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Study Highlights Complexity of 'Hearing Voices'
March 12, 2015

 

WEDNESDAY, March 11, 2015 (HealthDay News) -- Rachel Waddingham hears voices.

"I hear about 13 or so voices," she said in a news release from Durham University, in England. "Each of them is different -- some have names, they are different ages and sound like different people. Some of them are very angry and violent, others are scared, and others are mischievous."

In fact, "for me, the word 'voices' isn't sufficient," said Waddingham, a trustee of the National Hearing Voices Network in the United Kingdom, and the International Society for Psychological and Social Approaches to Psychosis.

She said that while she uses the word voices to convey her experience, the word also "hides the embodied parts of my experience for which I have few words to describe."

Now, a new study from Durham University highlights the complexity and variety of the "voices" some psychiatric patients and others experience.

The study was led by Angela Woods of Durham's Center for Medical Humanities. It included 127 people who had been diagnosed with a psychiatric disorder and 26 others with no history of mental illness. The participants completed an online questionnaire that asked them to describe their experiences of hearing voices in their head.

Many said they hear multiple voices (81 percent) with distinct, character-like qualities (70 percent). Two-thirds said they also experience physical effects from the voices, such as hot or tingling sensations in their hands and feet.

Voices that affected the body were more likely to be abusive or violent and, in some cases, were linked to traumatic experiences, respondents said.

Fear, anxiety, depression and stress were often associated with voices in the head, but 31 percent of the participants also felt positive emotions, according to the study published online March 10 in The Lancet Psychiatry.

Less than half of the people in the study said they heard purely auditory voices, with 45 percent reporting either thought-like or "in-between" voices with both thought-like and auditory features.

This finding challenges the belief that voices in the head are always auditory, and may prove important in future studies into what occurs in the brain when people hear voices, the researchers said.

The authors also reported that their study confirms that both people with and without mental illness hear voices.

"It is crucial to study mental health and human experiences such as voice-hearing from a variety of different perspectives to truly find out what people are experiencing, not just what we think they must be experiencing because they have a particular diagnosis," Woods said in the news release. "We hope this approach can help inform the development of future clinical interventions," she said.

Experts in the United States agreed the new findings are important. Dr. Sophia Frangou is chief of the psychosis research program at Icahn School of Medicine in New York City. She said that while the study of voices "goes back a very long way," the new report "makes a small but interesting contribution."

And Dr. Alan Manevitz, a clinical psychiatrist at Lenox Hill Hospital in New York City, added that auditory hallucinations are a hallmark of many psychiatric ills. "The treatment and resolution of this symptom has been the way medicine and psychiatry traditionally tracks improvement in patients," he said.

Manevitz stressed that the new study had several limitations, including the fact that the survey was offered online under less-controlled conditions, had more than double the number of women than men, and didn't adequately represent minority populations, which are known to have a higher incidence of these types of symptoms of psychosis compared to whites.

Still, Manevitz said the research revealed new details into the nature of voices. For example, "command" voices -- the type thought to be most closely linked to the potential for physical harm -- were relatively rare, "only prevalent in 5 percent of those participating," Manevitz said.

In addition, four-fifths of survey respondents "heard multiple voices with different 'character' qualities -- that means they were of specific age, gender and had distinct identities," he said. Two-thirds also reported bodily sensations happening alongside the voices.

Those findings are echoed in Waddingham's own experience. "Sometimes, I hear a child who is very frightened," she said. "When she is frightened I can sometimes feel pains in my body -- burning. If I can help the voice calm down, by doing some grounding strategies, the burning pains stop."

Waddingham called the new research "a step forward. If we want to understand more about voice-hearing, it makes sense to ask a voice-hearer -- and be willing to modify our perception of what it means to hear voices based on their answers."

More information

The Hearing Voices Network has more about hearing voices and having visions.


SOURCES: Alan Manevitz, M.D., clinical psychiatrist, Lenox Hill Hospital, New York City; Sophia Frangou, M.D., professor of psychiatry, chief, psychosis research program, division of psychiatric genomics, department of psychiatry, Icahn School of Medicine...

