Drug-induced mental disorders: a common reason for concern?

Most psychoactive drugs alter our cognitive and emotional states, but does chronic use implicate a pathological change in our mental condition?

If we chronically alter transmitter pathways, adaptations will certainly take place. Adaptations are expressed during addiction in sensitization and desensitization of transmitter pathways. This leads to an up- or downregulation of receptors and transporters and eventually to tolerance as well as craving when the drug is withdrawn. These adaptations originate out of natural compensation, but leave former drug users with an imbalanced brain chemistry and an increased risk for several mental disorders. Patients with substance disorders are twice as likely to suffer from mood and anxiety disorders (National Institute on Drug Abuse). Basically, all drugs alter dopaminergic regulation and consequently, our motivation and ability to experience pleasure is changed. Several drugs also cause neurotoxicity and can therefore easily lead to permanent damage, e.g. depression after prolonged ecstasy use due to serotonergic cell death. 
Apart from emotional disturbances, the most common drug-induced illness is psychosis; with alcohol (18%), cannabis (13%) and cocaine (18%) being the most common inducers [1]. One could blame everything on 'high risk drugs', yet, for many mental disorders susceptibility genes have been found, e.g. the VAL/VAL variant of the COMT-gene in cannabis users who go on to develop schizophrenia [2]. Other factors, such as food intake, can severely affect mental outcome after chronic drug use, for example vitamin b12 deficiency in alcoholics, which can lead to several mental disorders, including psychosis and depression.
Hence, aside from chronic substance use, our environmental and genetic conditions play a decisive role in the development of long lasting drug-induced mental pathologies.
  
[1] Drake et al., Am J Psychiatry, 2011
[2] Caspi et al., Biol Psychiatry, 2005

By Anne Schwerk, PhD Alumna, AG Neuronal Regeneration and Plasticity (Dr. med. Barbara Steiner)


This article originally appeared in CNS Volume 5, Issue 1, Mental Health Disorders

38% of Europeans affected by mental disease

Arguably, one of the most profound findings of 2011 was an epidemiological report on the mental health status of the European Union. Hans-Ulrich Wittchen and his international team of mental health experts have unraveled striking data on just how extensively disorders of the brain impact European society, and if the trend has been changing over the last three decades.   

With an initial goal to systematically assess the prevalence and burden of neurological and mental disorders in the European Union, experts from each disease category met and combined their data, only to find that it was difficult to segregate prevalence between mental and neurological disorders, due to significant overlap. However, it was possible to assess the burden of mental and neurological disease separately, when expressed as disability adjusted life years. Previous knowledge on this subject has been sparse - the World Health Organization reported an estimated 13% of global health burden to be from mental disorders. The World Mental Health Survey quotes that one in three adults suffers from a mental disorder.

Mental and Neurological Disorders Come to the Forefront: Significant Health Burden on Society

Wittchen and colleagues set out to sample all of the EU countries as well as Norway, Iceland, and Switzerland. The team combined retrospective studies, consistent reanalyses of existing epidemiological datasets and supplementary survey data from national experts to gather the best possible comprehensive dataset. 19 epidemiological panels were dispatched and at least one international expert was recruited per diagnostic group. Data was collected as far back as 1980, when the first diagnostic criteria were published on an international level (Diagnostic and Statistical Manual of Mental Disorders (DSM) and International Statistical Classification of Diseases and Related Health Problems (ICD)).
The results were startling: 38% of all Europeans are affected by disorders of the brain. Combined, mental and neurological diseases comprise Europe's largest disease burden, in terms of disability adjusted life years. The highest proportion of this burden was due to anxiety disorder, unipolar depression and insomnia.
Previously, Wittchen and colleagues had published a similar report in 2005, where the numbers were significantly more conservative, citing that 27% of the EU population are affected by mental disorder. However, this study produced a much more restrictive estimate due to age restrictions of the sample (only adults and not kids nor elderly were included), and a much more limited set of criteria for mental disorders. This time around, the team decided to get an unrestricted estimate regardless of age range or disease type.

