Tag: iab-mental health

Up to 60% of stroke survivors may develop cognitive decline within a year | CNN

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CNN
 — 

Up to 60% of all stroke survivors develop memory and thinking problems within a year, and one-third go on to develop dementia within five years, according to a new American Stroke Association scientific statement.

“The numbers are staggering, right?” said Dr. Andrew Freeman, director of cardiovascular prevention and wellness at National Jewish Health in Denver.

“This is a call to action to up our game and focus on prevention,” said Freeman, who was not part of the scientific committee who prepared the statement.

An estimated 9.4 million American adults — about 3.6% of the US adult population — report having had a stroke, according to 2023 statistics from the American Heart Association.

“Cognitive impairment is an often under-reported and under-diagnosed but yet very common condition stroke survivors frequently deal with,” said Dr. Nada El Husseini, an associate professor of neurology at Duke University Medical Center in Durham, North Carolina, in a statement.

About 40% of the survivors of stroke have mild cognitive impairment that does not meet the diagnostic criteria for dementia. Mild or not, the mental difficulties can seriously affect quality of life, said El Husseini, who chaired the writing committee for the statement.

“Cognitive impairment after stroke ranges from mild impairment to dementia and may affect many aspects of life, such as remembering, thinking, planning, language and attention, as well as a person’s ability to work, drive or live independently,” El Husseini said.

Cognitive impairment is most common within the first two weeks after a stroke, the statement said. Mental decline may go hand in hand with other conditions associated with a stroke such as behavioral and personality changes, depression, physical disability and disruption in sleep, all of which can contribute to a lower quality of life.

The American Stroke Association’s statement did offer some good news: About 20% of people who experience mild cognitive impairment after a stroke fully recover their cognitive function, typically within the first six months.

People are at higher risk for strokes if they have atrial fibrillation, an irregular heartbeat that sufferers often describe as a quiver, flutter or flip-flop of the heart in the chest. Those with uncontrolled high cholesterol or high blood pressure are also at high risk, as are people who smoke or use drugs or alcohol. Being diabetic or obese can be risk factors, too.

Ischemic strokes, caused by a clot in the blood vessels that feed blood to the brain, account for 87% of all strokes, according to the statement. Brain bleeds caused by a rupture of a weak vessel in the brain, called hemorrhagic strokes, are much less common, accounting for some 13% of all strokes.

The following are signs of a stroke, according to the National Institute of Neurological Disorders and Stroke:

  • Sudden numbness or weakness in the face, arm or leg, especially on one side of the body.
  • Sudden confusion, trouble speaking or difficulty understanding speech.
  • Sudden trouble seeing in one or both eyes.
  • Sudden trouble walking, dizziness, loss of balance or lack of coordination.
  • Sudden severe headache with no known cause.

Other, less commons symptoms include dizziness, disorientation, nausea, memory loss or vomiting.

Any of the warning signs may last only a few moments and then disappear, which could mean the person is having a minor stroke or a transient ischemic attack, or TIA. Any symptom should not be ignored, experts say, as it can signal a more serious stroke to come.

“One might call a TIA a ‘lucky stroke’ because it’s less serious, but it really is a sentinel event,” Freeman said.

It’s never too late for prevention, but serious effort is needed after even mild stroke to “extinguish the fire if you will, with aggressive change and aggressive medication therapy when appropriate,” Freeman added.

“It should push people to make very drastic lifestyle changes: Eat better, exercise more, go on the appropriate statins or aspirins or whatever their doctor suggests are appropriate so that their risk is as low as possible,” he said.

Damage to the brain occurs when some cells stop getting oxygen and die, while other brain cells may die due to bleeding in the brain. As a result, permanent brain damage can occur within minutes to hours, according to the institute. “Some brain cells die quickly but many linger in a compromised or weakened state for several hours,” it said.

Immediate medical attention is key to lessening the impact of a stroke. Learning the symptoms of a stroke using the acronym FAST can help identify the signs quickly, according to the US Centers for Disease Control and Prevention.

  • F — Face: Ask the person to smile. Does one side of the face droop?
  • A — Arms: Ask the person to raise both arms. Does one arm drift downward?
  • S — Speech: Ask the person to repeat a simple phrase. Is the speech slurred or strange?
  • T — Time: If you see any of these signs, call 911 right away.

Be sure to capture the time when any symptom first appears, the CDC advises, to help medical personnel determine the best course of treatment.

Additional strokes only worsen potential cognitive decline, the scientific statement said, so prevention is key. Stroke risk factors, such as hypertension, high cholesterol and type 2 diabetes, should be treated, as should atrial fibrillation.

Keeping high blood pressure under control has been linked to a reduction in risk for additional strokes as well as mild cognitive impairment, the statement said.

“Stroke survivors should be systematically evaluated for cognitive impairment so that treatment may begin as soon as possible after signs appear,” El Husseini said.

“Perhaps the most pressing need, however, is the development of effective and culturally relevant treatments for post-stroke cognitive impairment,” she said. “We hope to see big enough clinical trials that assess various techniques, medications and lifestyle changes in diverse groups of patients that may help improve cognitive function.”

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Suicides and suicide attempts by poisoning rose sharply among children and teens during the pandemic | CNN

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CNN
 — 

The rate of suspected suicides and suicide attempts by poisoning among young people rose sharply during the Covid-19 pandemic, a new study says. Among children 10 to 12 years old, the rate increased more than 70% from 2019 to 2021.

The analysis, published Thursday in the US Centers for Disease Control and Prevention’s Morbidity and Mortality Weekly Report, looked at what the National Poison Data System categorized as “suspected suicides” by self-poisoning for 2021 among people ages 10 to 19; the records included both suicide attempts and deaths by suicide.

The data showed that attempted suicides and suicides by poisoning increased 30% in 2021 compared with 2019, before the pandemic began.

Younger children, ages 10 to 12, had the biggest increase at 73%. For 13- to 15-year-olds, there was a 48.8% increase in suspected suicides and attempts by poisoning from 2019 to 2021. Girls seemed to be the most affected, with a 36.8% increase in suspected suicides and attempts by poisoning.

“I think the group that really surprised us was the 10- to 12-year-old age group, where we saw a 73% increase, and I can tell you that from my clinical practice, this is what we’re seeing also,” said study co-author Dr. Chris Holstege, professor of emergency medicine and pediatrics chief at the University of Virginia School of Medicine. “We’re seeing very young ages ages that I didn’t used to see attempting suicide by poisoning.

“It was pretty stunning from our perspective,” he said.

Twenty or so years ago, when he started working at the University of Virginia, he said, they rarely treated anyone ages 9 to 12 for suicide by poisoning. Now, it’s every week.

“This is an aberration that’s fairly new in our practice,” Holstege said.

The records showed that many of the children used medicines that would be commonly found around the house, including acetaminophen, ibuprofen and diphenhydramine, which is sold under brand names including Benadryl.

There was a 71% jump from 2019 to 2021 in attempts at suicide using acetaminophen alone, Holstege said.

The choice of over-the-counter medications is concerning because children typically have easy access to these products, and they often come in large quantities.