Health Highlights: Dec. 12, 2014
December 12, 2014

 

Here are some of the latest health and medical news developments, compiled by the editors of HealthDay:

Mali's Last Ebola Patient Released From Hospital
The last Ebola patient in Mali was released from hospital on Thursday after several tests for the deadly disease came back negative, health officials say.
The country had eight recorded cases of Ebola, but now has no confirmed or suspected cases. However, 26 people who had contact with Ebola patients are still being monitored, the Associated Press reported.
It can take up to 21 days for a person infected with Ebola to show symptoms, and a country is not declared Ebola-free until 42 days have passed since anyone had contact with a confirmed or probable case of the disease.
More than 18,100 people have been sickened and about 6,500 of them have died in the current Ebola outbreak, the AP reported. The vast majority of cases have been in Guinea, Liberia and Sierra Leone.

-----

Antipsycotic Drug Ziprasidone Can Cause Dangerous Skin Reaction: FDA
The antipsychotic medicine Geodon (ziprasidone) and generic versions of the drug can cause a rare, dangerous skin reaction that can progress to affect other parts of the body, the U.S. Food and Drug Administration says.
The agency has ordered that ziprasidone's label carry a new warning about this condition, called Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS).
Patients who are taking ziprasidone and develop a fever with a rash and/or swollen lymph glands should seek immediate medical care. If DRESS is suspected, doctors should immediately take patients off the drug, the FDA said.
DRESS can lead to inflammation of the liver, kidney, lungs, heart or pancreas, and possibly death.
Ziprasidone is used to treat schizophrenia and bipolar disorder.
-----

Ebola Vaccine Trial in Switzerland Suspended

Tests on an Ebola vaccine have been temporarily halted after some participants reported concerning side effects, Swiss scientists say.

The clinical trial involving 59 people began in November, but was suspended after four cases of mild joint pain in the hands and feet of volunteers who received the vaccine 10 to 15 days earlier, the Associated Press reported.

The trial was suspended "as a precautionary measure," and is scheduled to resume in January after a review of the side effects, according to a statement released Thursday by the Hopitaux Universitaires de Geneve.

The same vaccine is being tested in the United States, Canada, Germany and Gabon. It was developed by the Canadian government and is licensed by NewLink and Merck, the AP reported.


...

Study Finds Need for Improved Schizophrenia Care
December 04, 2014

 

THURSDAY, Dec. 4, 2014 (HealthDay News) -- Improper drug treatment is given to nearly 40 percent of people who suffer their first episode of schizophrenia, according to a new study.

Because schizophrenia is typically a chronic illness, early treatment can have an effect on a patient's long-term outcome, the researchers noted. Inappropriate drug treatment can lead to problems that cause patients to stop taking their medication.

The study included 404 people who suffered a first episode of schizophrenia. They were seen at community treatment centers in 21 states. Of those patients, 159 received drug treatment that was inconsistent with recommendations for first-episode patients.

Some of the more common mistakes the researchers cited included:

  • Prescribing more than one antipsychotic drug.
  • A higher-than-recommended dose of an antipsychotic.
  • The use of psychotropic medication other than an antipsychotic.
  • Prescribing an antidepressant without justification.
  • The use of the antipsychotic olanzapine, which is especially likely to cause major weight gain but was often prescribed at high doses.

The study appears in The American Journal of Psychiatry.

"Academic research has found that optimal medication selection and dosing for first-episode patients differs from that for patients with longer illness durations. The challenge to the field is to get this specialized knowledge to busy clinicians who are treating patients," study author Dr. Delbert Robinson, a psychiatrist at the Zucker Hillside Hospital in Glen Oaks, N.Y., said in a journal news release.

"Our finding that treatment differed based upon patients' insurance status suggests that in order to improve first-episode care we may also need to address treatment system issues," Robinson said.

More information

The U.S. National Institute of Mental Health has more about schizophrenia.
Copyright © 2014 HealthDay. All rights reserved.


SOURCE: The American Journal of Psychiatry, news release, Dec. 4, 2014...

Stem Cell Research Offers Clues About Schizophrenia
September 12, 2014

 

FRIDAY, Sept. 12, 2014 (HealthDay News) -- New research involving stem cells may provide clues about the chemical basis for schizophrenia, scientists report.

Brain cells of people with this chronic and disabling brain disorder give off higher amounts of three neurotransmitters linked to a range of psychiatric disorders, researchers found. Neurotransmitters are chemicals that trigger or block the transmission of electrical signals in the brain.

