not be better accounted for by changes in alcohol, cigarette and caffeine consumption, exercise, diet, or sleep. This replication of the NZ earthquake studies (Rucklidge et al., , 2012Rucklidge and Blampied, 2011) suggests the possibility that micronutrients could be useful for the reduction and prevention of mental health problems following natural disasters and that a greater spectrum of nutrients is more effective than one nutrient alone. Although the measure of dietary quality employed in this study was a general one, and did not assess actual nutrient intake, the results are consistent with what would be expected: that nutrient intake in people displaced from their homes would decrease from the crisis but would increase over time as they returned to their normal life patterns. ...
... The initial 7.1 magnitude earthquake on 4th September 2010 occurred in the context of ongoing trials of New Zealand adults with attention-deficit/hyperactivity disorder taking a micronutrient supplement called Q3 EMPowerplus ™ (EMP+), which supplies 36 ingredients (vitamins, minerals, amino acids, and anti-oxidants). A comparison of the self-reported depression, anxiety, and stress responses of adults with ADHD who were and were not taking the micronutrient supplement at the time of the earthquake showed, at 2 weeks post-quake, that those taking EMP+ reported feeling significantly less anxious and stressed than those not taking it, with a medium to large effect size, suggesting that the micronutrients provided resilience in the face of the ongoing stress of the earthquake and subsequent aftershocks (Rucklidge and Blampied, 2011;. ...
... The impact of a large scale disaster such as the Christchurch earthquakes is substantial and enduring. This study and others (Rucklidge and Blampied, 2011; suggest that nutritional 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 ...
We investigated whether micronutrients given acutely following the Christchurch earthquakes continued to confer benefit 1 year following the treatment.
Sixty-four adults from the original 91 participants experiencing heightened anxiety or stress 2-3 months following the 22nd February 2011 earthquake and who had been randomized to receive three different doses of micronutrients completed on-line questionnaires assessing mood, anxiety, stress, and symptoms associated with post-traumatic stress disorder 1 year after completing the initial study. Twenty-one out of 29 nonrandomized controls who did not receive the treatment also completed the questionnaires.
Both the treated and control groups experienced significant improvement in psychological functioning compared with end-of-trial. However, treated participants had better long-term outcomes on most measures compared with controls (ES = 0.69-1.31). Those who stayed on micronutrients through to follow-up or stopped all treatment reported better psychological functioning than those who switched to other treatments including medications. About 10% of the sample continued to have post-traumatic stress disorder symptoms.
Disaster survivors improve psychologically over time regardless of receiving intervention; however, those taking micronutrients during the acute phase following a disaster show better outcomes, identifying micronutrients as a viable treatment for acute stress following a natural disaster with maintenance of benefits 1 year later. ACTRN 12611000460909 Copyright © 2014 John Wiley & Sons, Ltd.
... To identify possible significant changes in performance from the baseline to follow-up session, we adopted a modified Brinley plot analysis (Jacobson and Truax, 1991;Rucklidge and Blampied, 2011). When we applied the modified Brinley plot to interpret the follow-up performance, we assigned the X-axis to be an individual's performance in the baseline session, and the Y-axis was the performance in the follow-up session; we then plotted each individual's data point in the X-Y plane. ...
Objective
Attention and executive function (EF) are vulnerable to aging. However, whether all these functions generally decline with aging is not known. Furthermore, most evidence is based on cross-sectional data and fewer follow-up data are available in the literature. Longitudinal follow-up studies are necessary to characterize individualized and precise changes in cognitive function. Additionally, relatively few aging studies have included middle-aged adults to examine age-related differences in attention and EF. Therefore, this study aims to examine whether general or specific attention and EF decline with aging from adulthood to old age by combining cross-sectional and longitudinal follow-up approaches.
Methods
This study recruited 253 participants aged 20 to 78 years. passing a prescreening procedure (see main text for detail) for the baseline session, and 123 of them were invited to return 1 ~ 2 years after their first visit to participate in the follow-up session. The participants completed a series of attention and EF tasks at both the baseline and follow-up sessions, which measured alerting, orienting, conflict control, stopping, memory updating, and switching abilities. We applied linear and nonlinear regression models to evaluate the cross-sectional age effect on attention and EF and employed a modified Brinley plot to inspect follow-up performance against baseline in attention and EF.
Results
The results of cross-sectional data showed that older adults exhibited decreased efficiency in alerting, stopping, and memory updating but paradoxically increased efficiency in conflict control and switching abilities and no changes in orienting efficiency with age. However, the results of longitudinal data showed that only alerting and memory updating continued to show decreased efficiency. Furthermore, conflict control and switching showed increased efficiency with aging, whereas the orienting network, and stopping no longer showed decreased efficiency.
Conclusion
Thus, converging the cross-sectional and longitudinal data showed that the alerting and memory updating function exhibited the most robust deficit with age (cross-sectional) and aging (longitudinal). Alerting and memory updating abilities are crucial survival skills for human beings. Therefore, developing methods to prevent and improve an individual’s alertness and working memory ability is an important practical issue in aging research.
... Blampied (2017) has shown how other information, such as ES, means and confidence intervals, can be added to the plot to assist further interpretation (see also Black et al. 2019). Graphs of this kind (Figs 1 and 2) can display large amounts of data for visual inspection, revealing trends and outcomes much more immediately than data tables, and if different symbols are used for different aspects of cases or treatments, may reveal moderator variable effects and treatment by severity interactions (Follette and Callaghan, 2001; see Black et al., 2019, andBlampied, 2011, for examples). Figure 2 shows the same data using a simpler dot plot. ...
In 1984 Jacobson and colleagues introduced the concept of reliable change, viz the amount of change on a measure that an individual needed to show to determine that it exceeded the extent of change likely due to measurement error alone. Establishing reliable change was a pre-requisite for determining clinical significance. This paper summarizes the rationale for determining reliable change as providing an individual-focused, idiographic alternative to the dominant nomothetic approach to clinical outcome research based on group mean data and statistical significance. The conventional computational steps for calculating an individual’s standardized difference (reliable change) score and the minimum raw change score on the measure (a reliable change index) required to classify individuals as reliably positively changed, indeterminate, or reliably deteriorated are described. Two methods for graphically representing reliable change are presented, and a range of possible uses in both research and practice settings are summarized. A number of issues and debates concerning the calculation of reliable change are reviewed. It is concluded that the concept of reliable change remains useful for both cognitive behavioural researchers and practitioners, but that there are options regarding methods of computation. In any use of reliable change, the rationale for selecting among method options and the exact computations used need clear and careful description so that we can continuously judge the utility and appropriateness of the use of reliable change and enhance its value to the field.
Key learning aims
(1) Recognizing why the concept of reliable change and the reliable change index is still important.
(2) Understanding the conventional formulas for calculating reliable change and the reliable change index (the Jacobson-Truax (JT) method).
(3) Seeing key ways that both researchers and practitioners can use reliable change to improve both research and practice.
(4) Understanding how several issues and debates that have arisen concerning the estimation of reliable change (e.g. how to accommodate practice effects) have progressed.
(5) Recognizing that there are a range of ways that reliable change may be estimated, and the need to provide full details of the method used in any particular instance of its use.
... After de-duplication and full text review, 25 papers were available for inclusion. These papers were combined with six additional studies [12][13][14][15][16][17] not identified in the initial search strategy that were sourced through cross-referencing and personal knowledge of the literature to give a total of 31 studies. A number of these studies were by authors who published different outcomes for the same study population. ...