Holstege encourages caregivers to keep all medications in lock boxes, even the seemingly innocuous over-the-counter ones.

If a child overdoses on something like acetaminophen or diphenhydramine, Holstege encourages parents to bring their children into the hospital without delay, because the toxicity of the drug worsens over time. It’s also a good idea to call a poison center, a confidential resource that is available around the clock.

“We want to make sure that the children are taken care of in regards to their mental health but also in regards to the poisoning if there’s suspicion that they took an overdose,” he said.

There were limitations to the data used in the new study. It captured only the number of families or institutions that reached out to the poison control line; it cannot account for those who attempted suicide by means other than poison. It also can’t capture exactly how many children or families sought help from somewhere other than poison control, so the increase in suspected suicides could be higher.

The American Academy of Pediatrics has noted that the Covid-19 pandemic exacerbated existing mental health struggles that existed even. In 2021, the group called child and adolescent mental health a “national emergency.” Emergency room clinicians across the country have also said they’ve seen record numbers of children with mental health crises, including attempts at suicide.

In 2020, suicide was the second leading cause of death among children ages 10 to 14 and the third leading cause among those 15 to 24, according to the CDC.

Although the height of the pandemic is over, kids are still emotionally vulnerable, experts warn. Previous attempts at suicide have been found to be the “strongest predictor of subsequent death by suicide,” the study said.

“An urgent need exists to strengthen programs focused on identifying and supporting persons at risk for suicide, especially young persons,” the study said.

Research has shown that there is a significant shortage of trained professionals and treatment facilities that can address the number of children who need better mental health care. In August, the Biden administration announced a plan to make it easier for millions of kids to get access to mental and physical health services at school.

At home, experts said, families should constantly check in with children to see how they are doing emotionally. Caregivers also need to make sure they restrict access to “lethal means,” like keeping medicines – even over-the-counter items – away from children and keeping guns locked up.

Dr. Aron Janssen, vice chair of clinical affairs at the Pritzker Department of Psychiatry and Behavioral Health at Lurie Children’s in Chicago, said he is not surprised to see the increase in suspected suicides, “but it doesn’t make it any less sad.”

Janssen, who did not work on the new report, called the increase “alarming.”

The rates of suicide attempts among kids had been increasing even prior to the pandemic, he said, “but this shows Covid really supercharged this as a phenomenon.

“We see a lot of kids who lost access to social supports increasingly isolated and really struggling to manage through day to day.”

Janssen said that he and his colleagues believe these suspected suicides coincide with increased rates of depression and anxiety and a sense of real dread about the future.

One of the biggest concerns is that “previous suicide attempts is the biggest predictor of later suicide completion,” he said. “We really want to follow these kids over time to better understand how to support them, to make sure that we’re doing everything within our power to help steer them away from future attempts.”

Janssen said it’s important to keep in mind that the vast majority of children survived even the worst of the pandemic and did quite well. There are treatments that work, and kids who can get connected to the appropriate care – including talk therapy and, in some cases, medication – can and do get better.

“We do see that. We do see improvement. We do see efficacy of our care,” Janssen said. “We just have to figure out how we can connect kids to care.”

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What is autism? An expert explains | CNN

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CNN
 — 

Some individuals with autism have challenges processing senses. Others struggle to communicate. Still others might have a tough time socializing, thinking, physically moving or just going about daily living.

People with autism have their own ways of interacting with the world, because autism is a developmental disability that affects everyone who has it a little differently, according to Dr. Daniel Geschwind, the Gordon and Virginia Macdonald distinguished professor of human genetics, neurology and psychiatry at UCLA.

Geschwind has spent 25 years studying autism and what causes it. To mark Autism Awareness Month, CNN talked with him about what autism is and what causes it.

This conversation has been lightly edited and condensed for clarity.

CNN: What is autism?

Dr. Daniel Geschwind: Autism refers to a broad range of conditions characterized by challenges with social skills and social and communication and repetitive behaviors, resistance to changes in routine, or restricted interests. I prefer to call it “the Autisms,” because it’s not one thing, and no two autistic children or adults are exactly alike even though they may share basic features. People with autism may also have some sensory-motor integration issues, especially sensory hypersensitivity.

CNN: How prevalent is autism today?

Geschwind: It isn’t rare. The most recent statistics (from the US Centers for Disease Control and Prevention) came out in March, pulled data from 11 sites (in the United States) and reported 1 out of every 36 kids is autistic. The study before that estimated around 1 in 40. About 10 years ago, the autism rate was 1 in 100, or even lower.

It would be easy to look at this trend and say autism is increasing, but that’s not really what is happening. The most recent data reflects that our ability to recognize autism and diagnose it early has improved dramatically. We’re now able to diagnose people with autism who might have (previously) fallen through the cracks.

Everybody is neurodivergent to some extent. For example, if you look at a simple IQ test, a substantial portion of people will perform really badly on one specific item. That doesn’t mean they have problems — it’s just that it means we all have strengths and weaknesses.

If I were being tested on artistic ability, for example, or engineering ability, I would be far below what’s called typical. I think we have to accept that intelligence is not just one thing, that cognition isn’t one thing, that there’s not just one way to behave.

CNN: What does it mean when people describe some as being “on the spectrum”?

Geschwind: About a decade ago, the term “autism spectrum disorder” was adopted to encompass everything that we called autism into one rubric. The intent was simply to describe the variability in how people with autism act and behave biomedically. There are some autistic individuals who just need accommodations and don’t need treatment. There are other autistic individuals who need a lot of treatment. The spectrum was intended to include them all.

Over time, non-autistic people began referring to the spectrum in a linear fashion: high to low. That means some autistic individuals were categorized as “high-functioning,” while others were categorized as “low-functioning.” For many, the notion of a spectrum is now a loaded term. Many believe that instead of talking about autism in a linear fashion, we should talk about it as a wheel or pie, where each slice represents a different trait and every individual has different strengths and weaknesses.

CNN: Is there a cure for autism?

Geschwind: There is no cure. At the same time, we’ve come very far in understanding what autism is, and we’re making progress on how to treat it. When I started researching autism 25 years ago, the autism rate was 1 in 1,000 or 1 in 2,000. To put it in deeper historical perspective, I think at that time there was only about $10 million a year or less in autism research being done that was funded (by the National Institutes of Health). And so, there was a huge disconnect between the research dollars, public awareness and the real needs of patients and families.

The notion of the term “curing” autism can be controversial. From my perspective, our true goal is to establish a kind of personalized medicine, or precision health in autism and other neuropsychiatric disorders, so that each autistic person is seen as the individual they are. We envision a world where individuals who are severely impacted by autism have the opportunity to get therapy and drugs that can help them — and those for whom a therapy is not warranted or who don’t want it will have opportunities to live life the way they want to as well. Patient autonomy and societal accommodation are important aspects when considering these issues.

CNN: What causes autism?

Geschwind: Almost every medical condition has both genetic and environmental components. In autism, it seems that heritability is very high. The most recent large study suggested that heritable genetic factors — the things that you get from your parents that your parents have in their DNA — are probably somewhere around 80% or slightly higher.