Although the cause of schizophrenia remains unknown and there is no cure, the study authors suggested their findings shed new light on the chemical basis of the disorder. Ultimately, they believe the study results could help scientists treat patients with schizophrenia more effectively.

"The study provides new insights into neurotransmitter mechanisms in schizophrenia that can lead to new drug targets and [treatments]," study senior author Vivian Hook, a professor with Skaggs School of Pharmacy at the University of California, San Diego, School of Medicine.

"All behavior has a neurochemical basis in the brain. This study shows that it is possible to look at precise chemical changes in neurons of people with schizophrenia," she said in a university news release.

In conducting the study, published online Sept. 11 in Stem Cell Reports, researchers created working brain cells using stem cell technology. The brain cells were activated to secrete neurotransmitters.

The brain cells taken from people with schizophrenia gave off higher amounts of three neurotransmitters: dopamine, norepinephrine and epinephrine.

The researchers also found that for people with schizophrenia, more brain cells were focused on production of tyrosine hydroxylase -- an initial step in the production of dopamine. They noted that both norepinephrine and epinephrine are made from dopamine.

Potentially, the findings could help doctors evaluate the severity of a patient's disease, identify different types of schizophrenia and determine which treatments would be most effective.

"It is very powerful to be able to see differences in neurons derived from individual patients," Hook concluded.

The U.S. National Institutes of Health provided partial funding for the study.

More information

The U.S. National Institute of Mental Health has more about schizophrenia.
Copyright © 2014 HealthDay. All rights reserved.


SOURCE: University of California, San Diego, news release, Sept. 11, 2014...

People With OCD May Have Higher Odds for Schizophrenia: Study
September 03, 2014

 

WEDNESDAY, Sept. 3, 2014 (HealthDay News) -- People with obsessive-compulsive disorder (OCD) may be at higher risk for schizophrenia, a new study suggests.

Still, the findings shouldn't cause undue worry in people with OCD, one expert said.

"In the general population, about 1 percent of people are diagnosed with schizophrenia -- a proportion that jumps to 2 percent among those who already have a diagnosis of OCD," explained Dr. Alan Manevitz, who was not involved in the study but reviewed its findings.

"But even with this doubled risk, it would be alarmist to suggest that a person with OCD has a high chance of developing schizophrenia," said Manevitz, a clinical psychiatrist at Lenox Hill Hospital in New York City. "In fact, that risk remains small."

While OCD and schizophrenia are two distinct mental disorders, prior research has suggested a link between the two conditions.

In the new study, Danish researchers led by Sandra Meier of Aarhus University tracked data from 3 million people who were born between 1955 and 2006. All of the participants were followed from 1995 through 2012.

Of the more than 16,200 people who developed schizophrenia, about 3 percent of them had a prior diagnosis of OCD, the researchers report online Sept. 3 in JAMA Psychiatry.

The data suggests that a prior diagnosis of OCD is associated with an increased risk of schizophrenia later in life. The researchers also found that children of parents diagnosed with OCD were at increased risk for schizophrenia.

The findings indicate some overlap between OCD and schizophrenia, but do not suggest that the disorders should be combined into one diagnosis, Meier's team said.

"Further research is needed to disentangle which genetic and environmental risk factors are truly common to OCD and schizophrenia," the study authors concluded.

"While this study confirms the small but perhaps significant increase in the category of patients suffering from both OCD and schizophrenia, it doesn't tell us why," Manevitz said. "I agree with the study authors that much more research into this field is warranted. If scientists can find overlapping biological or genetic markers common to the two conditions, such advancements could lead to new and better treatments for both."

Another expert had a different take on the findings.

"At least some of the association may have been a result of misdiagnosis in patients before they developed more specific symptoms of schizophrenia," said Dr. Aaron Pinkhasov, chairman of the department of behavioral health at Winthrop University Hospital in Mineola, N.Y.

"Notably, the study only looks at patients who have come in contact with a psychiatric hospital," he said. "As the majority of mild and moderate OCD patients are treated by general practitioners in an outpatient setting, it makes it difficult to apply these findings to all patients suffering from OCD. Hence, the risk may in fact be somewhat overestimated."

More information

Find out more about schizophrenia at the U.S. National Institute of Mental Health.
Copyright © 2014 HealthDay. All rights reserved.