Objective: This systematic review aims to identify and evaluate all studies that measured psychological distress or mental disorder following the Canterbury earthquakes to establish the psychological consequences of the earthquakes on those exposed. A secondary aim is to outline and emphasise key methodological factors in disaster research.
Method: Eligible studies were identified following a comprehensive literature search. A quality assessment was undertaken for all included studies. This was followed by methodological and descriptive review.
Results: Thirty‐one papers measuring psychological distress or mental disorder following the Canterbury earthquakes were identified. These papers reported outcomes from 20 separate studies of which seven were rated high‐quality, eight were rated medium and five were rated low‐quality. Key methodological findings and outcomes are discussed for each study.
Conclusion: The Canterbury earthquakes were associated with widespread but not universal adverse effects on mental health. Disaster research quality is assisted by representative samples, repeated measures, and the use of appropriate controls to allow accurate assessments of psychological consequences to be made.
Implications for public health: The presence of widespread adverse effects as a result of the earthquakes suggests broad‐ranging community initiatives are essential to mitigate the negative consequences of disasters.
... That is, iron, zinc, selenium iodine(Triggiani et al, 2009) and copper, manganese and magnesium(Bourre, 2006). These micronutrients reduced stress and anxiety (large effect size of 0.69) amongst a cohort with attention-deficit hyperactivity disorder(Rucklidge et al, 2011). By three months post-earthquake, people self-administrating supplements were experiencing better outcomes than controls with regards to stress and anxiety(Rucklidge et al, 2012). ...
Barriers to better mental health outcomes are stigma and sub-optimal mental health literacy. Mental health outcomes are being suppressed by both the residual eugenics beliefs and Nazi propaganda, that continue to dominate global public perceptions. As health professionals we need to move past these Nazi atrocities to modernize the delivery of mental health services. Mental health literacy is an invaluable resource. Many mental disorders are known to arise from the brain adapting to a low energy environment. An integrative literary review of brain energy requirements was conducted, to extrapolate recommendations that can inform clinical practice and policy. The quality of life aspect of mental health should emphasize cognitive well-being. Stress depletes our brain's iron and magnesium reserves. Smoking tobacco, heavy alcohol or marijuana use only worsens the damage that is occurring in the brain; from depleting levels of these important nutrients. Critically, do not fast for extended periods then eat ferociously or consistently skip meals. A variety of foods contain the recommended nutrients. Moreover, fish, seaweed or proteins possess higher levels of the nutrients required for thyroid hormone production to control energy expenditure. Eat iron, zinc and iodine rich foodstuffs and smaller portions of selenium, copper, magnesium and manganese to support your brain; especially if you have ever had a mild to severe hypoxic brain injury. Micronutrient preparations comprising of these nutrients may help to prevent mental disorders. See your doctor to have any gastro-intestinal or thyroid problems treated.
... Emerging evidence exploring the impact of broad-spectrum micronutrient supplementation on mental health has found a range of beneficial outcomes. Micronutrients improved depressive symptoms in older adults over six months [43], minimized stress and improved resiliency following various natural disasters in a community sample of adults [44,45] and also in adults with attention-deficit/hyperactivity disorder (ADHD) [46]. Micronutrients have also shown benefit for primary insomnia alongside additional improved mood, stress, and anxiety symptoms in adults [47]. ...
Background: Anxiety and depression are conferring an increasing burden on society. Although treatments exist for both conditions, side effects, and difficulties accessing treatment prevent many people from receiving adequate assistance. Nutritional approaches have demonstrated some success in treating anxiety and depression. We plan to investigate whether a micronutrient formula, Daily Essential Nutrients, improves symptoms of anxiety and depression compared to a placebo in a community recruited sample. Methods: This will be a randomized, double blind placebo controlled study (RCT). Two hundred adults will be assigned to either a placebo or micronutrient group (placebo or Daily Essential Nutrients (DEN)) in a 1:1 ratio. Baseline data will be collected for 2 weeks, followed by 10 weeks of placebo or micronutrient intervention. Psychometrics will be used to measure progress and participant safety will be monitored weekly. Results: The primary outcome measures will be total scores on three measures of symptom severity at 10 weeks. Linear mixed modelling will be used to measure between group differences and effect sizes will be calculated using pooled mean scores and standard deviations over the course of the trial. Conclusions: If effective, micronutrients could provide an alternative treatment, with fewer barriers and adverse events than currently available treatments.
... Presenting these data individually, as had Cuvo et al. (2001), occupied 45 graphs in Hensman (2013). Hence, for this publication, the data were plotted as Brinley plots, as modified similarly by Rucklidge and Blampied (2011). Brinley plots are scatter plots with axes such as preand post-treatment means for a particular dependent variable (DV), with a diagonal line superimposed, which is the line of no effect (i.e., indicating no change in behavior between conditions). ...
To date, research on the effects of providing sensory stimulating activities (e.g., multisensory environments) with persons with dementia has been inconclusive. We evaluated the behavioral effects of an occupational therapy program of individualized sensory-based activities (SBAs), in which activities were selected based on individuals’ sensory abilities and preferences. Six participants with severe cognitive impairment (aged 68–90 years) were selected by the staff of a residential dementia facility. The effects of SBA on behaviors considered desirable or undesirable by staff were assessed by behavioral measurement, and results were compared from immediately before SBA with data collected during and after SBA sessions. The results indicate that the use of SBA had immediate effects during the activity, but limited short-term after-effects.
... An open-label study examined 33 adults with ADHD who had either been treated with the Hardy-Stephan formula or received no treatment for 2 weeks before a major earthquake. 281,282 The treatments were conducted in the context of research studies that were interrupted by the earthquake. These subjects were continued on open-label Hardy-Stephan formula or no treatment for 2 weeks after the earthquake and then assessed by using the Depression, Anxiety, and Stress Scale (DASS). ...
Several different vitamins and minerals appear to be effective augmenting agents for mood-modifying drugs, but are not potent monotherapies in themselves for treating psychiatric disorders. In contrast, broad-spectrum micronutrient interventions appear in early trials to be as effective as psychiatric medications with fewer adverse effects for treating mood disorders, ADHD, aggressivity, and misconduct in youth and adults. Broad-spectrum treatments also may improve stress responses, cognition, and sense of well-being in healthy adults, but have been less well studied in youth. Current clinical data justify an extensive expansion of research on micronutrient mechanisms and treatments in psychiatry.
... The impact of a large scale disaster such as the Christchurch earthquakes is substantial and enduring. This study and our previous one on adults with ADHD (Rucklidge and Blampied, 2011;Rucklidge et al., 2011a) suggest that nutritional supplementation is one possible direction for first line intervention to reduce the emotional impact on the general population. Long-term health is essential for a community to recover. ...
To compare two micronutrient (vitamins and minerals) formulas (Berocca™ and CNE™) and assess their impact on emotions and stress related to the 6.3 earthquake on February 22(nd) 2011 in Christchurch, New Zealand.
91 adults experiencing heightened anxiety or stress 2-3 months following the earthquake were randomized to Berocca™, CNE™ low dose (CNE4), or CNE™ high dose (CNE8), for 28 days and monitored weekly via on-line questionnaires and followed 1 month post-trial. A nonrandomized control group (n = 25) completed questionnaires at baseline and 4 weeks.
All treatment groups experienced significant declines in psychological symptoms (p < .001). CNE™ groups experienced greater reduction in intrusive thoughts as compared with Berocca™ (p = .05), with no group differences on other measures of psychological symptoms. However, CNE8 group reported greater improvement in mood, anxiety, and energy (p < .05) with twice as many reporting being "much" to "very much" improved and five times more likely to continue taking CNE™ post-trial than Berocca™ group. Treated participants had better outcomes on most measures over 4 weeks as compared to controls.