That leaves 20% that’s nonheritable, and of that we know that at least 10% of autism is caused by rare mutations that are not inherited. And that sounds like a paradox, but it’s not. If you think about Down syndrome, that’s a genetic mutation that the parents don’t have in their DNA. That’s called a new, or de novo, mutation.

You can calculate a risk score for having autism based on genetics, (but) right now, the risk score for autism is not that predictive because we haven’t done enough research. For other conditions like cardiovascular or certain cancers, risk scores are very predictive because very large numbers of people have been studied.

Even so, this autism risk score is strongly correlated with high educational attainment, or a high IQ, which again speaks to the strengths associated with being autistic and highlights that we need to be more aware of the strengths that autistic individuals may have as well to optimize their opportunities to achieve their goals or contribute to society.

There also are several environmental factors that have been shown to increase the risk of autism. One of them is maternal exposure to valproate, which is an anti-epilepsy medication. There are several maternal viral infections that have been associated with autism. And two other things: the interbirth interval — how quickly after one birth a mother has another — and the age of the father. The thought on the last point is that as a man ages, their DNA repair mechanisms are maybe less active, and there are more frequent mutations in sperm.

A key point is that all these known environmental factors act prenatally, so in most cases the tendency towards being on the spectrum is something that individuals are born with.

CNN: To what extent has research debunked the controversial notion that vaccines can cause autism?

Geschwind: The notion that vaccines cause autism has been entirely (disproved). There have been dozens of studies, using very different methodologies. There is absolutely no evidence that vaccines cause autism, and there’s been much more harm than good done by purveyors of that fiction.

CNN: How do you treat autism?

Geschwind: It is imperative to have an early diagnosis, because we know that early identification and early intervention with behavioral therapies can be effective in up to 50% of kids. Some kids will respond so well that it’s very hard to make a diagnosis of autism when they’re 9 years old if the therapy is started early enough.

The problem is that for many autistic individuals, current therapies are not that effective. There’s a lot of work being done developing more effective cognitive behavioral therapies, figuring out which therapy is the best for which child. There’s also work being done to develop medications that can be helpful to treat certain symptoms such as injurious behavior, repetitive behavior or difficulty with changes in routines.

My colleagues and I want to use treatment to augment and improve people’s symptoms, not change who they are fundamentally. We believe strongly in every individual’s autonomy. We also believe in personalized medicine so that it’s not one-size-fits-all. There will be some patients in whom we’re trying to correct a severe genetic mutation that has profound consequences, and there’ll be others that need only a handful of accommodations, just like we provide for folks who need wheelchairs.

CNN: What will your research focus on next?

Geschwind: There are two basic frontiers in my research. One recognizes that most of the work in neuropsychiatric disorders and autism has been done in primarily White European populations and focuses on a pressing need to be studying diverse populations. About seven or eight years ago, I started working with African American communities because certain aspects of genetics are population-specific, and we as researchers really need to understand that.

The frontier that is crosscutting across all of this is we need to be able to move from genetics in a population to genetics in an individual, so that by looking at somebody’s genetic makeup, we can understand the mechanism of their autism. This is precision medicine.

My work is trying to understand how specific genetic variants, how specific mutations, impact brain development to eventually lead to the symptoms of autism. If my colleagues and I can understand that mechanism, just like we can understand the genetic mechanism in cancer, we can find a drug to target that and improve those symptoms over time.

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Why we have nightmares and how to stop them | CNN

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Sign up for CNN’s Sleep, But Better newsletter series. Our seven-part guide has helpful hints to achieve better sleep.



CNN
 — 

We leave behind our fears of monsters under the bed as we say goodbye to our childhoods, but one can follow us into adulthood and loom over our heads.

Nightmares are more common in childhood, but anywhere from 50% to 85% of adults report having occasional nightmares.

Almost everyone can experience nightmares.

“Dreams do usually incorporate things that happened during the day, leading some researchers to hypothesize that dreams and rapid eye movement sleep is essential for memory consolidation and cognitive rejuvenation,” said Joshua Tal, a sleep and health psychologist based in Manhattan.

“Nightmares are the mind’s attempts at making sense of these events, by replaying them in images during sleep.”

Nightmares are what the American Academy of Sleep Medicine call “vivid, realistic and disturbing dreams typically involving threats to survival or security, which often evoke emotions of anxiety, fear or terror.”

If someone has frequent nightmares — more than once or twice weekly — that cause distress or impairment at work or among people, he or she might have nightmare disorder. Treatments include medications and behavioral therapies.

Addressing frequent nightmares is important since they have also been linked to insomnia, depression and suicidal behavior. Since nightmares can also cause sleep deprivation, they are linked to heart disease and obesity as well.

Trying out these 10 steps could help you ease your nightmares and improve your sleep and quality of life.

Nightmares occur during rapid eye movement sleep, the phase during which our muscles relax and we dream. Waking up during REM sleep enables recollection of the dream and resulting distress, said Jennifer Martin, a professor of medicine at the David Geffen School of Medicine at the University of California, Los Angeles, and member of the American Academy of Sleep Medicine’s board of directors.

“One of the most effective ways to treat nightmare problems in adults is actually to get them sleeping more soundly (so) they wake up less often,” Martin said.

A healthy sleep routine begets sound sleep. Develop one by exercising, setting regular sleep and waking times, ensuring your room is dark and cool, avoiding stimulating beverages after midafternoon and engaging in relaxing activities.

Alcoholic beverages can induce restlessness and awakenings throughout the night — potentially helping you remember nightmares, Martin said.

“A lot of people use alcohol as a way to wind down and feel sleepy at the end of the day, but it’s really not the right solution,” she added. Instead, try herbal teas and other beverages conducive to sleep. If drinking was the only part of your relaxation routine, chat with your partner or read instead.

One drink more than three hours before bedtime is OK, Martin said. Just pay attention to whether it causes a post-dinner nap and alertness at bedtime, and eliminate that drink if it does.

Avoid snacking before bed to prevent spiking your metabolism and activating your brain.

Snacking can boost metabolism, which causes your brain to be more active and could lead to nightmares, according to the National Sleep Foundation.

While some people sleep better after eating a light snack, you should stop eating two to three hours before bedtime. If you notice that you have nightmares afterward, try avoiding nighttime snacking or heavier meals before bed.

Some medications can prompt nightmares by interrupting REM sleep.

“If people can identify that their nightmares either started or increased when they had a change in their medication, that’s definitely a reason to talk to their doctor” about their medication schedule or alternatives, Martin said.

Melatonin, while a popular sleep aid, influences our circadian rhythm that regulates REM sleep, and can lead to more or fewer nightmares. If you want to take melatonin for better sleep, work with a sleep specialist to ensure you’re taking it at the right time and not compounding the problem, Martin said.

Calming activities can deactivate your fight-or-flight response and trigger your relaxation system.

Progressive muscle relaxation — tensing muscle groups as you inhale and relaxing them as you exhale — has been effective for reducing nightmares.

“Nightmares activate the sympathetic nervous system, the ‘fight or flight system,’ the body’s natural response to imminent danger,” said Tal via email.