SOURCE: JAMA Psychiatry, news release, Sept. 3, 2014...

Many With Schizophrenia Say They're Happy: Study
August 19, 2014

 

TUESDAY, Aug. 19, 2014 (HealthDay News) -- Even though schizophrenia is one of the most severe forms of mental illness, nearly 40 percent of people with the disorder say they're happy, new research contends.

Researchers at the University of California, San Diego, surveyed 72 schizophrenia patients, ranging in age from 23 to 70, living in the San Diego area, and found that 37 percent said they were happy all or most of the time.

Their happiness wasn't related to the length or severity of their mental illness, to their mental or physical status, or to factors such as age and education. Instead, their happiness was associated with positive mental and social characteristics such as optimism, resilience and lower stress levels, the researchers said.

The findings are valuable because these positive traits can be taught to many people, said the authors of the study, which was published online Aug. 18 in the journal Schizophrenia Research.

"People tend to think that happiness in schizophrenia is an oxymoron," senior author Dr. Dilip Jeste, a professor of psychiatry and neurosciences, said in a university news release.

"Without discounting the suffering this disease inflicts on people, our study shows that happiness is an attainable goal for at least some schizophrenia patients. This means we can help make these individuals' lives happier," Jeste added.

By way of comparison, about 83 percent of people without schizophrenia said they were happy most or all of the time. And none of the people without schizophrenia said they were never or rarely happy, compared with about 15 percent of those with the mental disorder.

"People with schizophrenia are clearly less happy than those in the general population at large, but this is not surprising," study lead author Barton Palmer, a professor in the university's department of psychiatry, said in the news release.

"What is impressive is that almost 40 percent of these patients are reporting happiness and that their happiness is associated with positive psychosocial attributes that can be potentially enhanced," Palmer added.

The study was funded, in part, by the U.S. National Institute of Mental Health (NIMH).

According to the NIMH, schizophrenia is a chronic, severe and disabling brain disorder. People with the disorder may hear voices other people don't hear, they may believe other people are reading their minds, controlling their thoughts or plotting to harm them. This can make them withdrawn or extremely agitated.

More information

The U.S. National Institute of Mental Health has more about schizophrenia.
Copyright © 2014 HealthDay. All rights reserved.


SOURCE: University of California, San Diego, news release, Aug. 18, 2014...

Gene Discoveries Could Shed New Light on Schizophrenia
July 22, 2014

 

TUESDAY, July 22, 2014 (HealthDay News) -- One of the largest studies ever conducted into the genetic origins of a psychiatric disorder has uncovered 83 new sites on chromosomes that harbor inherited genes tied to schizophrenia.

The findings, made by an international team of researchers, now bring the total number of common gene variants linked to the disorder to 108.

Although these schizophrenia-associated genes aren't specific enough to be used as a test to predict who will or will not develop the illness, researchers say they might someday be used as a screening tool for high-risk people who may benefit from preventative treatments.

Right now, the total group of schizophrenia-linked genes "only explains only about 3.5 percent of the risk for schizophrenia," Dr. Thomas Insel, director of the U.S. National Institute of Mental Health, said in an agency news release. However, "even based on these early predictors, people who score in the top 10 percent of risk may be up to 20-fold more prone to developing schizophrenia."

Prior research had only identified about 30 common gene variants linked to schizophrenia. In looking for more clues to the molecular basis of the disorder, an international team of more than 500 scientists at more than 80 research institutions in 25 countries re-examined all available schizophrenia gene samples from people with schizophrenia.

The combined data involved more than 37,000 people with schizophrenia and 113,000 people without the disorder.

The analysis looked at people's complete genomes -- the "map" of DNA that makes up a human. Out of a pool of roughly 9.5 million gene variants, the study authors found 108 sites on various chromosomes that appear to be linked to schizophrenia.

The newly discovered sites are grouped around pathways tied to certain processes associated with the disorder. These include communication between brain cells, as well as pathways involving learning, memory and immune function. One site was even focused on a specific target for schizophrenia medication, the study revealed.

One association was confirmed with a variation in a gene that codes for a receptor for dopamine -- a brain chemical messenger that is a known target for drugs used to treat schizophrenia.

The researchers believe that even more genetic clues to schizophrenia could be uncovered in studies with even larger numbers of patients.