This study supports micronutrients as an inexpensive and practical treatment for acute stress following a natural disaster with a slight advantage to higher doses ACTRN 12611000460909. Copyright © 2012 John Wiley & Sons, Ltd.
Surf therapy programs have been successfully utilised with vulnerable populations worldwide. This study is the first to examine the effects of a surf therapy program on the psychosocial functioning of young men at high risk of adverse life outcomes in Aotearoa New Zealand. A single-group pre-test post-test research design, with repeated measures and replication was used. The Youth Outcome Questionnaire Self-Report’s Reliable Change Index and clinical cut-off scores were employed to assess outcomes pertaining to each individual. Effect size measures were used to estimate an overall treatment effect. Modified Brinley plots revealed that 25 out of 27 participants demonstrated reliable improvement in psychosocial functioning, 20 of whom also demonstrated clinically significant improvement. The effect size measures also confirmed a large overall treatment effect. Findings suggest that the Tai Wātea surf therapy program may be a highly effective intervention for reaching, retaining and improving the psychosocial functioning of high-risk young men.
The paper reviews the history, construction and interpretation of modified Brinley plots, a scatter-plot used in therapy outcome research to compare each individual participant?s scores on the same dependent variable at time one (normally pre-treatment baseline; X-axis) with scores at selected times during or after treatment (Y-axis). Since 1965 eponymously named Brinley plots have occasionally been used in experimental psychology to display group mean data. Between 1979 and 1995 a number of clinical researchers modified Brinley plots to show individuals? data but these plots have received little subsequent use. When constructed with orthogonal axes having the same origin and scale values, little or no change over time is shown by individuals? data points lying on or closely about the diagonal (45?o) while the magnitude and direction of any improvement (or deterioration), outliers, and the extent of replication across cases shows via dispersion of points away from 45?o. Interpretation is aided by displaying reliable change boundaries, clinical cut-offs, means, variances, confidence intervals, and effect sizes directly on the graph. Modified Brinley plots are directly informative about individual change during therapy in the context of concurrent change in others in the same (or a different) condition, clearly show if outcomes are replicated and if they are clinically significant, and make nomothetic group information, notably effect sizes, directly available. They usefully compliment other forms of analysis in therapy outcome research.
Following trauma, most people with initial symptoms of stress recover, but it is important to identify those at risk for continuing difficulties so resources are allocated appropriately. There has been limited investigation of predictors of posttraumatic stress disorder following natural disasters. This study assessed psychological difficulties experienced in 101 adult treatment seekers following exposure to a significant earthquake. Peritraumatic dissociation, posttraumatic stress symptoms, anxiety, depression, and emotional support were assessed. Path analysis was used to determine whether the experience of some psychological difficulties predicted the experience of other difficulties. As hypothesized, peritraumatic dissociation was found to predict posttraumatic stress symptoms and anxiety. Posttraumatic stress symptoms then predicted anxiety and depression. Depression and anxiety were highly correlated. Contrary to expectations, emotional support was not significantly related to other psychological variables. These findings justify the provision of psychological support following a natural disaster and suggest the benefit of assessing peritraumatic dissociation and posttraumatic stress symptoms soon after the event to identify people in need of monitoring and intervention.
Prior research shows that micronutrients, particularly amino acids, can assist individuals with substance dependence to quit various drugs of abuse, including cannabis, alcohol, and cocaine. As part of a wider investigation of the impact of micronutrients (mostly vitamins and minerals) on psychiatric symptoms, such as Attention-Deficit/Hyperactivity Disorder (ADHD), depression, and anxiety, we observed that many participants reduced or eliminated use of alcohol, cigarettes, and cannabis. One case using a single-case reversal (off-on-off-on-off) design is presented and shows not only on-off control of psychiatric symptoms as micronutrients are consumed or withdrawn, but also simultaneous on-off use of cannabis and cigarettes, despite not directly targeting this substance use as part of the treatment protocol. This case adds to a growing body of research supporting the use of micronutrients in the treatment of psychiatric symptoms and suggests it may extend to substance dependence. Micronutrients, by assisting with mood regulation and reductions in anxiety, may assist with successful cessation of drug use. Alternatively, they may directly impact on the brain reward circuitry believed to be involved in the expression of addictions, thereby providing the appropriate precursors and cofactors necessary for adequate neurotransmitter synthesis. This case should continue to stimulate researchers to consider the role of nutrients, in particular vitamins and minerals, in drug treatment programs and encourage more rigorous trials.
Psychosis is difficult to treat effectively with conventional pharmaceuticals, many of which have adverse long-term health consequences. In contrast, there are promising reports from several research groups of micronutrient treatment (vitamins, minerals, amino acids and essential fatty acids) of mood, anxiety and psychosis symptoms using a complex formula that appears to be safe and tolerable. We review previous studies using this formula to treat mental symptoms, and present an 11-year-old boy with a 3-year history of mental illness whose parents chose to transition him from medication to micronutrients. Symptom severity was monitored in three clusters: anxiety, obsessive compulsive disorder and psychosis. Complete remission of psychosis occurred, and severity of anxiety and obsessional symptoms decreased significantly (p<0.001); the improvements are sustained at 4-year follow-up. A cost comparison revealed that micronutrient treatment was <1% of his inpatient mental healthcare. Additional research on broad-spectrum micronutrient treatment is warranted.
At 4:35 A.M. local time on 4 September (1635 UTC, 3 September), a previously unrecognized fault system ruptured in the Canterbury region of New Zealand's South Island, producing a moment magnitude ( M w ) 7.1 earthquake that caused widespread damage throughout the area. In stark contrast to the 2010 M w 7.0 Haiti earthquake, no deaths occurred and only two injuries were reported despite the epicenter's location about 40 kilometers west of Christchurch (population ˜386,000). The Canterbury region now faces a rebuilding estimated to cost more than NZ$4 billion (US$2.95 billion).
On the positive side, this earthquake has provided an opportunity to document the dynamics and effects of a major strike‐slip fault rupture in the absence of death or serious injury. The low‐relief and well‐maintained agricultural landscape of the Canterbury Plains helped scientists characterize very subtle earthquake‐related ground deformation at high resolution, helping to classify the earthquake's basic geological features [ Quigley et al., 2010]. The prompt mobilization of collaborating scientific teams allowed for rapid data capture immediately after the earthquake, and new scientific programs directed at developing a greater understanding of this event are under way.
Background
Bipolar disorder is a lifelong problem with imperfect available treatments. Recent research has shown potential benefit of nutritional treatment for mood symptoms. The goal of the current study was to determine whether adults with bipolar disorder reported treatment benefit from consuming a micronutrient formula.
Methods
Self-report data were available from 682 adults who reported a diagnosis of bipolar disorder; 81% were taking psychiatric medications. Those reporting additional diagnoses were excluded, as well as those who provided data <60 times during 180 days of using the micronutrients, leaving 358 for analysis.
Results
Mean symptom severity was 41% lower than baseline after 3 months (effect size = 0.78), and 45% lower after 6 months (effect size = 0.76) (both paired t-tests significant, p < 0.001). In terms of responder status, 53% experienced ≥50% improvement at 6 months. Half the sample were taking medications approved for bipolar disorder (lithium, anticonvulsants, atypical antipsychotics), and half were either medication-free or taking other medications: the magnitude of treatment benefit did not differ between these two groups. Regression analyses indicated that decreased symptom severity over the 6 months was associated with increasing micronutrient dosage and with reducing medication. Symptom improvements were significant and sustained at 6 months, suggesting that benefits were not attributable to placebo/expectancy effects.