Wittchen et al., Eur. Neuropsychopharmacol, 2011
Wittchen and Jacobi, Eur. Neuropsychopharmacol, 2005
World Health Organization, The Global Burden of Disease, 2004 Update (WHO, 2008)


By Gina Eom, Alumna MedNeuro 

this article originally appeared in CNS Volume 5, Issue 1, Mental Health Disorders

Empirically Aesthetic? MPI Researchers Weigh In

It's fascinating to read about big concepts like philosophy and beauty, but what is it like to study them in your daily job? Malika Renz sat down with researchers from the Max Planck Institute for Empirical Aesthetics to find out.

Pauline Larrouy-Maestri

Pauline Larrouy-Maestri, you have a very diverse background – can you tell us how you got into neuroaesthetics?
Yes, I studied music, psychology and pedagogy and worked as a musician and a speech therapist. My PhD was in cognitive psychology, on the singing voice which is of course linked to aesthetics. But aesthetics wasn't my main focus then – it's more of a means of looking at how people interact with their environment, at auditory perception and processing. I've been working on this as a post-doc here at the MPI for 3 years now.

How do you start with something as vague and mysterious as beauty and end up learning about perception and processing mechanisms?
Suppose you start with the question: what makes something beautiful? Is it the same as being somehow correct? Or interesting? Recently, we've been working on pitch accuracy, so let's take that as an example. Beautiful singing voices or melodies are often associated with being "correct". Everyone can hear if a performance is in or out of tune – musicians, non-musicians, male, female, young and old – people usually agree on this. So what is it that makes all of us feel that one tone is correct and the other is not? It's hard to put a label on this, it just sounds right or wrong. Somehow, people must become sensitive to the criteria for a correct melody without ever being aware of it! And we know this holds true not only for music but also for other domains – we learn rules and we apply them to make an aesthetic judgment without even noticing.

But if we don't even notice it – how are we learning those rules?
The brain is made for taking in stimuli and building rules, and thus knowledge from it. It's similar to how children learn a language, a totally implicit process. To understand language you have to parse the auditory signal – you need to cut it into sensible units and concatenate them in a meaningful way. The same parsing and integrating of course happens in music appreciation as well and it is this process which I am interested in. Aesthetics is my vehicle to study how we learn auditory processing, what the minimal units and the rules of meaningful integration are.

How can you research music appreciation in the lab?
Me, I am doing psychophysics: I manipulate stimuli, I invite people to the lab and ask them to listen to these stimuli. We change single features of tones and ask something like “Which of these sounds is more in tune?”. The resulting data can tell us what differences are perceived and what magnitude of change is needed. That alone reveals a lot about the structure of sounds, its components and their relative importance. This was how we found out that the smallest meaningful units are not single notes –  it's the beginning and the end of a a note that matters. Once you find these units and confirm their discerning value, you can play with them: find out how the changes influence the perceived agreeableness or pitch accuracy. And whether people even agree on the direction of effect of a specific parameter.

Pardon my impoliteness, but apart from being fascinating, what use is there in all this?
Aesthetic appreciation of course is very fundamental. Many things are related to what you see and hear, all around you. Interaction with people is about tastes, preferences, about your appreciation of the environment. We all function with that all the time. But we don't understand the processes behind it very well: we know that the pleasure circuitry is based on automatic processes. For perceiving something as beautiful, however, indirect pathways, such as mediation by thought, are needed. Simply knowing how perception works has a clinical application. If someone has a speech impairment or a difficulty to understand language, is it because they cannot parse? Cannot concatenate? Didn't learn the appropriate rules? As soon as we have a working model we can tick which box is malfunctioning and focus training or treatment there.

To save the best for last: what was your personal research highlight?
I showed that we are all musicians. Let me explain. For decades, we had in the scientific literature a separation between musicians and non-musicians. It is categorical, but the idea has been around for a while – and it's nonsense! Take an opera performance. Who goes to the opera? No one does! Only a very small part of the general population, mostly educated people with a musical background or interest. And musicians agree to a very great extent on their judgment of what makes a beautiful opera voice. But here is what I found: people who have no idea what an opera voice is or should be apply the same criteria and come to the same conclusions. So, without ever going to the opera, without any explicit input, we build a representation that creates a link – between you and me, between people who are privileged enough to enjoy operas and those who aren't. Our learning mechanisms are fundamentally the same and they take whatever they can get from the environment.


 The interview was conducted by Malika Renz, MSc Student MedNeuro

Does Beauty Lie in the Face?

As the saying goes, ‘beauty is only skin-deep’. However, many times we cannot help but fall for an attractive face: the first impressions of a person do create an impact on our minds. What is considered ‘beautiful’? Are there features of faces across cultures that people find more attractive?