“The body also has an innate relaxation system: the parasympathetic nervous system, aka the ‘rest and digest’ system.” Progressive muscle relaxation and other relaxation activities can help activate that system.

Journaling can help you release your anxieties.

Write down your worries to get them all out ahead of time, lest they rear their disquieting heads at night. Journaling can be helpful for alleviating nightmares and stress in general, Tal said.

Images from any exciting or disturbing content you watched before bed can appear in your dreams.

Since our nighttime observations can appear during sleep, “spend some energy engaging with things that are more emotionally neutral or even positive” before bedtime, Martin suggested.

During the pandemic, our everyday lives are looking pretty scary, too. “Reading the news media and then hopping into bed is more likely to trigger disturbing and upsetting dreams than looking through pictures from your last vacation with your family,” she added.

Imagery rehearsal therapy is effective “when the chronic nightmares are showing similar themes and patterns,” Tal said.

Since nightmares can be learned behavior for the brain, this practice involves writing down in detail the narrative elements of the dream. Then rewrite the dream so that it ends positively. Just before falling asleep, set the intention to re-dream by saying aloud, “If or when I have the beginnings of the same bad dream, I will be able to instead have this much better dream with a positive outcome.”

“By practicing a rewrite during the daytime, you increase your chances of having them at night while you’re sleeping instead of your nightmare,” Tal said.

Silence is key in a sleep routine, but “for people who either don’t like it to be completely quiet or who are awakened by noises they can’t control during the night,” background noise “is a good strategy,” Martin said.

Try a fan or a white noise machine or app for several consecutive nights to help your brain adapt, she added.

If nothing works and you’re still having nightmares, talk with a therapist or sleep specialist.

“Nightmares might be a sign of a larger issue, such as PTSD or a mood disorder,” Tal said. “It is possible to treat the nightmares without treating the underlying disorder, but it may also be helpful to treat both the symptom and the disorder.

“There has been great progress on psychological treatments for nightmares, insomnia, anxiety and mood disorders,” Tal added. “Do not be afraid to ask for help; psychotherapy works and it is often short term and accessible.”

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Whether you’re a ‘shark,’ ‘teddy bear’ or ‘fox,’ here’s how to ease conflict with family and friends | CNN

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Editor’s Note: The views expressed in this commentary are solely those of the writers. CNN is showcasing the work of The Conversation, a collaboration between journalists and academics to provide news analysis and commentary. The content is produced solely by The Conversation.



The Conversation
 — 

For all the joy they bring, families and close friendships often involve conflict, betrayal, regret and resentment. Prince Harry’s recent memoir, “Spare,” is a reminder of the fact that the people closest to us often have the greatest power to hurt us. He describes power struggles, conflict, challenging family dynamics and decades of guilt, jealousy and resentment.

This sort of conflict can feel impossible to resolve. It’s not easy to move past, and sometimes it simply isn’t going to happen — at least in the short term. But psychology has helped us understand more about the breakdown of close relationships and what factors make resolution more likely.

In the course of a lifetime, it is difficult to avoid hurting, upsetting or being in conflict with people we love. It is an inevitable part of most lives, and learning how to negotiate it is a more useful and realistic goal than avoiding it. The first step is understanding what makes relationship conflict so difficult and the different approaches people have to it.

Canadian psychologists Judy Makinen and Susan Johnson have used the term attachment injuries to describe the sorts of wounds inflicted when we perceive that we have been abandoned, betrayed or mistreated by those closest to us.

These wounds sting so sharply because they lead us to question the safety, dependability or allegiance of these people. They trigger a myriad of emotional and behavioral responses, including aggression, resentment, fear, avoidance and reluctance to forgive. These responses have evolved as self-protection and are rooted to our personal histories and personality.

But the pain can linger indefinitely, continuing to influence us from the shadows. So what have psychologists learned about how people heal, move through the hurt and even learn and grow from it?

READ MORE: ‘Love languages’ might help you understand your partner — but it’s not exactly science

Much research has been carried out studying conflict resolution. Social psychologist David W. Johnson studied conflict management “styles” in humans and modeled the typical ways we respond to conflict.

He argued that our responses and strategies in conflict resolution tend to involve an attempt to balance our own concerns (our goals) with the concerns of the other people involved (their goals and preservation of the relationship).

Johnson outlined five main styles or approaches to this balancing act.

  • “Turtles” withdraw, abandoning both their own goals and the relationship. The result tends to be frozen, unresolved conflict.
  • “Sharks” have an aggressive, forceful take and protect their own goals at all costs. They tend to attack, intimidate and overwhelm during conflict.
  • “Teddy bears” seek to keep the peace and smooth things over. They drop their own goals completely. They sacrifice for the sake of the relationship.
  • “Foxes” adopt a compromising style. They are concerned with sacrifices being made on both sides and see concession as the solution, even when it results in less-than-ideal outcomes for both sides.
  • “Owls” adopt a style that views conflict as a problem to be resolved. They are open to solving it through whichever solutions offer both parties a pathway to achieve their goals and maintain the relationship. This can involve considerable time and effort. But owls are willing to endure the struggle.

READ MORE: Moving in with your partner? Talking about these 3 things first can smooth the way, according to a couples therapist

Research has suggested that our conflict resolution styles are related to our personalities and attachment histories. For example, people whose early attachment experiences taught them that their feelings are unimportant or invisible may be more likely to develop conflict management styles that instinctively minimize their needs (for example, the teddy bear).

Some psychologists have also suggested that our conflict management styles can be modified in long-term relationships but do not tend to change dramatically. In other words, while a teddy bear may have the potential to develop conflict management characteristics that reflect other styles, they are highly unlikely to turn into a shark.

Psychologists Richard Mackey, Matthew Diemer and Bernard O’Brien argued conflict is inevitable in all relationships. Their research found the duration of a relationship heavily depends upon how conflict is dealt with, and the longest-lasting, most fulfilling relationships are those in which conflict is accepted and constructively approached by both parties.

So, while a relationship between two sharks might be enduring, the likelihood that it will be harmonious is significantly less compared with a relationship between two owls.

READ MORE: Should I stay or should I go? Here are the factors people ponder when deciding to break up

Forgiveness is often hailed as the ultimate goal in relationship conflict. Jungian analysts Lisa Marchiano, Joseph Lee and Deborah Stewart describe forgiveness as reaching a place where we are able to “hold in our hearts at the same time, the magnitude of the injury that has been done to us and the humanity of the injurer.” That’s not an easy place to reach because it can feel as though we are minimizing our suffering by forgiving someone.

Psychologists Masi Noor and Marina Cantacuzino founded the Forgiveness Project, which provides resources to help people overcome unresolved grievances. They include a set of essential skills or tools that they argue can help us reach forgiveness.

These include understanding that all humans are fallible (including ourselves), giving up competing over who has suffered more, finding empathy for how others see the world and acknowledging that other perspectives exist, and accepting responsibility for how we might have contributed to our own suffering, even if it’s a bitter pill to swallow.

As Mark Twain put it: “Forgiveness is the fragrance that the violet sheds on the heel that has crushed it.”