Conclusions
Further research on this micronutrient formula is warranted.
Attention-deficit/hyperactivity disorder (ADHD) in adults is associated with significant impairment in many life activities and may thus increase the risk of chronic stress in everyday life. We compared adults with a DSM-IV ADHD diagnosis (n = 28) with healthy controls (n = 28) regarding subjective stress and amounts of stressors in everyday life, diurnal salivary cortisol in the everyday environment and salivary cortisol before and after cognitive stress in a laboratory setting. The association between cortisol concentrations and impulsivity was also investigated. Consistent with assumptions, individuals with ADHD reported significantly more self-perceived stress than controls, and subjective stress correlated with the amount of stressors in everyday life. The two groups were comparable with respect to overall diurnal cortisol levels and rhythm, as well as in pre- and post-stress cortisol concentrations. Post-stress cortisol (but not baseline cortisol) concentration was positively correlated with impulsivity. The group with high post-stress cortisol also reported more symptoms of depression and anxiety, as well as self-perceived stress and stressors in every-day life. The diagnosis of ADHD significantly increased the risk of belonging to the group with high post-stress cortisol levels. The results in this study warrant a focus not only on the primary diagnosis of ADHD, but also calls for a broader assessment of stressors and subjective stress in everyday life, as well as support comprising stress management and coping skills.
Eleven previous reports have shown potential benefit of a 36-ingredient micronutrient formula (known as EMPowerplus) for the treatment of psychiatric symptoms. The current study asked whether children (7-18 years) with pediatric bipolar disorder (PBD) benefited from this same micronutrient formula; the impact of Attention-Deficit/Hyperactivity Disorder (ADHD) on their response was also evaluated.
Data were available from an existing database for 120 children whose parents reported a diagnosis of PBD; 79% were taking psychiatric medications that are used to treat mood disorders; 24% were also reported as ADHD. Using Last Observation Carried Forward (LOCF), data were analyzed from 3 to 6 months of micronutrient use.
At LOCF, mean symptom severity of bipolar symptoms was 46% lower than baseline (effect size (ES) = 0.78) (p < 0.001). In terms of responder status, 46% experienced >50% improvement at LOCF, with 38% still taking psychiatric medication (52% drop from baseline) but at much lower levels (74% reduction in number of medications being used from baseline). The results were similar for those with both ADHD and PBD: a 43% decline in PBD symptoms (ES = 0.72) and 40% in ADHD symptoms (ES = 0.62). An alternative sample of children with just ADHD symptoms (n = 41) showed a 47% reduction in symptoms from baseline to LOCF (ES = 1.04). The duration of reductions in symptom severity suggests that benefits were not attributable to placebo/expectancy effects. Similar findings were found for younger and older children and for both sexes.
The data are limited by the open label nature of the study, the lack of a control group, and the inherent self-selection bias. While these data cannot establish efficacy, the results are consistent with a growing body of research suggesting that micronutrients appear to have therapeutic benefit for children with PBD with or without ADHD in the absence of significant side effects and may allow for a reduction in psychiatric medications while improving symptoms. The consistent reporting of positive changes across multiple sites and countries are substantial enough to warrant a call for randomized clinical trials using micronutrients.
Bipolar disorder with co-occurring attention-deficit/hyperactivity disorder (ADHD) is a challenge to treat. Ten previous reports have shown potential benefit of a micronutrient treatment (consisting mainly of vitamins and minerals) for various psychiatric symptoms, including mood and ADHD. This case study aimed to investigate the longer term impact of the micronutrients on both psychiatric and neurocognitive functioning in an off-on-off-on (ABAB) design with 1 year follow-up. A 21-year-old female with bipolar II disorder, ADHD, social anxiety, and panic disorder entered an open-label trial using a nutritional treatment following a documented 8 year history of on-going psychiatric symptoms not well managed by medications. After 8 weeks on the formula she showed significant improvements in mood, anxiety, and hyperactivity/impulsivity. Blood test results remained normal after 8 weeks on the formula. She did not report any adverse side effects associated with the treatment. She then chose to come off the formula; after 8 weeks her depression scores returned to baseline, and anxiety and ADHD symptoms worsened. The formula was reintroduced, showing gradual improvement in all psychiatric symptoms. This case represents a naturalistic ABAB design showing on-off control of symptoms. After 1 year, the patient is now in remission from all mental illness. Neurocognitive changes mirrored behavioral changes, showing improved processing speed, consistency in response speed, and verbal memory. A placebo response and expectancy effects cannot be ruled out although previous poor response to treatment and the duration of the current positive response decrease the likelihood that other factors better explain change. These consistently positive outcomes alongside an absence of side effects indicate that further research, particularly larger and more controlled trials, is warranted using this multinutrient approach.
Autism spectrum disorder (ASD) is often accompanied by self-injurious behavior (SIB), aggression, and tantrums, symptoms that have reportedly improved with micronutrient (vitamins and minerals) treatment. The current study took advantage of naturally occurring differences in parental preferences for treatment approaches. The micronutrient group asked for treatment without pharmaceuticals (n = 44, aged 2-28 years at entry [M = 8.39 +/- 5.58]). Their records were matched with those of 44 similar children whose families requested conventional treatment (medication group). Both groups improved on both the Childhood Autism Rating Scale and the Childhood Psychiatric Rating Scale (all p values <0.0001). Both groups also exhibited significant decreases in total Aberrant Behavior Checklist scores, but the micronutrient group's improvement was significantly greater (p < 0.0001). SIB Intensity was lower in the micronutrient group at the end of the study (p = 0.005), and improvement on the Clinical Global Impressions scale was greater for the micronutrient group (p = 0.0029). It is difficult to determine whether the observed changes were exerted through improvement in mood disorder or through an independent effect on autistic disorder. There were some advantages to treatment with micronutrients-lower activity level, less social withdrawal, less anger, better spontaneity with the examiner, less irritability, lower intensity SIB, markedly fewer adverse events, and less weight gain. Advantages of medication management were insurance coverage, fewer pills, and less frequent dosing.
To investigate the effect of a 36-ingredient micronutrient formula consisting mainly of minerals and vitamins in the treatment of adults with both ADHD and severe mood dysregulation (SMD).
14 medication-free adults (9 men, 5 women; 18-55 years) with ADHD and SMD completed an 8-week open-label trial.
A minority reported transitory mild side effects. Significant improvements were noted across informants (self, observer, clinician) on measures of inattention and hyperactivity/impulsivity, mood, quality of life, anxiety, and stress all with medium to very large effect sizes (all ps < .01); however, the mean of inattention remained in a clinical range whereas the means on measures of mood and hyperactivity/impulsivity were normalized. Follow-up data showed maintenance of changes or further improvement for those who stayed on the micronutrients.
Although this study, as an open trial, does not in itself prove efficacy, it provides preliminary evidence supporting the need for a randomized clinical trial of micronutrients as treatment for the more complex presentations of ADHD.
