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The process of grieving can be compared to the workings of a pinball machine, where mourners’ movement between different stages of grief such as shock and depression may be unpredictable, according to authors writing in September’s issue of Mental Health Practice journal.

Margaret Baier of Baylor University, Waco, Texas and Ruth Buechsel of Brooke Army Medical Center, Fort Sam Houston, San Antonio, Texas, say they are not trying to suggest grief is a game or downplay the experience, but that the metaphor can help people understand that grieving is not a linear process.

As on a pinball machine, there are triggers which can prolong or even restart the process. For the mourner these could be the anniversary of a death or a special event they used to share with their loved one. This model can be used in therapy by healthcare professionals to help people understand that their
responses are normal. It may also be adaptable to help those coping with separation, divorce, loss of employment or financial loss, say the authors.

They identify numerous models and factors for understanding grief in the literature as helpful in predicting coping and adjustment in bereavement. However, they say, many of the models are misinterpreted as linear. Grieving patients often speak of feeling as though they are ‘bouncing’ from one stage to another, which elicited the image of a pinball.

They say their model contains elements of the seminal work by Kubler-Ross (1969) but illustrates the process in a way that helps bereaved people see and understand their emotional processes, which helps them normalise and move through the experience of grief. This normalisation may help people to relax and better process grief, make sense of a seemingly chaotic experience, and be prepared when grief is triggered by other events or prolonged, as in the process of complicated grief.

Reference

Kubler-Ross E (1969) On Death & Dying. Macmillan, New York NY.

Source: RCN Publishing Company Baier M, Buechsel (2012) A model to help bereaved individuals understand the grief process. Mental Health Practice. 16, 1, 28-32.

Image: Norma Desmond

The diagnostic manual of the American Psychiatric Association defines autism in what seems to be a fairly comprehensive way: social impairment, difficulties with communication, repetitive behavior and restricted interests – the so-called “core symptoms” of the autism spectrum disorders.

But autism is a complex condition, and even a description as official and thorough as this one may leave out something important.

“If you talk to parents of children with autism, they’ll say all these characteristics are important,” said Stanford psychology Professor James Gross. “But what’s not featured in the diagnostic manual is the extreme difficulty many kids with autism have with emotion.”

From a caretaker’s perspective, sudden emotional outbursts can be one of the single most disruptive aspects of the disease. Still, emotion regulation in autism has attracted relatively little research.

In a survey of adults with high-functioning autism or Asperger’s syndrome, Gross, psychology postdoctoral scholar Andrea Samson and University of Fribourg psychology Professor Oswald Huber found that individuals with the disorder consistently reported using less effective emotion regulation strategies than typically developing individuals.

Now, in an ongoing collaboration with Stanford School of Medicine psychiatry Associate Professor Antonio Hardan, Samson and Gross have begun to take a closer look at emotional development among children and youths with autism – and how this knowledge might lead to new treatments for the condition. [continue reading…]

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In a study published online and in the upcoming issue of the journal Neurology, scientists have taken a step toward developing a blood test for Alzheimer’s, finding a group of markers that hold up in statistical analyses in three independent groups of patients.

“Reliability and failure to replicate initial results have been the biggest challenge in this field,” says lead author William Hu, assistant professor of neurology at Emory University School of Medicine. “We demonstrate here that it is possible to show consistent findings.”

Hu and his collaborators at the University of Pennsylvania and Washington University, St. Louis, measured the levels of 190 proteins in the blood of 600 study participants at those institutions. Study participants included healthy volunteers and those who had been diagnosed with Alzheimer’s disease or mild cognitive impairment (MCI). MCI, often considered a harbinger for Alzheimer’s disease, causes a slight but measurable decline in cognitive abilities.

A subset of the 190 protein levels (17) were significantly different in people with MCI or Alzheimer’s. When those markers were checked against data from 566 people participating in the multicenter Alzheimer’s Disease Neuroimaging Initiative, only four markers remained: apolipoprotein E, B-type natriuretic peptide, C-reactive protein and pancreatic polypeptide.

Changes in levels of these four proteins in blood also correlated with measurements from the same patients of the levels of proteins [beta-amyloid] in cerebrospinal fluid that previously have been connected with Alzheimer’s. The analysis grouped together people with MCI, who are at high risk of developing Alzheimer’s, and full Alzheimer’s.

“We were looking for a sensitive signal,” says Hu. “MCI has been hypothesized to be an early phase of AD, and sensitive markers that capture the physiological changes in both MCI and AD would be most helpful clinically.”

“The specificity of this panel still needs to be determined, since only a small number of patients with non-AD dementias were included,” says Hu. “In addition, the differing proportions of patients with MCI in each group make it more difficult to identify MCI- or AD-specific changes.”

Neurologists currently diagnose Alzheimer’s disease based mainly on clinical symptoms. Additional information can come from PET brain imaging, which tends to be expensive, or analysis of a spinal tap, which can be painful.

“Though a blood test to identify underlying Alzheimer’s disease is not quite ready for prime time given today’s technology, we now have identified ways to make sure that a test will be reliable,” says Hu. “In the meantime, the combination of a clinical exam and cerebrospinal fluid analysis remains the best tool for diagnosis in someone with mild memory or cognitive troubles.”

Hu’s research began while he was a fellow at the University of Pennsylvania. Collaborators included David Holtzman from Washington University at St. Louis, Leslie Shawand John Trojanowski from the University of Pennsylvania, and Holly Soares from Bristol Myers Squibb.

The Alzheimer’s Disease Neuroimaging Initiative is supported by the National Institutes of Health and several pharmaceutical companies. Hu’s research is supported by the Viretta Brady Discovery Fund.

Reference: W.T. Hu et al. Plasma multianalyte profiling in mild cognitive impairment and Alzheimer disease. Neurology 79, 897-905 (2012)