READ MORE: Sex, love and companionship … with AI? Why human-machine relationships could go mainstream

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Why you keep having the same dream | CNN

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CNN
 — 

For years, dreams of my teeth cracking, loosening or falling out plagued my sleep. Loved ones of mine have repeatedly dreamed of flying, rolling away in a self-operating car, or running late for school or work. These aren’t typical nightmares, which usually happen once. They’re some of the most common recurring dreams, which tend to lean negative and can take some work to overcome.

“Recurring dreams are likelier to be about very profound life experiences or just very character logic issues that are kind of guaranteed to recur in waking life because they’re part of you rather than a one-time event,” said dream researcher Deirdre Barrett, a lecturer of psychology in the department of psychiatry at Harvard Medical School.

Since our dreams typically don’t repeat themselves, all it takes is dreaming the same dream twice or more for it to be considered recurring, Barrett said. They’re more common in childhood, Barrett said, but can last into adulthood. And recurring dreams don’t always happen in close proximity to each other — they can pop up multiple times per month or years apart, Barrett said.

Recurring dreams might be the same every time, or they might just recycle the same types of scenarios or worries, experts said.

“It is difficult to assess the prevalence of recurrent dreams because it is not something that happens on a regular basis for most people,” said clinical psychologist Dr. Nirit Soffer-Dudek, a senior lecturer in the department of psychology at Ben-Gurion University of the Negev in Israel, via email. “And when people are asked about past dreams in their life, they may be influenced by memory distortions, interest in dreams (or lack thereof), or other factors.”

Regardless, anything that comes up repeatedly is worth investigating, said sleep medicine specialist Dr. Alex Dimitriu, founder of Silicon Psych, a psychiatry and sleep medicine practice in Menlo Park, California.

“People have this kind of touch-and-go approach with things that are uncomfortable or fear-inducing, and I think dreams are, in some way, the same way,” Dimitriu said. “As a psychiatrist, I’m inclined to say that there is some message that might be trying to be conveyed to you. And the answer, then, might be to figure out what that is. And I think when you do, you might be able to put the thing to rest.”

Here’s how to figure out what’s triggering your recurring dreams.

For some recurring dreams, the message is straightforward — if you repeatedly dream about running late for school or work, you’re probably just often nervous about being unprepared for those things. But others, despite their commonness, might not have a universal meaning, requiring you do some soul-searching to learn more.

“In interpretation, we really don’t believe there are universal symbols, but that (it’s) what an individual’s own sort of personal symbol system is and their associations to something are,” Barrett said.

In addition to unpreparedness, other common themes of recurring dreams include social embarrassment, feeling inadequate compared with others, and danger in the form of car crashes or natural disasters, Barrett and Dimitriu said.

Some people have dreams revolving around test anxiety even if they haven’t been in school in years, Barrett said. This can reflect a general fear of failure or a sense of being judged by authority figures. Dreams of tooth loss or damage might have to do with loss of something else in your life, feelings of hopelessness or defenselessness, or health concerns.

When faced with a recurring dream, ask yourself what the message could be, Dimitriu said. What is your relationship to the things or people in the dream? What are your fears and belief systems about those things? What are the top five things in your life that might be triggering it or related to it? What are you really worried about?

“I definitely think it’s fine to do informal dream interpretation, either on your own or with a close, trusted person who may just sort of see things to question in it that you don’t,” Barrett said.

People with post-traumatic stress disorder or anxiety are more likely to have recurring dreams, especially ones with anxious natures, Dimitriu said. A PTSD dream stems from a trauma so severe it keeps returning as a nightmare.

“The brain is trying to resolve something and lay it to rest,” he added. But “in people with PTSD, their dreams are so vivid that they wake them up from sleep. And that becomes the problem because the dream never gets processed. … And that’s why it recurs — it’s unfinished work.”

Sometimes recurring dreams can point to biological sources, too. “People with sleep apnea will report dreams of, like, drowning, suffocating, giant waves, gasping for air, being underwater or being choked,” Dimitriu said, when they’re actually experiencing breathing interruptions because of their condition.

There can be environmental triggers as well, such as a car alarm down the street or a dripping faucet, he added, which can set off dreams with imagery of those things.

Once you have a better sense of what your worries are, writing about them before bed can be helpful for alleviating negative recurring dreams and stress in general.

“For my patients and myself, journaling is such a powerful tool,” Dimitriu said. Meditating could also help.

When you know what fear is behind your dream, Dimitriu recommended processing it via a three-column method used in cognitive behavioral therapy: What is your automatic thought? What’s your automatic feeling? Lastly, what’s the more reality-based alternative thought?

Dream rehearsal therapy, also known as imagery rehearsal therapy, can be effective for both recurring dreams and nightmares. This approach involves writing down in detail the narrative elements of the dream, then rewriting it so it ends positively. Right before falling asleep, you’d set the intention to re-dream by saying aloud, “If or when I have the beginnings of the same bad dream, I will be able to instead have this much better dream with a positive outcome.”

If your recurring dreams are making you stressed or unhappy, causing other symptoms, or starting to impair your ability to function on a regular basis, it’s time to seek professional help, experts said.

Recurring dreams could also stem from poor sleep hygiene, Soffer-Dudek said.

“A lot of awkward things happen in the night when people are sleep deprived, drink caffeine too late, drink alcohol too late, worked too late or slept four hours last night because they stayed up too late,” he said. “The fundamental core and foundation of healthy dream life starts with healthy sleep.”

Dimitriu also recommended limiting distractions that interfere with your time to reflect and process, such as spending unnecessary time on your phone or always filling the silence.

When your mind is always occupied, “what happens is all that processing has to happen somewhere,” he said. “So now there’s more pressure for that to happen in your dream life.”

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How to tell when stress is a problem | CNN

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It’s National Stress Awareness Month, which means it’s a good time to sign up for CNN’s Stress, But Less newsletter. Our six-part mindfulness guide will inspire you to reduce stress while learning how to harness it.



CNN
 — 

As we mark Stress Awareness Month in April, I know there’s so much to be stressed out—mass shootings, wars around the world, the pandemic’s long-term effects and the daily stresses of living and working in the 21st century. I’m sure you’ve got your list.

Everyone experiences stress at different points in their life. But when is stress a problem that requires our attention? What symptoms should people be on the lookout for? What are the health impacts of long-term stress? What are healthy and unhealthy coping mechanisms? And what techniques can help in addressing—and preventing—stress?

Fresh from dropping off my kid at school late (sorry, kid, my fault), I was looking forward to this advice from CNN Medical Analyst Dr. Leana Wen. Wen is an emergency physician and professor of health policy and management at the George Washington University Milken Institute School of Public Health. She previously served as Baltimore’s Health Commissioner and as Chair of Behavioral Health Systems Baltimore.

CNN: Let’s start with the basics. What exactly is stress?

Dr. Leana Wen: There is no single definition of stress. The World Health Organization’s definition refers to a state of worry or tension caused by a difficult situation. Many people experience stress as mental or emotional strain. Others also have physical manifestations of stress.