Early-onset bipolar disorder has significant morbidity and mortality. Development of safe, effective treatments to which patients will adhere is critical. Pharmacologic interventions for childhood bipolar spectrum disorders are limited and are associated with significant risk for adverse events. Diet and nutrition research suggests vitamins, minerals, and other nutrients are important underpinnings of general physical and mental health; furthermore, they may even be useful in treating mood dysregulation by providing a more favorable risk-benefit ratio than contemporary psychotropic agents. This article reviews the literature on multinutrient supplementation and mental health, and examines a case study of a 12-year-old boy with bipolar disorder and co-morbid diagnoses treated for 6 years with conventional medication and finally a multinutrient supplement. The multinutrient supplement in this case study is EMPowerplus (EMP+), a 36-ingredient supplement containing 16 minerals, 14 vitamins, 3 amino acids, and 3 antioxidants. It was used to treat a 12-year-old boy initially diagnosed with bipolar disorder not otherwise specified (BP-NOS) at age 6, and whose diagnosis evolved by age 10 to bipolar I (BP-I), mixed, with psychotic features. He also met criteria for generalized anxiety disorder by age 8 and obsessive-compulsive disorder by age 10. After 6 years of conventional treatment (ages 6-12), he received 14 months of EMP+. Symptom manifestation over 7 years is described in conjunction with treatment history. EMP+ resulted in outcome superior to conventional treatment. This report adds to accumulating preliminary evidence that further basic science and clinical studies of multinutrient supplements are warranted.
Attention-deficit/hyperactivity disorder (ADHD) is a chronic, debilitating psychiatric illness that often co-occurs with other common psychiatric problems. Although empirical evidence supports pharmacological and behavioral treatments, side effects, concerns regarding safety and fears about long-term use all contribute to families searching for alternative methods of treating the symptoms of ADHD. This review presents the published evidence on supplementation, including single ingredients (e.g., minerals, vitamins, amino acids and essential fatty acids), botanicals and multi-ingredient formulas in the treatment of ADHD symptoms. In most cases, evidence is sparse, mixed and lacking information. Of those supplements where we found published studies, the evidence is best for zinc (two positive randomized, controlled trials); there is mixed evidence for carnitine, pycnogenol and essential fatty acids, and more research is needed before drawing conclusions about vitamins, magnesium, iron, SAM-e, tryptophan and Ginkgo biloba with ginseng. To date, there is no evidence to support the use of St John's wort, tyrosine or phenylalanine in the treatment of ADHD symptoms. Multi-ingredient approaches are an intriguing yet under-researched area; we discuss the benefits of this approach considering the heterogeneous nature of ADHD.
To assess the effects of a multivitamin-mineral combination (Berocca Calmag) treatment on stress in a large sample of South Africans.
This was a multiple-dose, double-blind, placebo-controlled, double-centre study. Patients were drawn from two centres with high stress levels (Durban and Johannesburg), each study recruiting the same number of patients (150) from 1,000 adults with predetermined high stress levels. Dropouts from the study were replaced. Study medication safety was evaluated by recording adverse events. On day 1 (baseline) patients were subjected to an individual in-depth assessment that included a biographical questionnaire, four psychological scales, and collateral information from close relatives. On day 30 (end of the study period) or at the latest 7 days after the last planned medication intake, the assessment was repeated for purposes of pre- and post-response comparison.
Thirty-three patients dropped out and were replaced, leaving 300 patients who completed the study--151 in group 1 (multivitamin-mineral combination), and 149 in group 2 (placebo). There were no statistically significant differences between the two groups regarding demographics and baseline stress scores at study entry. Both groups improved between baseline and the end of treatment as assessed. The degree of improvement was statistically significant and greatest in group 1 for all psychometric instruments, with this beneficial effect increasing over the course of the day. Subgroup analyses for age (18-44 and 45-65 years), gender and ethnicity showed no general effect on the overall study outcome.
The multivitamin-mineral combination tested is well tolerated and can be used as part of a treatment programme for stress-related symptoms at the recommended dose.
Several studies have demonstrated that psychiatric symptoms such as depression, mood swings, and aggression may be ameliorated by supplementation with broad-based nutrient formulas containing vitamins, minerals, and sometimes essential fatty acids. These findings have been reported in young criminal offenders as well as in adults with mood disturbance and other psychiatric disorders. The purpose of the current case series was to explore the potential efficacy of a nutrient supplement in children. Children with mood and behavioral problems (N = 11; 7 boys, 4 girls; 8-15 years old) participated; 9 completed this open-label trial. Parents completed the Child Behavior Checklist (CBCL), Youth Outcome Questionnaire (YOQ), and Young Mania Rating Scale (YMRS) at entry and following at least 8 weeks of treatment. Intent-to-treat analyses revealed decreases on the YOQ (p < 0.001) and the YMRS (p < 0.01) from baseline to final visit. For the 9 completers, improvement was significant on seven of the eight CBCL scales, the YOQ, and the YMRS (p values from 0.05-0.001). Effect sizes for all outcome measures were relatively large. The findings suggest that formal clinical trials of broad nutritional supplementation are warranted in children with these psychiatric symptoms.
Despite growing interest in adult attention deficit hyperactivity disorder (ADHD), little is known about its prevalence or correlates.
A screen for adult ADHD was included in a probability subsample (N=3,199) of 18-44-year-old respondents in the National Comorbidity Survey Replication, a nationally representative household survey that used a lay-administered diagnostic interview to assess a wide range of DSM-IV disorders. Blinded clinical follow-up interviews of adult ADHD were carried out with 154 respondents, oversampling those with positive screen results. Multiple imputation was used to estimate prevalence and correlates of clinician-assessed adult ADHD.
The estimated prevalence of current adult ADHD was 4.4%. Significant correlates included being male, previously married, unemployed, and non-Hispanic white. Adult ADHD was highly comorbid with many other DSM-IV disorders assessed in the survey and was associated with substantial role impairment. The majority of cases were untreated, although many individuals had obtained treatment for other comorbid mental and substance-related disorders.
Efforts are needed to increase the detection and treatment of adult ADHD. Research is needed to determine whether effective treatment would reduce the onset, persistence, and severity of disorders that co-occur with adult ADHD.
In this article, the authors explore the breadth and depth of published research linking dietary vitamins and minerals (micronutrients) to mood. Since the 1920s, there have been many studies on individual vitamins (especially B vitamins and Vitamins C, D, and E), minerals (calcium, chromium, iron, magnesium, zinc, and selenium), and vitamin-like compounds (choline). Recent investigations with multi-ingredient formulas are especially promising. However, without a reasonable conceptual framework for understanding mechanisms by which micronutrients might influence mood, the published literature is too readily dismissed. Consequently, 4 explanatory models are presented, suggesting that mood symptoms may be expressions of inborn errors of metabolism, manifestations of deficient methylation reactions, alterations of gene expression by nutrient deficiency, and/or long-latency deficiency diseases. These models provide possible explanations for why micronutrient supplementation could ameliorate some mental symptoms.
One third of older people in nursing and/or residential homes have significant symptoms of depression. In younger people, deficiencies in selenium, vitamin C and folate are associated with depression. This study examines the association between micronutrient status and mood before and after supplementation. The objective was to determine whether the administration of selenium, vitamin C and folate improved mood in frail elderly nursing home residents. Mood was assessed using the Hospital Anxiety and Depression rating scale (HAD), and Montgomery-Asberg Depression Rating Scale (MADRS). Micronutrient supplementation was provided for 8 weeks in a double-blinded randomised controlled trial. Significant symptoms of depression (29%) and anxiety (24%) were found at baseline. 67% of patients had low serum concentrations of vitamin C, but no-one was below the reference range for selenium. Depression was significantly associated with selenium levels, but not with folate or vitamin C levels. No individual with a HAD depression score of >or=8, had selenium levels >1.2 microM. In those patients with higher HAD depression scores, there was a significant reduction in the score and a significant increase in serum selenium levels after 8 weeks of micronutrient supplementation. Placebo group scores were unchanged. This small study concluded that depression was associated with low levels of selenium in frail older individuals. Following 8 weeks of micronutrient supplementation, there was a significant increase in selenium levels and improved symptoms of depression occurred in a subgroup.