Facial Symmetry

According to researchers, a face is perceived as beautiful if it is symmetrical and represents the average traits of the population. Our eyes recognize symmetrical faces with similar proportions on left and right side of the face. The quest to define a golden standard for a facial feature - for example, the size or shape of the eyes or lips - dates back to antiquity. The Ancient Greeks believed that the essence of beauty lied in the golden ratio of 1:1.618. More recently, researchers have discovered that people find a female face attractive when the distance between the eyes is just under half of the width of the face. They also found that the eye-to-mouth distance should be just over one-third of the height of the face. These two ratios have been termed as the ‘golden ratios’, which correspond to that of an average face [1].

Example of faces with different length and width ratios. Boxes mark the optimal length and width ratios that people found attractive [1].

 

What is the reason behind the choice of such features? This can be explained by two existing theories: one is an evolutionary aspect where humans tend to choose healthy mates with physical characteristics resembling the average population. The other is a cognitive aspect where, due to repeated exposures, we tend to prefer prototypical facial features which are easier to process.

Golden ratio: can beauty be quantified? 

So, are facial preferences based on nature or nurture? Do we have a preference for certain faces as babies? The answer seems to be: yes! Babies of 2-3 months tend to look at attractive faces for longer time than unattractive ones [2]. The perception of attractiveness is also affected by familiarity: Hazda people, hunter-gatherers from Tanzania who have not been exposed to European faces, found the average face of a Hazda more attractive than an European face [3]. But spatial aspects of the face are not the only determinants of attractiveness - sexually dimorphic features like full lips and longer eyelashes also influence what people find attractive [1 ].

The Power of a Smile

A smile has more powerful influence on people’s perception than facial features or makeup, according to psychologists. People with genuine smiles were seen as healthier and more attractive by virtue of being optimistic and cheerful than people with blank expressions [4,5]. Thus, the secret to healthy appearance and being attractive? Smile!

For the evolutionary basis of beauty, check out Helge's article on page 5. Given the fact that there is an innate bias inside all of us towards 'beautiful' faces, it is even more important for us to think twice before making judgements on other people based just on their appearances!

How an average American woman will look like in 50 years
(Courtesy: National Geographic)

What will future humans look like?

It has been predicted that globalization, cultural diffusion and interracial marriages will eventually homogenize the human population, averaging out more and more people's traits such as hair, eye color, facial features, and eye shape. Dominant traits will be expressed more than recessive traits (which need not one but two copies of the gene to be expressed). In other words, we are going to become a huge amalgamated race!

by Aarti Swaminathan, PhD Student AG Schmitz

 [1] Pallett P.M, Link S, and Lee K. Vision Res. 2010.
 [2] Hoss R.A. and Langlois J.H. The Development of Face Processing in Infancy and Early Childhood: Current Perspectives. 2003.
 [3] Apicella C.L et al. Perception, 2007.
 [4] Golle et al. Cognition and Emotion, 2013
 [5] Jones A.L et al. Visual Cognition, 2017.

The Weird and Wonderful World of Body Modifications

Body modification is the deliberate alteration of one's physical appearance. It is the wilful action that produces a permanent or semi-permanent modification to the body that is not normally found in nature. 

In the last 30 years, body modifications have experienced a resurgence and increase in popularity, spanning a wider range of social classes and including a long list of practices. From the simple haircut and earrings to the piercing of lips, nipples and genitals, from eyeball bleaching to subdermal horns or bars, or implantation of bio-polymers to augment the size of breast and buttocks; from anabolic steroid injections for bodybuilding, to extreme fasting- all are examples of altering one's appearance over time [1]. Importantly, many of these practices are no longer related to cultural traditions and have become commercialized and legitimized by society. They are especially influenced by media that dictates the current ideals of beauty and fashion. The perception of beauty and morphing the body to obtain it, however, has evolved over time; and with it have also evolved the techniques and tastes for how to modify the body [2].