Stress is a natural reaction. It’s a human response that prompts us to respond to challenges and perceived threats. Some stress can be healthy and can prompt us to fulfill obligations. Perceived stress can spur us to study for a test or complete a project by a certain deadline. Virtually everyone experiences that kind of stress to some extent.

CNN: Why can stress be a problem?

Wen: The same human response that motivates us to work hard and finish a project can also lead to other emotions, like not being able to relax and becoming irritable and anxious. Some people develop physical reactions, like headaches, upset stomach and trouble sleeping. Longer-term stress can lead to anxiety and depression, and it can worsen symptoms for people with pre-existing behavioral health conditions, including substance use.

CNN: What are symptoms of stress that people should be on the lookout for?

Wen: In addition to feeling irritable and anxious, people experiencing stress can also feel nervous, uncertain and angry. They often express other symptoms, including feeling a lack of motivation; having trouble concentrating; and being tired, overwhelmed and burnt out. Many times, people in stressful situations will report being sad or depressed.

It’s important to note that depression and anxiety are separate medical diagnoses. Someone with depression and/or anxiety could have their symptoms exacerbated when they are undergoing times in their life with added stress. Long-term stress can also lead to depression and anxiety.

One way to think about the difference between stress versus anxiety and depression is that stress is generally a response to an external issue. The external cause could be good and motivating, like the need to finish a project. It could also be a negative emotional stress, like an argument with a romantic partner, concerns about financial stability or a challenging situation at work. Stress should go away when the situation is resolved.

Anxiety and depression, on the other hand, are generally persistent. Even after a stressful external event has passed, these internal feelings of apprehension, unworthiness and sadness are still there and interfere with your ability to live and enjoy your life.

CNN: What are the health impacts of long-term stress?

Wen: Chronic stress can have long-term consequences. Studies have shown that it can raise the risk of heart disease and stroke. It’s associated with worse immune response and decreased cognitive function.

Individuals experiencing stress are also more likely to endorse unhealthy behaviors, like smoking, excessive drinking, substance use, lack of sleep and physical inactivity. These lifestyle factors in turn can lead to worse health outcomes.

CNN: What techniques can help in addressing stress?

Wen: First, awareness is important. Know your own body and your reaction to stress. Sometimes, anticipating that a situation may be stressful and being prepared to deal with it can reduce stress and anxiety.

Second, identifying symptoms can help. For example, if you know that your stress reaction includes feeling your heart rate increase and getting agitated, then you can detect the symptoms as they occur and become aware of the stressful situation as it’s occurring.

Third, know what stress relief techniques work for you. Some people are big fans of mindfulness meditation. Those, and deep breathing exercises, are good for everyone to try.

For me, nothing beats stress relief like exercise. For me, what helps is exercising, in particular swimming. Aerobic exercise is associated with stress relief, and mixing it up with high-intensity regimens can help, too.

A lot of people have other specific techniques that help them. Some people clean their house, organize their closets or work in their gardens. Others spend time walking in nature, writing in a journal, knitting, playing with their pets or cycling.

I’d advise that you experiment with what works, take stock of existing techniques that help you and incorporate some of those practices into your regular routine. Then, in times of stress, they are good tools to turn to that you know will help you.

CNN: What unhealthy copings strategies should people avoid?

Wen: Definitely. There are things people turn to in an effort to make themselves feel better in the short-term that can actually make things worse. Excessive alcohol intake, using drugs and smoking aren’t healthy coping strategies. It’s the same with staying up all night, binge-eating and taking out your frustration on loved ones. These have wide-ranging consequences, and you should reconsider them if they have been your go-to coping mechanisms in the past.

CNN: When is it time to seek help?

Wen: If the stress you are feeling is consistently interfering with your work, social or personal life or if you are experiencing signs and symptoms of depression, anxiety and other mental health disorders, it’s time to seek help.

Consider speaking with your primary care physician to get a referral to a therapist. Your workplace may have an Employee Assistance Program that you can turn to, too. And the federal mental health crisis hotline number, 988, is another resource.

This April, for Stress Awareness Month, I hope we can all assess our own stress levels as well as our reaction to stress. We should recognize what helps us to reduce and alleviate stress as we aim to improve our physical and emotional well-being.

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What someone with an eating disorder wishes you knew | CNN

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Editor’s Note: This story is part of an occasional series covering disordered eating and diet culture.



CNN
 — 

Getting diagnosed with an eating disorder happened by accident to Emily Boring.

She went to her university’s mental health office to talk about anxiety she was feeling, and through conversations learned that her behaviors with food were classified as an eating disorder, she said.

Now 27 and a graduate student at the Yale Divinity School in New Haven, Connecticut, her journey of recovery and relapse has taught her a lot about how to care for herself and others, she said.

During Eating Disorders Awareness Week in late February, Boring spoke to CNN about the misunderstanding, shame and stigma around eating disorders so they can be better understood.

This conversation has been edited and condensed for clarity.

CNN: What do you want people to know about disordered eating and eating disorders?

Emily Boring: I wish people knew that it is everywhere. The vast majority of people will experience some kind of disordered relationship to food in their bodies, simply because of the culture we live in.

What I would say first and foremost is disordered eating — and this also applies to formal eating disorders — don’t look a certain way. They affect everyone regardless of gender, race, ethnicity, age, socioeconomic status. Disordered eating and eating disorders do not come with a “thin” or underweight body.

CNN: How do you understand eating disorders and treatment?

Boring: Eating disorders are now classified as metabo-psychiatric illnesses — metabolism referring to the way the body processes energy, and then the psychiatric portion related to brain and behavior.

This has confirmed the experience of people with eating disorders. We for decades — and clinicians also — have noticed that eating disorders tend to be activated when someone falls into energy deficit or doesn’t take in enough calories to support their body.

Eating disorders are not shameful. They’re not a choice, and they’re not a failure. There’s still some lingering stigma around the thought that eating disorders are something that you choose. I would add on to that: if someone is on the precipice of realizing they have an eating disorder or receiving that diagnosis from someone else, I would stress the importance of early intervention. And I would say that the first step to recovery is finding a really good eating disorder team (including a) therapist, dietician and a doctor.

CNN: How should loved ones talk to people in recovery from eating disorders?

Boring: I do speak mostly from my own experience, but I’ve also mentored quite a few teenagers during this process. I’ve learned the hard way what isn’t helpful to say to them, and I’ve also been the recipient (of unhelpful comments).

To the extent that you can, avoid comments and actions that we associate with diet culture. Especially in this country, the way that we privilege fitness in popular culture is antithetical to recovery. Diet culture oftentimes hides beneath the banner of healthism — that’s basically the belief that there is a standard of fitness and able-bodiedness that everyone can attain if we just work hard.

There’s a whole body of literature — scientific literature showing that health and weight are not all causally related. So higher weight doesn’t necessarily equal poor health outcome.

CNN: What do you mean when you say not to use “the eating disorder’s own voice” to talk back to it?

Boring: Let’s say I show up in a doctor’s office, and I’m afraid of what’s happening to my body. I’m afraid I’m going to gain weight. And a clinician may say well meaningly, “Don’t worry, your body’s not going to change that much. Your weight doesn’t have to go higher.”

