Medical Marijuana Shown to Ease Migraines

Patients diagnosed with migraine headaches saw a significant drop in their frequency when treated with medical marijuana, according to a new study.

Published in the journalPharmacotherapy, the study examined patients diagnosed with migraines and treated with medical marijuana between January 2010 and September 2014.

It found the frequency of migraines dropped from 10.4 to 4.6 headaches per month, a number considered statistically and clinically significant, according to researchers at the Skaggs School of Pharmacy and Pharmaceutical Sciences at the University of Colorado Anschutz Medical Campus.

Of the 121 patients studied, 103 reported a decrease in monthly migraines, while 15 reported the same number, and three saw an increase in migraines.

The researchers found various forms of cannabis utilized. Inhaled marijuana appeared to be the favorite for treating acute migraines, while edible cannabis, which takes longer to impact the body, helped prevent headaches.

Exactly how cannabis relieves migraines is still not fully understood, the researchers noted.

Cannabinoid receptors can be found throughout the body, including the brain, connective tissues and immune system. And they appear to have anti-inflammatory and pain-relieving properties, according to Borgelt. These cannabinoids also seem to affect critical neurotransmitters like serotonin and dopamine, she noted.

“We believe serotonin plays a role in migraine headaches, but we are still working to discover the exact role of cannabinoids in this condition,” Borgelt said.

She added that while the results were “quite remarkable,” more controlled studies are needed in the future.

The ideal study, she said, would be a randomized, placebo-controlled clinical trial with a marijuana washout period prior to start. It would also require providing subjects with standardized quantities and potencies of medical marijuana while tracking the occurrence of migraines just like prescription drug studies.

But given federal anti-drug laws, that kind of study would likely require legislative changes before it could be done, Borgelt said.

“If patients are considering medical marijuana they should speak to their health care provider and then follow up so we can track the impact of their overall treatment,” she said. “Open communication is necessary because we need to know how all of these treatments work together.”

Emotional Tone of Your Own Voice Affects Your Mood

As we listen to other people speak, we can usually determine whether they are happy, sad, bored, nervous, and so on, based on the sound of their voice.

A new study has found that we may actually be doing this with our own voices as well — listening to pick up on our own emotional states — rather than simply using our voices to reflect how we already feel.

For the study, researchers developed a digital audio platform that is able to change the emotional tone of people’s voices to make them sound happier, sadder or more fearful right as they are speaking (not listening to an older recording). The findings show that while listening to their altered voices, participants’ emotional states change to match the new emotion.

“Very little is known about the mechanisms behind the production of vocal emotion,” said lead author Jean-Julien Aucouturier, Ph.D., from the French National Centre for Scientific Research (CNRS), France.

“Previous research has suggested that people try to manage and control their emotions, for example hold back an expression or reappraise feelings. We wanted to investigate what kind of awareness people have of their own emotional expressions.”

During the experiment, participants read a short story aloud while hearing their own voice, altered to sound happier, sadder or more fearful, through a headset.

The findings show that the participants were unaware that their voices were being manipulated, even as their emotional state changed in accordance with the manipulated emotion in their voices. This suggests that people do not always control their own voice to meet a specific goal and that people listen to their own voice to learn how they are feeling.

“The relationship between the expression and experience of emotions has been a long-standing topic of disagreement in the field of psychology,” said Petter Johansson, Ph.D., one of the authors from Lund University, Sweden. “This is the first evidence of direct feedback effects on emotional experience in the auditory domain.”

The researchers developed algorithms to simulate the acoustic components of emotional vocalizations. For example, to make a voice sound happier, the researchers manipulated the speaker’s original pitch, inflection, and range to make it sound more positive, confident, and excited.

The researchers believe this novel audio platform opens up many new areas of research.

“Previously, this kind of emotion manipulation has not been done on running speech, only on recorded segments,” said Aucouturier. “We are making a version of the voice manipulation platform available as open-source on our website, and we invite anyone to download and experiment with the tools.”

