Richard G. Petty, MD

Psychiatric Illnesses and Fibromyalgia

There’s an interesting and important article in last month’s issue of the Journal of Clinical Psychiatry, by a group of investigators from the University of Cincinnati.

They have shed important new light on fibromyalgia. We’ve recently learned how it is linked to disturbances of the serotonin transporter, as well as anti-inflammatory proteins, and that is may respond best to the kind of comprehensive multi-leveled approaches that we use in Integrated Medicine.

The new research compared people with fibromyalgia with people with rheumatoid arthritis, and it found that fibromyalgia, but not rheumatoid, may be associated with a range of psychiatric illnesses:

  1. Major depressive disorder
  2. Bipolar disorder
  3. Comorbid anxiety disorders including panic disorder, social phobia, posttraumatic stress disorder and obsessive-compulsive disorder
  4. Eating disorders and
  5. Substance abuse

What was particularly important in this study was that the psychiatric problems usually preceded the onset of fibromyalgia. So it wasn’t that people were developing psychological problems because they were in chronic pain.

It’s beginning to look as if fibromyalgia is part of a larger group of disorders that all share common etiologies or causes. Family studies have indicated that fibromyalgia and mood disorders share some of the same – perhaps genetic – determinants.

The study also confirms what we have said before: fibromyalgia is not only associated with some psychiatric problems, but also with other medical disorders, several of which may also co-exist with the same psychiatric problems. They include:

  1. Chronic fatigue syndrome
  2. Irritable bowel syndrome
  3. Interstitial cystitis
  4. Multiple chemical sensitivities and
  5. Migraine

Not only does this research highlight the need to check people with fibromyalgia to see if they might also be struggling with a psychiatric problem, but it is helping us home in on some of the mechanisms linking these apparently separate problems.

This particular study was done mainly in white women, and the investigators knew who had fibromyalgia, so there’s more work to be done.

But if you or a loved one is struggling with fibromyalgia, it is good news to know that we are making rapid progress in unraveling this horrible illness.

Combat Stress

The British Ministry of Defense has announced that it is going to pardon all 306 soldiers shot for cowardice during the First World War.

This is the culmination of a campaign that has been going on for years, after it was discovered that most of these soldiers were actually suffering from “shell shock.” From the historical records it seems highly likely that this was actually post traumatic stress disorder (PTSD). Some people have said that there’s no point in issuing posthumous pardons ninety years after the events.

I don’t agree. It’s virtually impossible for us to imagine the horrors of trench warfare, and I think that it’s important to recognize the terrible psychological consequences of it.

Hospitals in the United States are already beginning to see a great many cases of PTSD from the current conflicts in Iraq and Afghanistan. We know that there are some predictors of who will suffer from PTSD, but that given enough trauma, it can likely happen to anyone.

Memory and Anticipation

“Nothing is so wretched or foolish as to anticipate misfortunes. What madness is it to be expecting evil before it comes.”
–Lucius Annaeus Seneca (a.k.a. Seneca the Younger, Spanish-born Roman Philosopher and Statesman, c.4 B.C.E.-A.D. 65)

We are all aware that memories of powerful and in particular disturbing emotional events – such as an act of violence or the unexpected death of a loved one – are more vivid and deeply imprinted in the brain than mundane recollections of everyday matters. When I was sixteen years old I was in a head-on car crash: I can still recall the number of the license plates of the car that was driving down the wrong side of the road as it barreled into us. But particularly positive emotions are also remembered in far more vivid detail, and those memories are less likely to be lost. This all makes good sense from an evolutionary perspective: we need to be able to remember things that carry a strong emotional charge.

Colleagues at the University of Wisconsin in Madison have found that the mere anticipation of a fearful situation can activate two memory-forming regions of the brain: even before the event has occurred.

The investigators used functional MRI scans with 40 healthy participants who viewed aversive or neutral pictures preceded by predictive warning cues. Previous research reported sex differences in the way in which memory and emotion interact: in women, memory associations were found with a region called the left amygdala. But the association was with the right amygdala in men. This new study refines these findings: they were confined to the ventral amygdala during picture viewing and delayed memory.

Both men and women who had previously been given an indication that gruesome pictures were going to be shown were more likely to remember them.

What this means is that the act of anticipation may play an important role in whether the memory of a tough experience remains fresh and vivid. This makes sense based on our own experiences of events: do you remember the fear associated with a visit to the dentist that built and built before you got there? That anticipation can itself modify the memories of an event.