A Brief History of Body Modifications

History abounds with examples of body modification. Culturally imposed body alterations have been performed for centuries with strong religious or socio-economical belief. The aristocratic class of Mayan civilisation used to compress the skulls of new born babies. Their cranium would be elongated into a shape believed to resemble that of the gods. In China, the feet of young girls were bound together tightly to reshape them into petit stubs to mimic a lotus flower. These women could hardly walk or work, and as such belonged to the privileged high-classes. Many other cultures, from Japan to the islands of Samoa, have empowered their sense of tribal community by tattooing their bodies and faces with symbols of affiliation. While many of these practices were supposed to enhance beauty or infuse power to the beholder, other alteration included the forceful branding, tattooing or scarification of slaves and war prisoners to symbolise their diminished identity or their status as objectified property [3].

While many of these practices have disappeared, other dehumanising and disfiguring operations, such as female genital mutilation, are still conducted to date. Although all the above examples can be considered forms of body modifications, today the term encompasses a different and largely less harmful set of transformative practices.

A collection of bodymodifications, source: Wikimedia Commons

What Drives Body Modification Today?

The definition of body modification today is based firstly on the concept of voluntarism. It is a practice undertaken by active subjects, often after long consideration of the results and side effects. A second distinction must also be made between voluntary body modification and that due to medical purposes. These include all operations that are required and performed by the medical establishment. Prosthetic fittings, gender reassignment and cosmetic surgery, therefore, while broadly falling under the idea of a physical modification, should not be considered as such [4].

Tattoos and piercings: a style statement

 

Body modification, according to the community that endorses and promotes it today, means piercing, tattooing and cutting - in its extreme forms. Simply piercing one's ears is considered ornamental rather than transformative. Bearers of body modifications sit through hours of excruciatingly painful procedures to obtain what they want. The reasons behind extensive remodelling of the self have been the subject of much investigation - and are, indeed, most fascinating to understand from a psychological point of view. A sense of belonging to subcultural or religious groups or a demonstration of resistance against society are strong motivations driving body alteration. However, the primary force driving the desire to modify some part of the body is embellishment. The transformation is seen as a work of art, a novel quality that renders one more beautiful. Through this piece, the bearer also establishes their identity. They are special and exhibit their distinctive and unique trait to prove it. Reshaping some part of the body may also involve an act of catharsis: either to forget something or to never forget it, and it becomes part of one´s personal narrative of life. The pain felt during the actual operations is another common reason to undergo transformative operations. Testing one's limit, enduring the hardness, feeling the endorphins rush: all generate a sense of pleasure and reward alongside the physical pain, and a potential sense of atonement. Finally, reckless impulsivity also often leads to body modification [5]. But would you not regret waking up with the Chinese symbol for ‘soup’ tattooed on your arm?

Body Modification of the Future?

Body modification today is enjoying a rise in popularity, promoted by tattoo conferences and websites dedicated exclusively to body alteration (for those adventurous, check out BME.com). But what could be the body modifications of the future? Some college students are experimenting with subdermal implants of magnets to perceive the energy fields of metal objects - a sort of sixth sense [6]. But while the power to feel when a mobile phone is charged might be more useful than attractive, will the body modification community accept other forms of aesthetic transformation or enhancement? For example those that could be moulded by genetic modification? It's a brave new world.

by Maria Lucia Pigazzini, PhD Student AG Kirstein

[1] Featherstone, Body and Society, 1999

[2] Adams, Sociologial Prespectives, 2009

[3] Rubin, Marks of civilization, 1988

[4] Lane, Sociology Compass, 2017

[5] Wohlrab et al., Body Image, 2007

[6] Wired Gear http://bit.ly/2soFHnh, 2006

How Stress Gets Under Your Skin

With two square meters surface and 3.6 kg weight, the skin is the largest organ of the human body [1]. As first human organ to develop it represents the first line of communication within the womb. Some experts even call it the “social organ”. Culturally, skin defines our social standard of beauty. Youthful and smooth skin signals health and vitality [2].

The social pressure to be beautiful is used by global skincare markets, which make up a $121 billion industry [3]. According to the American Society of Plastic Surgeons, around 15 million cosmetic procedures were performed in the United States in 2013, 13.4 million of which being minimally invasive including Botox injections and chemical peels [4], with experts predicting an upward trend for the future [5]. Out of all the money spent for beauty, skin products are at the top. Beauty-wise our skin seems to be the most valuable organ to us. After all, it is the first thing people see.