The researchers believe the findings could help enhance the emotional impact of Karaoke or live singing performances, or perhaps alter the emotional atmosphere of conversations in online meetings and gaming.

Importantly, the findings could open the door for new types of psychological therapies, particularly for patients with mood disorders. For example, a patient might experience a positive mood change from retelling emotional memories or events in a modified tone of voice.

By Traci Pedersen

Students Think Better While Standing

New research suggests standing tests improve cognitive performance among high school students.

The study is the first to find evidence of neurocognitive benefits of stand-height desks in classrooms — where students are given the choice to stand or sit based on their preferences.

Researchers from the Texas A&M School of Public Health studied high school freshman assessing academic performance at the beginning and again at the end of the academic year.

Study findings appear in the International Journal of Environmental Research and Public Health.

Ranjana Mehta, Ph.D. explored the neurocognitive benefits using four computerized tests to assess executive functions. Executive functions are cognitive skills we all use to analyze tasks, break them into steps and keep them in mind until we get them done.

These skills are directly related to the development of many academic skills that allow students to manage their time effectively, memorize facts, understand what they read, solve multi-step problems, and organize their thoughts in writing.

Because these functions are largely regulated in the frontal brain regions, a portable brain-imaging device (functional near infrared spectroscopy) was used to examine associated changes in the frontal brain function by placing biosensors on students’ foreheads during testing.

“Test results indicated that continued use of standing desks was associated with significant improvements in executive function and working memory capabilities,” Mehta said.

“Changes in corresponding brain activation patterns were also observed.”

While prior studies focused on energy expenditure the current study observed increased attention and better behavior of students using standing desks. Mehta’s research study is the first study not subject to bias or interpretation that objectively exams students’ cognitive responses and brain function while using standing desks.

“Interestingly, our research showed the use of standing desks improved neurocognitive function, which is consistent with results from previous studies on school-based exercise programs,” Mehta said.

“The next step would be to directly compare the neurocognitive benefits of standing desks to school-based exercise programs.”

“There has been lots of anecdotal evidence from teachers that students focused and behaved better while using standing desks,” added Mark Benden, Ph.D., CPE, co-researcher and director of the Texas A&M Ergonomics Center.

“This is the first examination of students’ cognitive responses to the standing desks, which to date have focused largely on sedentary time as it relates to childhood obesity.”

Experts believe continued investigation of this research may have influence policy makers, public health professionals and school administrators to consider simple and sustainable environmental changes in classrooms.

The small changes may help to reduce obesity and enhance cognitive development and education outcomes.

Psychiatry Ponders Whether Extreme Bias Can Be an Illness

The 48-year-old man turned down a job because he feared that a co-worker would be gay. He was upset that gay culture was becoming mainstream and blamed most of his personal, professional and emotional problems on the gay and lesbian movement.