Regardless of the factualness of that statement or not, that’s just playing right into the eating disorder’s belief. It’s so easy to try to reassure (your loved one) using the eating disorder’s own language, and I found that that just really doesn’t work in the long run.

CNN: What are ways to talk to people without using the voice of the eating disorder?

Boring: Some questions that I encourage folks to ask themselves are things like, “Is what I’m about to say implying that some bodies are better than other bodies? Or that some foods have greater or lesser moral worth?” Also try to avoid mentioning anything with numbers, whether that is weight or calories or number of hours exercising per week.

Don’t assume someone’s inner state based on how they do or don’t look on the outside. As much as people can, step back and ask questions, instead of making an assumption.

An example: “I see that you’re improving in these behaviors, like we set the goal of last week. How’s that feeling to you? How was your mind reacting?” So that process of gentle inquiry rather than statements and assumptions is really key.

CNN: What do people need to know about relapse?

Boring: That it is not a failure, and that doesn’t have to lead you back to the worst of illness that you’ve ever experienced. You can catch it early, and you can turn things around.

What I wish that I had known about relapse is that it happens more quickly and more sudden and all consumingly than I thought.

If you’re someone who has the genes for an eating disorder — whether that’s anorexia, bulimia, binge-eating disorder, any (disease) on the spectrum — you’re probably always going to have to be careful and vigilant about maintaining nutrition, eating an abundance and variety of foods, insulating yourself from diet culture. Because it can happen fast — a few days of restriction, a few lost pounds and all of a sudden, you’re back fully in the eating disorder.

And I would also say that relapse is a learning opportunity. It doesn’t always feel like that in the moment, but the times that I’ve relapsed, I look back and I realized in each instance, I’ve discovered something about what recovery means to me.

I guess that’s just a way to say, be gentle with yourself and be open-minded that yes, relapse is a crisis, and you need to do everything you can to get out of it. But also, it’s not a failure and it’s not a sign that you’ll be struggling with this forever.

CNN: What have you learned about recovery?

Boring: When I first started recovering, people — mostly clinicians, but also on some of the books and blogs that I’d read from people who’ve recovered — frame recovery, mostly in terms of absence. When you’re recovered, you won’t have these troubling symptoms anymore, or you won’t spend so much time thinking about food in your body.

In reality, what it’s like to be recovered is completely about presence. It is an ability to be present to relationships around you to the things that you’re interested in. It’s also just a physical presence of awareness of your own body, ability to perceive sensations, ability to eventually listen to your body’s cues of hunger and fullness.

The eating disorder is completely gray, and it feels like I’m kind of dragging myself through the days. … When I’m recovered, the world comes back into color again.

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Mental health struggles are driving more college students to consider dropping out, survey finds | CNN

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CNN
 — 

Isabel, a 20-year-old undergraduate student, is no stranger to hard work. She graduated high school a year early and spent most of 2021 keeping up with three jobs. But when she started college that fall, she felt like she was “sinking.”

She knew that she wasn’t feeling like herself that first semester: Her bubbly personality had dimmed, and she was crying lots more than she was used to.

It all came to a head during a Spanish exam. Isabel, who identifies as both Latina and Black, overheard a video that other students were watching about racism in her communities. Negative emotions swelled, and she had to walk out without finishing the test. She rushed back to her room, angry and upset, and broke her student card when hitting it on the door to get in.

“And I just started having a full-blown panic attack,” she said. “My mind was racing everywhere.”

Isabel says she begged her parents to let her stay on campus, but they insisted that she make the three-hour drive home, and she soon took a medical withdrawal.

A new survey shows that a significant number of college students struggle with their mental health, and a growing share have considered dropping out themselves.

Two out of 5 undergraduate students – including nearly half of female students – say they frequently experience emotional stress while attending college, according to a survey published Thursday by Gallup and the Lumina Foundation, a private independent organization focused on creating accessible opportunities for post-secondary learning. The survey was conducted in fall 2022, with responses from 12,000 adults who had a high school degree but had not yet completed an associate’s or bachelor’s degree.

More than 40% of students currently enrolled in an undergraduate degree program had considered dropping out in the past six months, up from 34% in the first year of the Covid-19 pandemic, the survey found. Most cited emotional stress and personal mental health as the reason, far more often than others like financial considerations and difficulty of coursework.

Young adult years are a vulnerable time for mental health in general, and the significant changes that often come with attending college can be added stressors, experts say.

“About 75% of lifetime mental health problems will onset by the mid-20s, so that means that the college years are a very epidemiologically vulnerable time,” said Sarah K. Lipson, an assistant professor at Boston University and principal investigator with the Healthy Minds Network, a research organization focused on the mental health of adolescents and young adults.

“And then for many adolescents and young adults, the transition to college comes with newfound autonomy. They may be experiencing the first signs and symptoms of mental health problems while now in this new level of independence that also includes new independence over their decision-making as it relates to mental health.”

An estimated 1 in 5 adults in the United States lives with a mental illness, and young adults between the ages of 18 and 25 are disproportionately affected. The share of college students reporting anxiety and depression has been growing for years, and it has only gotten worse during the Covid-19 pandemic.

An analysis of federal data by the Kaiser Family Foundation shows that half of young adults ages 18 to 24 have reported anxiety and depression symptoms in 2023, compared with about a third of adults overall.

Mental health in college is critically important, experts say.

It’s “predictive of pretty much every long-term outcome that we care about, including their future economic earnings, workplace productivity, their future mental health and their future physical health, as well,” Lipson said.

And the need for support is urgent. About 1 in 7 college students said that they had suicidal ideation – even more than the year prior, according to a fall 2021 survey by the Healthy Minds Network.

Isabel knew that she was struggling, but it took a while to realize the extent of her mental health challenges.

“The number one thing I struggled with was feeling overwhelmed and like I had space to even remember to eat,” she said. “People were like, ‘You don’t know how to take care of yourself.’ But no – I had five papers due, and assignments, and I also had to work and go to [class] on top of that. And then I also had to find time to sleep. Most of the time, I was chugging an energy drink. And God forbid if you have a social life.”

For Isabel, as with many college students, thinking about or deciding to leave a degree program because of mental health challenges can often bring its own set of negative emotions, such as anxiety, fear and grief.

“For a lot of students, this isn’t what they saw their life looking like. This isn’t the timeline that they had for themselves,” said Julie Wolfson, director of outreach and research for the College ReEntry program at Fountain House, a nonprofit organization that works to support people with mental illness.

“They see their friends continuing on and becoming juniors and seniors, graduating and getting their first job. But they feel stuck and like they’re watching their life plan slipping away.”

It can create a sort of “shame spiral,” Lipson said.

But mental health professionals stress the importance of prioritizing personal needs over the status quo.

“There’s no shame in taking some time off,” said Marcus Hotaling, a psychologist at Union College and president of the Association of University and College Counseling Center Directors.

“Take a semester. Take a year. Get yourself better – whether it be through therapy or medication – and come back stronger, a better student, more focused and, more importantly, healthier.”

They also encourage higher education institutions to help ease this pressure by creating policies that simplify the process to return.