This study investigated post-traumatic symptoms among survivors of the October 2005 earthquake in Pakistan. A total of 125 survivors who were admitted in different hospitals of Lahore city were interviewed using following measures: Detailed Assessment of Post-traumatic Stress (DAPS), General Health Questionnaire (GHQ) and Other Dimensions of Trauma (ODOT). Both quantitative and qualitative analyses were carried out on the data. The respondents showed significantly higher scores on all subscales of the DAPS and GHQ. Women showed significantly greater symptoms of stress both at the DAPS and GHQ. Signifi cantly greater number of people were coping by crying and requesting God to forgive their sins. On the basis of current findings, both short and long-term counselling strategies were suggested for psychological rehabilitation of the victims.
Three kinds of evidence point toward declines of some nutrients in fruits and vegetables available in the United States and the United Kingdom: 1) early studies of fertilization found inverse relationships between crop yield and mineral concentrations—the widely cited ''dilution effect''; 2) three recent studies of historical food composition data found apparent median declines of 5% to 40% or more in some minerals in groups of vegetables and perhaps fruits; one study also evaluated vitamins and protein with similar results; and 3) recent side-by-side plantings of low- and high-yield cultivars of broccoli and grains found consistently negative correlations between yield and concentrations of minerals and protein, a newly recognized genetic dilution effect. Studies of historical food composition data are inherently limited, but the other methodscanfocusonsingle cropsofanykind, canincludeanynutrientofinterest, andcanbecarefullycontrolled. Theycan also test proposed methods to minimize or overcome the diluting effects of yield whether by environmental means or by plant breeding. This article summarizes three kinds of evidence pointing toward declines during the last 50 to 100 years in the concentration of some nutrients in vegetables and perhaps also in fruits available in the United States and the United Kingdom.
The aim of this study was to determine posttraumatic stress symptoms of people still living in the Marmara region 15-18 months after the earthquakes, that occurred there and examine differences in the nutritional status of these people. A daily nutrient consumption form and symptom checklist were used to collect data. Results indicated that there was no significant difference among the body mass index groups on the Global Symptom Index. However, underweight and normal-weight people had higher paranoid thoughts than obese people. On psychotic tendencies, underweight individuals were more negative than obese survivors.
The field of "mitochondrial medicine" has advanced rapidly since the first patient with a mitochondrial disorder, a concept primarily used for defects of the respiratory chain, was described in 1962 and the first mitochondrial DNA (mtDNA) mutations were described in 1988. Because of the ubiquitous requirement for energy and unique aspects of mtDNA genetics, mtDNA mutations are known to cause a bewildering spectrum of clinical manifestations. However, because of its high-energy requirement, brain is the primary tissue affected in mitochondrial disorders. Using a variety of approaches, mitochondrial function has been shown in numerous studies to be abnormal in patients with schizophrenia and depression. Although less studied, an increase of psychiatric symptoms and disorders, in particular depression, are likely present in patients with mitochondrial disorders. The major categories of drugs used to treat schizophrenia and depression have been demonstrated to exert effects on mitochondria. The authors conclude that an association between energy metabolism and the mental disorders of schizophrenia and depression has been well documented, but that no conclusive evidence as yet demonstrates a causal relationship. A "mitochondrial psychiatry" model is proposed in which a moderate reduction in mitochondrial energy metabolism, genetically determined and/or acquired, is one predisposing factor in the multi-factorial development of certain chronic mental disorders. Clinical implications of our hypothesis, present and future, include the presence of co-morbid somatic symptoms/conditions, and specific treatment at least in highly-selected cases.
Aim:
This study was undertaken 5 months after the 2004 Niigata-Chuetsu earthquake in Japan to assess factors that impacted on psychological distress and its recovery.
Methods:
Three thousand and twenty-six adult victims who lived in temporary shelter and in seriously damaged areas were evaluated by questionnaire. The questionnaire queried subject profile, degree of house damage, health status, and psychological distress using a 5-point scale before, immediately and 5 months after the earthquake.
Results:
Immediately after the earthquake, 59.3% of the subjects had psychological distress. At 5 months after the earthquake, however, this percentage decreased to 21.8%. The psychological distress immediately after the earthquake was significantly serious in victims who: (i) were female; (ii) felt stronger fear of the earthquake and the aftershocks; (iii) lived at home or office after the earthquake; and (iv) were injured due to the earthquake or suffered from sickness after the earthquake. In contrast, the factors impairing psychological recovery 5 months after the earthquake were as follows: (i) being with unfamiliar member(s) during the night after the earthquake; (ii) serious house damage; (iii) living in temporary shelter or at a relative's home after the earthquake; and (iv) physical illness after the earthquake.
Conclusion:
Despite differences between disasters, these results were consistent with those in some previous studies and may be useful for long-term mental care support.
An important issue in the alcohol field is how to present treatment outcome findings in a way that conveys the nature of the full range of outcomes (i.e., how individuals fared). Results should also be presented so as to be readily understood by practitioners. To illustrate how treatment outcome reports can be enriched by graphic portrayals of outcome findings, previously unpublished results from a study of Guided Self-Change treatment for problem drinkers are first presented in a traditional manner. Then, supplemental graphic methods of data reporting, including the use of frequency distributions and scatter plots, are presented. These portrayals are shown to address issues that receive little attention in reports limited to statistical analyses. It is also shown that reported success rates, “yardsticks of success,” are highly dependent on small changes in the criteria used to define success.
The role of good nutrition for resilience in the face of stress is a topic of interest, but difficult to study. A 7.1 earthquake took place in the midst of research on a micronutrient treatment for Attention-Deficit/Hyperactivity Disorder (ADHD), providing a unique opportunity to examine whether individuals with ADHD taking micronutrients demonstrated more emotional resilience post-earthquake than individuals with ADHD not taking micronutrients. Thirty-three adults with ADHD were assessed twice following the earthquake using a measure of depression, anxiety and stress also completed at some point pre-earthquake (baseline). Seventeen were not taking micronutrients at the time of the earthquake (control group), 16 were (micronutrient group). While there were no between-group differences one week post-quake (Time 1), at two weeks post-quake (Time 2), the micronutrient group reported significantly less anxiety and stress than the controls (effect size 0.69). These between group differences could not be explained by other variables, such as pre-earthquake measures of emotions, demographics, psychiatric status, and personal loss or damage following the earthquake. The results suggest that micronutrients may increase resilience to ongoing stress and anxiety associated with a highly stressful event in individuals with ADHD and are consistent with controlled studies showing benefit of micronutrients for mental health.
The symptoms of posttraumatic stress disorder and associated risk factors were investigated among health care workers in earthquake-affected areas in southwest China. 343 health care workers completed the Chinese version of the Impact of Event Scale-Revised 3 mo. after the Wenchuan Earthquake. The prevalence of probable PTSD was 19%. The significant risk factors identified for PTSD severity included being female, being bereaved, being injured, and higher intensity of initial fear. These findings suggest that PTSD is a common mental health problem among health care workers in earthquake-affected areas. The present information can be useful in directing, strengthening, and evaluating disaster-related mental health needs and interventions after an earthquake.