These fixations preoccupied him every day. Articles in magazines about gays made him agitated. He confessed that his fears had left him socially isolated and unemployed for years: A recovering alcoholic, the man even avoided 12-step meetings out of fear he might encounter a gay person.
"He had a fixed delusion about the world," said Sondra E. Solomon, a psychologist at the University of Vermont who treated the man for two years. "He felt under attack, he felt threatened."
Mental health practitioners say they regularly confront extreme forms of racism, homophobia and other prejudice in the course of therapy, and that some patients are disabled by these beliefs. As doctors increasingly weigh the effects of race and culture on mental illness, some are asking whether pathological bias ought to be an official psychiatric diagnosis.
Advocates have circulated draft guidelines and have begun to conduct systematic studies. While the proposal is gaining traction, it is still in the early stages of being considered by the professionals who decide on new diagnoses.
If it succeeds, it could have huge ramifications on clinical practice, employment disputes and the criminal justice system. Perpetrators of hate crimes could become candidates for treatment, and physicians would become arbiters of how to distinguish "ordinary prejudice" from pathological bias.
Several experts said they are unsure whether bias can be pathological. Solomon, for instance, is uncomfortable with the idea. But they agreed that psychiatry has been inattentive to the effects of prejudice on mental health and illness.
"Has anyone done a word search for 'racism' in DSM-IV? It doesn't exist," said Carl C. Bell, a Chicago psychiatrist, referring to psychiatry's manual of mental disorders. "Has anyone asked, 'If you have paranoia, do you project your hostility toward other groups?' The answer is 'Hell, no!' "
The proposed guidelines that California psychologist Edward Dunbar created describe people whose daily functioning is paralyzed by persistent fears and worries about other groups. The guidelines have not been endorsed by the American Psychiatric Association, which publishes the Diagnostic and Statistical Manual of Mental Disorders (DSM); advocates are mostly seeking support for systematic study.
Darrel A. Regier, director of research at the psychiatric association, said he supports research into whether pathological bias is a disorder. But he said the jury is out on whether a diagnostic classification would add anything useful, given that clinicians already know about disorders in which people rigidly hold onto false beliefs.
"If you are going to put racism into the next edition of DSM, you would have enormous criticism," Regier said. Critics would ask, " 'Are you pathologizing all of life?' You better be prepared to defend that classification."
"I think it's absurd," said Sally Satel, a psychiatrist and the author of "PC, M.D.: How Political Correctness Is Corrupting Medicine." Satel said the diagnosis would allow hate-crime perpetrators to evade responsibility by claiming they suffered from a mental illness. "You could use it as a defense."
Psychiatrists who advocate a new diagnosis, such as Gary Belkin, deputy chief of psychiatry at New York's Bellevue Hospital, said social norms play a central role in how all psychiatric disorders are defined. Pedophilia is considered a disorder by psychiatrists, Belkin noted, but that does not keep child molesters from being prosecuted.
"Psychiatrists who are uneasy with including something like this in the Diagnostic and Statistical Manual need to get used to the fact that the whole manual reflects social context," said Belkin, who is planning to launch a study on pathological bias among patients at his hospital. "That is true of depression on down. Pathological bias is no more or less scientific than major depression."
Advocates for the new diagnosis also say most candidates for treatment, such as the man Solomon treated, are not criminals or violent offenders. Rather, they are like the young woman in Los Angeles who thought Jews were diseased and would infect her -- she carried out compulsive cleansing rituals and hit her head to drive away her obsessions. She realized she needed help but was afraid her therapist would be Jewish, said Dunbar, a Los Angeles psychologist who has amassed several case studies and treated several dozen patients for racial paranoia and other forms of what he considers pathological bias.
Another patient was a waiter so hostile to black people that he flung plates on the table when he served black patrons and got fired from multiple jobs.
A third patient was a Vietnam War veteran who was so fearful of Asians that he avoided social situations where he might meet them, Dunbar said.
"When I see someone who won't see a physician because they're Jewish, or who can't sit in a restaurant because there are Asians, or feels threatened by homosexuals in the workplace, the party line in mental health says, 'This is not our problem,' " the psychologist said. "If it's not our problem, whose problem is it?"
Opponents say making pathological bias a diagnosis raises the specter of social engineering -- brainwashing individuals who do not fit society's norms. But Dunbar and others say patients with disabling levels of prejudice should be treated for the same reason as are patients with any other disorder: They would feel, live and function better.
"They are delusional," said Alvin F. Poussaint, a professor of psychiatry at Harvard Medical School, who has long advocated such a diagnosis. "They imagine people are going to do all kinds of bad things and hurt them, and feel they have to do something to protect themselves.