The findings are published in this week’s issue of the Proceedings of the National Academy of Sciences. They have important implications for the treatment of some psychological conditions such as post-traumatic stress disorder (PTSD) and social anxiety that are often characterized by flashbacks and intrusive memories of upsetting events

We have long known that our memories are not like some video recording forever preserved within our neurons. Some memories are false, many change over time and others lose their emotional charge. It is possible to implant false memories in people, and by re-writing our own life stories we can change the narrative of our lives and how we react to life events.

Samuel Johnson once said that, “The true art of memory is the art of attention.”

I’m quite sure that he is correct, and this research proves it. I’ve always been blessed – or cursed – with a prodigious memory, to the extent of being able to remember the lab values on every patient that I ever saw during my clinical years, and when I was younger being able to read pages of a textbook from memory. I’m quite convinced that my memory is no better than anyone else’s: I’m just a little better at using it.

The trick to using my memory was discovering at an early age that I could remember virtually anything if I really focused my attention on it. So I would focus on the book to the exclusion of everything else for a minute or two. Rest for a minute and then do it again. To this day, that is the best technique that I know for laying down long-term memory. My father also had this faculty, and when I was a youngster he would tell me not to write down things like shopping lists or to construct “To do” lists. He told me that, “if you really have to remember things you will. And if you’re not interested in something you don’t need a “to do” list.”

I only use lists if I have to do something tedious. This is a good test for you. If something that you are doing really engages your attention it is likely one of your core desires, and there is no need to be writing down a list of things to do. If it does not, and you have to write everything down, it’s probably not a core desire. You may still need to write down an action plan, but that’s to get your creative juices flowing, not to stimulate your memory.

I have developed quite a number of techniques for improving memory and concentration. Some are home grown, others modified from methods and techniques that others have taught me. I’ve been collecting and testing them for years. I’m doing a lot of flying this week, so I shall have the time to be put some of them together into a free report. I shall let you know when it’s ready and if you ask, I shall send you a copy.

There is one important reason for writing down thoughts once you have done something, and that is to help them be part of your legacy. That’s a topic to which we are going to return many times in the next few weeks.

“What we anticipate seldom occurs, what we least expected generally happens.”
–Benjamin Disraeli, 1st Earl of Beaconsfield (English Statesman, Novelist and, in 1868 and from 1874-1880, British Prime Minister, 1804-1881)

Posttraumatic Stress Disorder, Resilience and the Brain

There has always been a puzzle about posttraumatic stress disorder (PTSD): why do some people get it and others don’t? It has always seemed that if the stress was bad enough, and particularly if it was unexpected, then pretty much anyone could get PTSD. But in between the mild stressor that makes one person fall apart and suffer terribly, while others scarcely notice, and the severe trauma that catches almost everyone, is a great unexplained mass of suffering people.

Six years ago research by Tamara Gurvits and her colleagues from the VA in Manchester, New Hampshire first suggested that people with PTSD may have some subtle neurological problems that couldn’t be explained away by alcohol abuse or injury. Now the same group has published a new study that adds significantly to our knowledge about this issue. A study of twins lead the investigators to conclude that the neurological abnormalities predated the PTSD and most likely predisposes patients to it.

The researchers studied 49 pairs of identical male twins in whom one twin had been exposed to combat during the Vietnam War and the other had not.

In 25 pairs the combat-exposed twin had a current diagnosis of PTSD, while the remaining 24 twins did not have the problem.

All the subjects were tested for what we call neurological “soft signs.” This is not a good term, and refers to subtle neurological disturbances, usually involving some complex systems of the brain. They include things like an impaired sense of direction, being able to do rapid, complex motor actions, copying pictures and movements. The combat veterans with PTSD scored higher on the soft signs tests than did the veterans without PTSD. But now it gets interesting: the identical twins of people with PTSD also had high soft sign scores. In other words there appears to a familial vulnerability to developing PTSD. This is consistent with a fascinating new paper on the neurological circuitry involved in fear. We can now map out some of the neurological vulnerabilities involved in PTSD as well as some of the neurological consequences of severe PTSD. Nobody knows if we can reverse them with psychological or other approaches, but we now think it is very possible.

There is a lot more work to be done. But as a first suggestion: someone who has this kind of evidence of vulnerability to PTSD should be the first to get advanced training in developing resilience. We already know that even the most limited efforts to bolster and develop resilience can have marked effects.

The key is to start building your resilience starting today.

“Always plan. It wasn’t raining when Noah built the ark.”
–Richard C. Cushing (American Roman Catholic Cardinal, 1895-1970)

Technorati tags:

logo logo logo logo logo logo