The triage theory posits that some functions of micronutrients (the approximately 40 essential vitamins, minerals, fatty acids, and amino acids) are restricted during shortage and that functions required for short-term survival take precedence over those that are less essential. Insidious changes accumulate as a consequence of restriction, which increases the risk of diseases of aging. For 16 known vitamin K-dependent (VKD) proteins, we evaluated the relative lethality of 11 known mouse knockout mutants to categorize essentiality. Results indicate that 5 VKD proteins that are required for coagulation had critical functions (knockouts were embryonic lethal), whereas the knockouts of 5 less critical VKD proteins [osteocalcin, matrix Gla protein (Mgp), growth arrest specific protein 6, transforming growth factor beta-inducible protein (Tgfbi or betaig-h3), and periostin] survived at least through weaning. The VKD gamma-carboxylation of the 5 essential VKD proteins in the liver and the 5 nonessential proteins in nonhepatic tissues sets up a dichotomy that takes advantage of the preferential distribution of dietary vitamin K1 to the liver to preserve coagulation function when vitamin K1 is limiting. Genetic loss of less critical VKD proteins, dietary vitamin K inadequacy, human polymorphisms or mutations, and vitamin K deficiency induced by chronic anticoagulant (warfarin/coumadin) therapy are all linked to age-associated conditions: bone fragility after estrogen loss (osteocalcin) and arterial calcification linked to cardiovascular disease (Mgp). There is increased spontaneous cancer in Tgfbi mouse knockouts, and knockdown of Tgfbi causes mitotic spindle abnormalities. A triage perspective reinforces recommendations of some experts that much of the population and warfarin/coumadin patients may not receive sufficient vitamin K for optimal function of VKD proteins that are important to maintain long-term health.
Obsessive Compulsive Disorder (OCD) affects 0.5-2% of young people many of whom are resistant to conventional treatments. This case study describes an 18-year-old male with OCD who first underwent cognitive behavioral therapy (CBT) for a 1-year period with a modest response (his OCD had shifted from severe to moderate). Within a year, his anxiety had deteriorated back to the severe range and he now had major depression. He then entered an ABAB design trial using a nutritional formula consisting mainly of minerals and vitamins (together, known as micronutrients). After 8 weeks on the formula, his mood was stabilized, his anxiety reduced, and his obsessions were in remission. The treatment was then discontinued for 8 weeks, during which time his obsessions and anxiety worsened and his mood dropped. Reintroduction of the formula again improved the symptoms. This case illustrates the importance of considering the effect micronutrients have on mental illness.
Because the diagnosis of attention deficit hyperactivity disorder (ADHD) in higher education settings is rapidly becoming a contentious issue, particularly among patients with high IQs, we sought to assess the validity of diagnosing ADHD in high-IQ adults and to further characterize the clinical features associated with their ADHD.
We operationalized high IQ as having a full-scale IQ120. We identified 53 adults with a high IQ who did not have ADHD and 64 adults with a high IQ who met diagnostic criteria for ADHD. Groups did not differ on IQ, socio-economic status or gender.
High-IQ adults with ADHD reported a lower quality of life, had poorer familial and occupational functioning, and had more functional impairments, including more speeding tickets, accidents and arrests. Major depressive disorder, obsessive-compulsive disorder and generalized anxiety disorder diagnoses were higher in high-IQ adults with ADHD. All other psychiatric co-morbidities, including antisocial personality disorder and substance abuse, did not differ between the two high-IQ groups. ADHD was more prevalent in first-degree relatives of adults with ADHD relative to controls.
Our data suggest that adults with ADHD and a high IQ display patterns of functional impairments, familiality and psychiatric co-morbidities that parallel those found in the average-IQ adult ADHD population.
Preliminary to a stimulant comparison study, 31 children with minimal brain dysfunction randomly received either placebo or a megavitamin combination. During a two-week trial, only two children responded so well that stiumlants were not considered necessary; both were in the placebo group. Change scores from pretest to posttest on four blind ratings by teachers and parents did not show a significant difference between the placebo and vitamin groups.
The psychometric properties of the Depression Anxiety Stress Scales (DASS) were evaluated in a normal sample of N = 717 who were also administered the Beck Depression Inventory (BDI) and the Beck Anxiety Inventory (BAI). The DASS was shown to possess satisfactory psychometric properties, and the factor structure was substantiated both by exploratory and confirmatory factor analysis. In comparison to the BDI and BAI, the DASS scales showed greater separation in factor loadings. The DASS Anxiety scale correlated 0.81 with the BAI, and the DASS Depression scale correlated 0.74 with the BDI. Factor analyses suggested that the BDI differs from the DASS Depression scale primarily in that the BDI includes items such as weight loss, insomnia, somatic preoccupation and irritability, which fail to discriminate between depression and other affective states. The factor structure of the combined BDI and BAI items was virtually identical to that reported by Beck for a sample of diagnosed depressed and anxious patients, supporting the view that these clinical states are more severe expressions of the same states that may be discerned in normals. Implications of the results for the conceptualisation of depression, anxiety and tension/stress are considered, and the utility of the DASS scales in discriminating between these constructs is discussed.
The psychometric properties of the Depression Anxiety Stress Scales (DASS) were evaluated in two studies using large clinical samples (N = 437 and N = 241). In Study 1, the three scales comprising the DASS were shown to have excellent internal consistency and temporal stability. An exploratory factor analysis (principal components extraction with varimax rotation) yielded a solution that was highly consistent with the factor structure previously found in nonclinical samples. Between-groups comparisons indicated that the DASS distinguished various anxiety and mood disorder groups in the predicted direction. In Study 2, the conceptual and empirical latent structure of the DASS was upheld by findings from confirmatory factor analysis. Correlations between the DASS and other questionnaire and clinical rating measures of anxiety, depression, and negative affect demonstrated the convergent and discriminant validity of the scales. In addition to supporting the psychometric properties of the DASS in clinical anxiety and mood disorders samples, the results are discussed in the context of current conceptualizations of the distinctive and overlapping features of anxiety and depression.
Attention-deficit hyperactivity disorder (ADHD) is a developmental disorder whose three main symptoms are impulsiveness, inattention, and hyperactivity. Researchers have proposed that the central deficit in ADHD is one of poor response inhibition. The present studies were designed to look at the functioning of the hypothalamic-pituitary-adrenal (HPA) axis in response to mental stress in aggressive ADHD subjects participating in a longitudinal study of various psychosocial treatments.
Pretest and posttest morning salivary samples for cortisol determination were collected from subjects given a battery of tests.
The study shows that ADHD subjects who maintained their diagnosis over the first year of the study had a blunted response to the stressor in comparison to those ADHD subjects who no longer retained the disorder 1 year later.
The data suggest that an impaired response to stress may be a marker for the more developmentally persistent form of the disorder.
Vitamin and mineral supplements may be associated with improved psychological status.
The present study tested the effects of a multivitamin and mineral supplement (Berocca) on psychological well-being.
In a double-blind randomised-control trial, 80 healthy male volunteers were assigned to either Berocca or placebo. Questionnaires measuring psychological state were completed and a blood sample taken to determine plasma zinc concentration on day 1 (pre-treatment) and again on day 28 (post-treatment), following 28 days of treatments, which were administered at a dosage of one tablet daily. At the end of the study, the acceptability of the treatment and participants' awareness of treatment condition were assessed, as was habitual dietary behaviour.
Relative to placebo, treatment with Berocca was associated with consistent and statistically significant reductions in anxiety and perceived stress. Participants in the Berocca group also tended to rate themselves as less tired and better able to concentrate following treatment. In addition, participants registered more somatic symptoms following placebo than following Berocca. These effects cannot be attributed to differences in the acceptability of the two treatments or to participants guessing what treatment they received.
These findings demonstrate that Berocca significantly reduces anxiety and perceived stress.