"When they reach that stage, they are very impaired," he said. "They can't work and function; they can't hold a job. They would benefit from treatment of some type, particularly medication."
Doctors who treat inmates at the California State Prison outside Sacramento concur: They have diagnosed some forms of racist hatred among inmates and administered antipsychotic drugs.
"We treat racism and homophobia as delusional disorders," said Shama Chaiken, who later became a divisional chief psychologist for the California Department of Corrections, at a meeting of the American Psychiatric Association. "Treatment with antipsychotics does work to reduce these prejudices."
* * *
Amid a profusion of recent studies into the nature of prejudice, researchers have found that biases are very common. Almost everyone harbors what might be termed "ordinary prejudice," the research indicates.
Anthony Greenwald, a psychologist at the University of Washington in Seattle, and Mahzarin R. Banaji, a psychologist at Harvard, developed tests for such biases. By measuring the speed with which people make mental associations, the psychologists found that biases affect even those who actively resist them.
"When things are more strongly paired in our minds, we can respond to them more quickly," Banaji said. "Large numbers of Americans cannot as swiftly make the association between 'black' and 'good' as they can between 'white' and 'good.' "
Similarly, psychologist Margo Monteith at the University of Kentucky in Lexington found that people can have prejudices against groups they know nothing about. She administered a test in which volunteers, under time pressure, had to associate a series of words with either "America" or a fictitious country she called "Marisat."
Volunteers more easily associated Marisat with such words as "poison," "death" and "evil," while associating America with "sunrise," "paradise" and "loyal."
"A large part of our self-esteem derives from our group membership," Monteith said. "To the extent we can feel better about our group relative to other groups, we can feel good about ourselves. It's likely a built-in mechanism."
If biases are so common, many doctors ask, can racism really be a mental illness?
"I don't think racism is a mental illness, and that's because 100 percent of people are racist," said Paul J. Fink, a former president of the American Psychiatric Association. "If you have a diagnostic category that fits 100 percent of people, it's not a diagnostic category."
But Poussaint said there is a difference between ordinary prejudice and pathological bias -- the same distinction that psychiatrists make between sadness and depression. All people experience sadness, anxiety and fear, but extreme, disabling forms of these emotions are called disorders.
While people with ordinary prejudice try very hard to conceal their biases, Solomon said, her homophobic patient had no embarrassment about his attitude toward gays. Dunbar said people with pathological prejudice often lack filtering capabilities. As a result, he said, they face problems at work and home.
"Everyone is inculcated with stereotypes and biases with cultural issues, but some individuals not only hold beliefs that are very rigid, but they are part of a psychological problem," Dunbar said.
The psychologist said he has helped such patients with talk therapy, which encourages patients to question the basis for their beliefs, and by steering them toward medications such as antipsychotics.
The woman with the bias against Jews did not overcome her prejudice, Dunbar said, but she learned to control her fear response in social settings. The patient with hostility against African Americans realized his beliefs were "stupid."
Solomon discovered she was most effective dealing with the homophobic man when she was nonjudgmental. When he claimed there were more gays and lesbians than ever before, she presented him with data showing there was no such shift.
At those times, she reported in a case study, the patient would say, "I know, I know." He would recognize that he was not being logical, but then get angry and return to the same patterns of obsession. Solomon did not identify the man because of patient confidentiality.
Standing in the central yard of the maximum-security California State Prison with inmates exercising around her, Chaiken explained how she distinguished pathological bias from ordinary prejudice: A prisoner who belonged to a gang with racist views might express such views to fit in with his gang, but if he continues "yelling racial slurs, assaulting others when it's clear there is no benefit" after he leaves the gang, the behavior was no longer "adaptive."
Prison officials declined to identify inmates who had been treated, or make them available for interviews.
Chicago psychiatrist Bell said he has not made up his mind on whether bias can be pathological. But in proposing a research agenda for the next edition of psychiatry's DSM of mental disorders, Bell and researchers from the Mayo Clinic, McGill University, the University of California at Los Angeles and other academic institutions wrote: "Clinical experience informs us that racism may be a manifestation of a delusional process, a consequence of anxiety, or a feature of an individual's personality dynamics."
The psychiatrists said their profession has neglected the issue: "One solution would be to encourage research that seeks to delineate the validity and reliability of racism as a symptom and to investigate the possibility of including it in some diagnostic criteria sets in future editions of DSM."

Shankar Vedantam

Washington Post Staff Writer 
Saturday, December 10, 2005