"These results underscore that genetic programming affects the brain in tiny, incremental ways that can increase the risk for developing schizophrenia," Thomas Lehner, chief of NIMH's Genomics Research Branch, said in the news release. "They also validate the strategy of examining both common and rare [gene] variation to understand this complex disorder."

The study was published online July 22 in Nature.

More information

The National Alliance on Mental Illness has more about schizophrenia.
Copyright © 2014 HealthDay. All rights reserved.


SOURCE: U.S. National Institute of Mental Health, news release, July 21, 2014...

Antipsychotics Linked to Lower Brain Volume in Schizophrenia Patients
July 18, 2014

 

FRIDAY, July 18, 2014 (HealthDay News) -- Antipsychotic drugs are associated with a slight decrease in both brain cells and connections between brain cells in schizophrenia patients, a new study indicates.

However, this loss of what is called brain volume does not worsen schizophrenia symptoms or affect overall mental function, researchers reported in the study published online July 18 in the journal PLoS One.

"It's important to stress that the loss of brain volume doesn't appear to have any effect on people over the nine-year follow-up we conducted, and patients should not stop their medication on the basis of this research," study author Dr. Graham Murray, of the Behavioral and Clinical Neuroscience Institute and the department of psychiatry at the University of Cambridge in England, said in a university news release.

"A key question in future will be to examine whether there is any effect of this loss of brain volume later in life. We need more research in larger studies with longer follow-ups to evaluate the significance of these brain changes," he added.

All people naturally lose some brain volume as they age, but schizophrenia patients lose brain volume at a faster rate. The reasons for this difference aren't known, but it's been suggested that the antipsychotic medications taken by schizophrenia patients may be a factor.

This study included 33 schizophrenia patients and a "control" group of 71 people without the disorder who had a series of brain scans over nine years, from ages 34 to 43. The schizophrenia patients lost 0.7 percent of brain volume a year, compared with 0.5 percent among those in the control group, the findings showed.

The rate of brain volume loss among schizophrenia patients was greater when their dose of antipsychotic medication was higher, the investigators found. However, this association does not prove that the medications actually caused this loss of brain volume.

The researchers also examined, but found no evidence of, any link between the amount of brain volume loss and the severity of schizophrenia symptoms or reduced mental function.

More information

The U.S. National Institute of Mental Health has more about schizophrenia.

Copyright © 2014 HealthDay. All rights reserved.


SOURCE: University of Cambridge, news release, July 18, 2014...

Premature Death, Suicides Up Among People With Schizophrenia, Study Says
June 04, 2014

 

WEDNESDAY, June 4, 2014 (HealthDay News) -- People with schizophrenia are facing higher risks of dying prematurely, killing themselves and committing violent crimes compared to the general population, a new Swedish study finds.

Researchers looked at nearly 25,000 adults in Sweden diagnosed with schizophrenia or related disorders over almost four decades. They found that within five years of diagnosis, one in 50 committed suicide; around 1 in 10 men was convicted of a violent offense, and overall, the odds of dying prematurely were eight times higher than for people without the mental illness.

"In recent years, there has been a lot of focus on primary prevention of schizophrenia -- preventing people from getting ill. While primary prevention is clearly essential and may be some decades away, our study highlights the crucial importance of secondary prevention -- treating and managing the risks of adverse outcomes, such as self-harm or violent behavior, in patients," said study lead author Dr. Seena Fazel of Oxford University in England.

The study appears in the June 4 issue of The Lancet Psychiatry.

The findings suggest much work is needed to develop new treatments and mitigate risks of adverse outcomes in people with schizophrenia, Fazel said in a journal news release.

Fazel's team tracked people diagnosed from 1972 to 2009. The researchers wanted to know how often they committed violent crimes, died prematurely or committed suicide.

The researchers found the risk for all these potential outcomes rose over those 37 years compared with the general population and siblings without schizophrenia.

They then tracked hospital admissions of people with schizophrenia and saw that rising rates of self-harm and other violent behaviors seem to be associated with decreasing levels of inpatient care for these patients. However, the research doesn't establish a cause-and-effect relationship between these factors.

In a commentary, researchers cautioned that "most people with schizophrenia and related disorders are neither violent nor suicidal." It's important that people with schizophrenia and related disorders who are not violent are not stigmatized or discriminated against, they said.