“When a student is trying to do the best thing for themselves, that should be celebrated and promoted. For a school to then put up a ton of barriers for them to come back, it makes students not want to seek help,” Wolfson said.

“I would hope that in the future, there could be policies and systems that are more welcoming to students who are trying to take care of themselves.”

Appropriately managing mental health is different for each person, and experts say a break from school isn’t the best solution for everyone.

Tracking progress through self-assessments of symptoms and gauges of functioning, like class attendance and keeping up with assignments, can help make that call, said Ryan Patel, chair of the American College Health Association’s mental health section and senior staff psychiatrist at The Ohio State University.

“If we’re making progress and you’re getting better, then it could make sense to think about continuing school,” he said. “But if you’re doing everything you can in your day-to-day life to improve your mental health and we’re not making progress, or things are getting worse despite best efforts, that’s where the differentiating point occurs, in my mind.”

Understanding the support system a student would have if they return home, including access to resources and treatment providers, is also a factor, he said.

For a while, experts say, it was a challenge to articulate the problem and build the case for broader attention to the mental health of college students. Now, the mental health of students is consistently cited as the most pressing issue among college presidents, according to a survey by the American Council on Education.

As the need for services increases, however, college counseling centers are struggling to meet demand – and the shortage of mental health professionals doesn’t stop at the edge of campus.

But colleges are uniquely positioned to surround students with a close network of support, experts say. Taking advantage of that structure needs buy-in to create a broader “community of care.”

“Colleges have an educational mission, and I would make the argument that spreads to education about health and safety,” Hotaling said.

College faculty should be trained in recognizing immediate concerns or threats to a student’s safety, he said. But they should also understand that students can face a range of mental health challenges and know the appropriate resource to direct them to.

Isabel recently graduated from Fountain House’s College ReEntry program and is back at school – this time at university that’s a little closer to home, one that a close friend from high school also attends. It helps her to know that she has a strong friend group to support her and an academic program that supports her professional goals – to become an art curator.

Things are still challenging this time around, but she says she feels like she now has the right tools to cope.

“This foundation I am building is constantly in need of maintenance. There’s like a crack every day,” she said. “Back when I was trying to figure everything out, I feel like I was looking for a screwdriver when I needed a hammer. Now, it’s not that I know I can handle it – but I know that I have the healthy coping mechanisms and strategies and people to help. That gave me confidence and stamina to do it again.”

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Men with advanced prostate cancer going without life-prolonging medication amid shortage | CNN

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CNN
 — 

Doctors across the United States who treat people with advanced prostate cancer can’t find supplies of a medicine that may help them live longer.

Pluvicto, a drug to treat metastatic castration-resistant prostate cancer, also known as mCRPC, is in such short supply that its maker, Novartis, said it cannot allow further supply to new patients until it can produce more of the drug. The company said it is working to produce enough doses to treat existing patients.

“We recognize that this situation is distressing for patients whether they are currently in the treatment process and being rescheduled, or waiting for their first dose of Pluvicto,” Novartis said in a statement to CNN. “Any interruption in the process, from unplanned manufacturing events to doses not arriving in time, may result in patient doses being rescheduled and can have a cascading effect on patients scheduled for future treatment.”

The Swiss company said it has been in touch with treatment centers and providers in the US and is “actively engaging with them to manage rescheduling of patient doses.”

The problem is that Novartis’ manufacturing facility in Ivrea, Italy, can’t keep up with demand for the drug. In May, it had to suspend production at the facility due to what it said was “an abundance of caution” related to potential quality issues. It also paused production at a New Jersey plant that makes the drug for the Canadian market.

Novartis resumed production at both plants in June.

The company hopes to get the New Jersey plant authorized to produce the drug for the US market, but it’s not clear when that might happen. Novartis said in early March that it had completed its filing for approval from the US Food and Drug Administration.

Someone who has a late-stage cancer that has spread to other parts of the body doesn’t have a lot of time to wait for the company to make more, doctors say, nor do they have many other treatment options. So even if Novartis got approval for the New Jersey plant quickly, the help will come too late for many people, according to Dr. Daniel Spratt, chair of the Department of Radiation Oncology at University Hospitals Seidman Cancer Center in Cleveland.

Novartis said it is prioritizing people who are currently being treated with Pluvicto, which is given in six cycles. But Spratt said the supply has recently been too low even for some of these patients.

“Many patients are missing months of therapy,” he said. “The real tragedy is the patients partially under treatment who have had great responses and we can’t get them the rest of their therapy in a timely fashion.”

Next to skin cancer, prostate cancer is the most common cancer in American men, according to the American Cancer Society. Most men do not die from prostate cancer, but about 34,700 people are expected to die from it this year. It’s the second leading cause of cancer death for American men, behind only lung cancer.

Pluvicto is a targeted radioligand therapy, meaning it uses radioactive atoms to deliver radiation to targeted cells, fighting cancer while limiting damage to the surrounding tissues.

There is no cure for this advanced stage of cancer, but Pluvicto can help people live longer. When the drug got FDA approval in March 2022, Spratt said, there was a lot of excitement about its potential. His patients who had heard about the trials have been asking about it for years.

One study from Novartis’ trials found that people who got the drug lived a median of about 15 months after diagnosis, four months longer than the median for people who didn’t get the treatment. For a handful of people, the recovery is even more dramatic.

“There are some patients that really do have those sort of miraculous responses, so it does occasionally give us one of those ‘wow’ moments,” said Dr. William Dahut, chief scientific officer at the American Cancer Society.

Dahut said doctors also like Pluvicto because, compared with other cancer treatments, it’s easy to administer and has relatively few side effects, other than dry mouth.

Another side effect of the shortage is that it’s slowing the progression of research. There is some indication that the drug could help people before their cancer reaches such a late stage.

“We’re anxious to have greater supply to study it in broader populations,” Dahut said.

Spratt said he is working closely with the medical oncologists in his health care system to try to find alternative treatment options, and he’s been looking to get people into clinical trials so they can get access to the therapy.

“But there’s really very few options available,” he said.

Novartis said that if the FDA approves its plant in Milburn, New Jersey, it could supply more Pluvicto as early as this summer.

The agency told CNN that it “is not able to discuss details regarding any possible communications or actions with companies due to commercial confidential information.”

“To be clear, FDA does not manufacture, produce, bottle, or ship drugs and cannot force companies to do so or make more of a drug. However, in general, the FDA works with firms making drugs in shortage to help them ramp up production if they are willing to do so. Often, they need new production lines approved or need new raw material sources approved to help increase supplies. FDA can and does expedite review of these to help resolve shortages of medically necessary drugs.”

Novartis is also building a plant in Indianapolis where the drug will be produced, but that won’t be up and running until the end of the year, the company said.

In the meantime, doctors will often have to tell their patients that they probably won’t be able to help get them this life-extending drug for some time.

“Some men and their physicians will feel that some hope was taken from them,” Spratt siad. “Cancer is the enemy here, not the company, but it’s unfortunate to have that excitement that your physician will be able to prescribe it to you and just not be able to give it to them.”

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