The Deeper Reasons for Skin Problems
Let’s face it! We are skincare addicts. We love the idea that we can just apply aloe vera, jojoba and some Q10 and look young and fresh. We may not know what these ingredients actually do or where they come from, but if the package says it’s anti-aging, it’s worth a try. These products, however, rather treat the symptoms than the cause. We elegantly overlook in our everyday lives that there are causes to our (skin) problems that we could treat if only we cared to look a bit deeper.
During embryonic development, skin cells and cells of the nervous system develop from the same embryonic tissue, the ectoderm [6]. The strong connection between brain and skin is thus not surprising. If you have ever blushed from embarrassment or itched from agitation, you’ve experienced a typical phenotype of the brain-skin-interaction.
A huge contributor of skin problems and diseases is chronic psychological stress. Contrary to common belief, your stress system is absolutely necessary and extremely beneficial to your health. It ensures survival in the face of danger. However, problems start occurring when this system is activated over a long period of time and stress has become chronic [7]. There are several ways in which chronic stress can influence your skin.

via flickr

Stress changes eating habits. Stress causes "emotional eating", which refers to eating high-carbohydrate, high-calorie foods with low nutritional value due to emotional stress. Such a diet can lead to acne and impure skin [8].

Stress reduces blood circulation in the skin. During stress, blood accumulates in vital organs providing them with oxygen and energy to allow the body a quick reaction to the stressor. As the skin is not life-saving in most threatening situations, it is less well irrigated and dries out quicker, making it dull and rough [9].

The negative effects of cortisol. Cortisol levels normally undergo daily oscillation with peak level in the early morning and lowest level around midnight. Under stress, these oscillations are impaired and significantly up-regulated cortisol reduces anti-inflammatory processes in the skin [10]. Furthermore, cortisol increases the skin’s oil production, which can exacerbate acne. Cortisol also inhibits the production of melatonin, a hormone important for the sleep-wake-cycle and a potential effective anti-skin aging compound [11].

Stress causes an increase in free radicals. Free radicals in high quantities attack the healthy skin cells and destroy their membrane. These cells quickly die, leading to saggy, wrinkly skin and more dark spots [11].

Stress speeds up the ageing process. Not only does stress and worrying provoke wrinkle causing facial expressions like frowning [9]. It also increases cortisol, which degrades collagen (for skin strength) and elastin fibers (for skin elasticity).

Skin conditions. Stress can also aggravate precedent skin disorders such as atopic dermatitis, herpes simplex, pruritus (itching) or psoriasis. Many people who suffer from chronic skin disorders report that their symptoms flare up when their stress levels are elevated [6].

The vicious cycle. The stress-related skin conditions can in turn cause psychological distress feeding in a vicious cycle of psychological stress and skin problems. It can be extremely difficult for affected people to break out of this cycle.

The brain and the skin are strongly connected

This is a lot of bad news for your skin. Does this mean everyone battling with blemished skin or wrinkles needs a therapist? Of course not. Not every skin problem or disease is necessarily stress-related. And there is an obvious flipside to all of this: positive experiences can be beneficial for your skin. An example of this is the famous “love glow”, which is the skin’s response to the release of oxytocin in the brain. Oxytocin is involved in social bonding such as between sexual partners or a mother and her child. It creates a feeling of deep attachment. Oxytocin is thought to reduce the body’s production of cortisol and inflammatory processes in the body that slow healing [12]. More oxytocin potentially leads to fewer skin irritation and may thereby promote the “love glow”.
It is important to recognize these strong interconnections between your brain and your skin, between your internal and external world. Keep in mind that any positive as well as any negative experiences can (quite literally) get under your skin.

By Alena Deuerlein, MSc Student Psychology/Interdisciplinary Neurosciences
Goethe University Frankfurt


[1] http://bit.ly/2nTUkuh
[2] http://bit.ly/2EgUy93
[3] http://prn.to/2B0PST4
[4] http://bit.ly/2EjfBYw
[5] http://bit.ly/2EUBr1y
[6] Shenefelt, Psychol Res Behav Manag, 2010; PMCID:PMC3218765
[7] Anderson, Ann N Y Acad Sci, 1998
[8] http://bit.ly/2G1wAuT
[9] http://bit.ly/2H2H12t
[10] Chen and Lyga, Inflamm Allergy Drug Targets, 2014; PMCID:PMC4082169
[11] Kleszczynski and Fischer, Dermatoendocrinol, 2012; DOI:10.4161/derm.22344[12] http://bit.ly/2EkrIEF