More information

For more about schizophrenia, see the National Alliance on Mental Illness.
Copyright © 2014 HealthDay. All rights reserved.


SOURCE: The Lancet Psychiatry, news release, June 3, 2014...

Schizophrenia May Raise Dementia Risk in Older Adults
May 30, 2014

 

FRIDAY, May 30, 2014 (HealthDay News) -- Older adults who have schizophrenia appear to face a higher risk of getting dementia, new research suggests.

"The rates of dementia in those with schizophrenia in the study were twice that of non-schizophrenic patients," said lead researcher Hugh Hendrie, a Regenstrief Institute investigator and a scientist at the Indiana University Center for Aging Research.

On the other hand, while those with schizophrenia were also more likely to develop other health problems, they were less likely to get cancer.

The study is published in the May issue of the American Journal of Geriatric Psychiatry.

As the diagnosis and treatment of schizophrenia have improved, those with the mental illness are living longer, researchers noted. But there has been little information about how they fare with other conditions, such as heart problems and dementia, as they age.

So Hendrie's team, from the Regenstrief Institute and Indiana University, looked at the medical records of over 31,000 older adults, average age 70, who received care from an urban public health system, including a mental health center, from 1999 to 2008.

Over the 10-year span, they zeroed in on 757 adults who had a diagnosis of schizophrenia from a mental health center. (In all, 1,635 had schizophrenia, but some of those diagnoses were not confirmed at a mental health center).

Schizophrenia, a mental illness marked by hallucinations and delusions, is typically diagnosed in adolescence or early adulthood. About 1 percent of the U.S. population is affected, according to the American Psychiatric Association.

The researchers evaluated the rates of common conditions, health use costs and death rates.

They found that those with schizophrenia had higher rates of congestive heart failure: 45 percent versus 38 percent in others. They also had more serious lung problems and more instances of low thyroid function.

However, they also had lower rates of cancer, with 30 percent of them diagnosed with a cancer compared to 43 percent of other patients.

The big surprise, Hendrie noted, was the rate of dementia. Dementia was twice as common in those with schizophrenia, diagnosed in 64 percent of those with the mental illness compared to 32 percent of others.

Those with schizophrenia were also more likely to die during the follow-up period.

"The good news is those with schizophrenia are living longer; the bad news is, they are getting more of the serious physical illnesses than other people," Hendrie said.

Health care use was higher in those with schizophrenia, which wasn't a surprise, the researchers found. But it was surprising that those patients' admissions to hospital were almost always for physical illness, not the mental illness, Hendrie said.

He can't explain the differences. As for the dementia, he asked: "Does this really mean dementia rates are double in those with schizophrenia? Or is it that the doctors are misinterpreting the information?"

When an older person goes to a doctor who has trouble understanding what they are saying, he said, the doctor may think the person is demented, when actually the communication issues may be related to the schizophrenia.

Another possibility, Hendrie said, is that there could be a unique form of dementia that develops in a schizophrenic patient.

Hendrie also can't explain the finding of lower cancer rates. Previous studies have found lower rates of gastrointestinal cancers in those with schizophrenia, he said, and researchers have speculated that the antipsychotic medicines they take may somehow help protect against those cancers.

What is needed, Hendrie added, is a health care system that integrates the mental health and physical health services needed by someone with schizophrenia.

The new finding ''highlights the relationship between the brain and the rest of the body," said Dr. Jeff Borenstein, president and CEO of the Brain & Behavior Research Foundation in New York City.

Experts have known that those with schizophrenia die from medical causes at a much earlier age than those who don't, he added, but the large numbers in the study add strength to the findings. That emphasizes the need to be sure that those with schizophrenia "get treatment not only for schizophrenia, but for physical conditions as well," Borenstein said.

But, he said, "if you are not in a place where that model is in place, you can still have the benefit by making sure the physicians [for mental and physical health services] are talking with each other."

More information

To learn more about schizophrenia, visit the National Alliance on Mental Illness.
Copyright © 2014 HealthDay. All rights reserved.


SOURCES: Hugh Hendrie, M.B., Ch.B., D.Sc., investigator, Regenstrief Institute, scientist, Indiana University Center for Aging Research and professor, psychiatry, IU School of Medicine, Indianapolis; Jeff Borenstein, M.D., president and CEO, Brain & B...

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