As many as one-third of mutations in a gene result in the corresponding enzyme having an increased Michaelis constant, or K(m), (decreased binding affinity) for a coenzyme, resulting in a lower rate of reaction. About 50 human genetic dis-eases due to defective enzymes can be remedied or ameliorated by the administration of high doses of the vitamin component of the corresponding coenzyme, which at least partially restores enzymatic activity. Several single-nucleotide polymorphisms, in which the variant amino acid reduces coenzyme binding and thus enzymatic activity, are likely to be remediable by raising cellular concentrations of the cofactor through high-dose vitamin therapy. Some examples include the alanine-to-valine substitution at codon 222 (Ala222-->Val) [DNA: C-to-T substitution at nucleo-tide 677 (677C-->T)] in methylenetetrahydrofolate reductase (NADPH) and the cofactor FAD (in relation to cardiovascular disease, migraines, and rages), the Pro187-->Ser (DNA: 609C-->T) mutation in NAD(P):quinone oxidoreductase 1 [NAD(P)H dehy-drogenase (quinone)] and FAD (in relation to cancer), the Ala44-->Gly (DNA: 131C-->G) mutation in glucose-6-phosphate 1-dehydrogenase and NADP (in relation to favism and hemolytic anemia), and the Glu487-->Lys mutation (present in one-half of Asians) in aldehyde dehydrogenase (NAD + ) and NAD (in relation to alcohol intolerance, Alzheimer disease, and cancer).
Exposure to uncontrollable, unpredictable appetitive events produces a variety of cognitive debilitations and vegetative changes, as does exposure to uncontrollable, unpredictable aversive events. Similarities include impaired escape from aversive events, impaired discrimination, finicky consumption, analgesia, and body weight loss. However, in stark contrast, uncontrollable aversive stress causes reduced motor activity where as similar appetitive treatment does not; aversively induced debilitation is causally related to energy regulation, whereas the appetitively induced effects are not. Parallel mechanisms are suggested to explain these effects in terms of a revised anxiety account of the aversive effects, and a frustration account of the appetitive effects. Finally, factors likely to limit important research to resolve the many remaining issues are identified: negative presentation of animal research, political decision making, and ignorance and fear in committees which review the ethics of research.
Disaster research related to earthquakes has almost exclusively dealt with their long-term psychosocial impact; besides, diagnoses were previously based only on DSM criteria. Therefore, it is pertinent to assess stress-related reactions of earthquake victims during the early post-disaster period through the application of ICD-10 criteria. For the first 3 weeks following an earthquake, 102 help-seekers were assessed based on a checklist of sociodemographic variables and a semi-structured interview for the detection of acute stress reaction (ASR) and posttraumatic stress disorder (PTSD) according to ICD-10. Forty-four subjects (43%) fulfilled the ICD-10 criteria for PTSD; all but one of them had suffered ASR. Moreover, among a series of potential predictors for PTSD, ASR was found to be the only significant one; this indicates a definite association between ASR and early development of PTSD. Logistic regression to predict group membership (PTSD/no PTSD) based on specific ASR symptoms showed that accelerated heart rate and feelings of derealization were the only significant predictors for early PTSD. Individuals who fulfill the ICD-10 diagnostic criteria for ASR following an earthquake are at high risk for subsequent occurrence of early PTSD. Increased heart rate and feelings of derealization within the first 48 h after the traumatic event appear to be the principal factors associated with the development of early PTSD. In addition to their potential value for timely prevention and treatment, these findings raise important nosological issues pertaining to the current diagnostic classification of stress-related disorders (ICD-10 versus DSM-IV).
Four and seven weeks after powerful earthquakes in El Salvador, the authors examined the relationships among demographics, traumatic event exposure, social support, resource loss, acute stress disorder (ASD) symptoms, depression, and posttraumatic growth. Participants were 253 college students (Study 1) and 83 people in the community (Study 2). In Study 1, female gender, traumatic event exposure, low social support, and loss of personal characteristic, condition, and energy resources contributed to ASD symptoms and depression. In Study 2, damage to home and loss of personal characteristic and object resources contributed to ASD symptoms and depression. Posttraumatic growth was not associated with ASD symptoms or depression. Findings support the conservation of resources stress theory (Hobfoll, 1998). Resource loss spirals, excessive demands on coping, and exposure to multiple disasters are discussed.
The effect of nutritional supplements on mental health in older patients has received little attention so far. The aims of this trial were therefore to test the effect of nutritional support on older patient's depressive symptoms and cognitive function.
In this prospective, double-blind, placebo-controlled study, we randomly assigned 225 hospitalised acutely ill older patients to receive either normal hospital diet plus 400 mL oral nutritional supplements (106 subjects) or normal hospital diet plus a placebo (119 subjects) daily for 6 weeks. The composition of the supplement was such as to provide 995 kcal for energy and 100% of the Reference Nutrient Intakes for a healthy old person for vitamins and minerals. Outcome measures were 6 weeks and 6 months changes in nutritional status, depressive symptoms and cognitive state.
Randomisation to the supplement group led to a significant increase in red-cell folate and plasma vitamin B12 concentrations, in contrast to a decrease seen in the placebo group. There were significant differences in symptoms of depression scores in the supplement group compared with the placebo group at 6 months (p = 0.021 for between groups difference). The effect of supplement was seen in all patient groups including those with no symptoms of depression, mild depression and those with severe depression (p = 0.007). There was no evidence of a difference in cognitive function scores at 6 months.
Oral nutritional supplementation of hospitalised acutely ill older patients led to a statistically significant benefit on depressive symptoms.
According to self-report and unsystematic observational data adult patients with attention-deficit/hyperactivity disorder suffer from increased vulnerability to daily life stressors. The present study examined psychological and physiological stress responses in adult ADHD subjects in comparison to healthy controls under laboratory conditions. Thirty-six subjects (18 patients with DSM-IV ADHD diagnosis, 18 sex- and age-matched healthy controls) underwent the Trier Social Stress Test (TSST; Kirschbaum, C., Pirke, K.-M., Hellhammer, D.H., 1993. The “Trier Social Stress Test”—a tool for investigating psychobiological stress responses in a laboratory setting. Neuropsychobiology 28, 76–81), a standardized psychosocial stress protocol which contains a stress anticipation phase and a stress phase with a free speech assignment and subsequent performance of a mental arithmetic. Physiological stress measures were salivary cortisol as an indicator of the HPA axis, heart rate (HR), and time- and frequency-domain heart rate variability (HRV) parameters. Subjective stress experience was measured via self-report repeatedly throughout the experimental session. In line with previous theoretical and empirical work in the field of childhood ADHD, it was hypothesized that the ADHD and control group would exhibit comparable baseline levels in all dependent variables. For ADHD subjects, we expected attenuated responses of the physiological parameters during anticipation and presence of the standardized stressor, but elevated subjective stress ratings. Hypotheses were confirmed for the baseline condition. Consistent with our assumptions in regard to the psychological stress response, the ADHD group experienced significantly greater subjective stress. The results for the physiological variables were mixed.
Manual for the WAIS-III. Psychological Corporation
- D Wechsler
Wechsler, D., 1997. Manual for the WAIS-III. Psychological Corporation, New York, NY.
Manual for the Depression Anxiety Stress Scales
- S H Lovibond
- P F Lovibond
Lovibond, S.H., Lovibond, P.F., 1995b. Manual for the Depression Anxiety Stress Scales.
Psychology Foundation, Sydney.
Database analysis of children and adolescents with bipolar disorder consuming a multinutrient formula
- J J Rucklidge
- D Gately
- B J Kaplan
Rucklidge, J.J., Gately, D., Kaplan, B.J., 2010. Database analysis of children and
adolescents with bipolar disorder consuming a multinutrient formula. BMC:
Psychiatry 74. doi:10.1186/1471-1244X-1110-1174.