Anxious Much? Turns Out Some Neuroticism Can Be Good for You

Worrywarts, here’s something to celebrate: If you’re one to obsess over symptoms, it might actually be a health boon – if you’re also conscientious.

According to URMC post-doctoral psychiatry fellow Nicholas Turiano, people who are both neurotic and conscientious (two of the “Big Five” personality traits) tend to be goal-oriented, well-organized, and highly reflective – all qualities that help them stay hyper-vigilant about their lifestyle and swift to seek treatment when problems arise. In fact, in a recent clinical study, Turiano’s team found hard evidence behind the phenomenon: In lab tests, self-described neurotics who were also conscientious tended to have the lowest levels of interleukin-6 – a biomarker linked with inflammation and bigger risk for chronic disease.

To learn more about this personality-health connection, we spoke with Turiano.

Scripts: The term “healthy neuroticism” was coined in 2000 – so, is it safe to assume your work builds on others’ findings?

Turiano: Yes. For a long time, experts have made a blanket assumption that neuroticism is harmful to health; after all, anxiety can drive people to alcohol and tobacco abuse. But, at the turn of the century, psychologist Howard Friedman suggested neuroticism may not always be a bad thing. Several important studies offered proof; some showed that individuals’ with moderate levels of neuroticism actually responded better to treatment. Others were less likely to die after a heart attack. It appeared these individuals actually benefited from their neuroses!

Since this earlier work, several studies have gone on to show that people with this personality combination practice remarkable restraint where others might not – so they’re often surprisingly tempered when it comes to drugs and alcohol. Our recent work looking at biomarkers goes a step further, suggesting this unique personality blend might be beneficial long-term, as it’s linked with less harmful inflammation. Of course, we’re not recommending that everyone find ways to start being more anxious – but we are recognizing that there’s a fragile balance of when neuroticism is healthy and when it’s not.

Scripts: Your recent work looked at interleukin-6. Can you tell us what that is, and why it works as an important measure of overall health?

Turiano: Called IL-6 for short, it’s a protein that helps jumpstart the body’s immune response.

See, when our bodies detect a threat (be it an infection, burn, scrape, tissue damage, etc.), IL-6 levels shoot up and the immune system kicks into gear. Over time, though, the process can run amok; IL-6 levels can increase too much or stay raised for too long, leading to chronic inflammation that actually causes harmful tissue damage. Increasing IL-6 levels are associated with getting older, and with conditions like heart disease, cancer, Alzheimer’s disease, and even an overall increased risk of dying young. So, they’re a good benchmark of how healthy an individual is.

Scripts: Makes sense. What do you think is behind the “healthy neuroticism” phenomenon?

Turiano: It’s probably a combination of factors. We know that neurotic people are more likely to have more subjective health complaints, even if they’re in perfect health. But this might not necessarily be a bad thing; after all, part of treating disease and sickness involves seeking help in the first place. So some anxiety can be good for individuals.

Really, this is where conscientiousness probably comes into play. Conscientious neurotics may be more likely to channel their anxiety in healthy ways, such as going to the doctor, and being disciplined stewards of their health in the first place (because they worry so much about getting sick). And as the adage goes, an ounce of prevention is worth a pound of cure. Their vigilance pays off.

Scripts: How will this information help physicians keep patients healthy?

Turiano: Granted, physicians already have a lot on their plates – but clearer understandings of patients’ personalities might help predict persons at risk for poor health behaviors (like substance abuse) or even health problems (especially those tied to chronic inflammation). What’s more, it also might help doctors to better tailor health interventions. For instance, folks who aren’t conscientious might need more check-ins and monitoring for a therapy regimen to work. Knowing that up front can help you choose strategies most likely to work. It certainly can’t hurt for physicians to better understand what motivates their patients.

Turiano’s research was funded by grants from the National Institute of Mental Health and the National Institute of Aging. URMC co-authors include Turiano’s mentor, Ben Chapman, Ph.D., M.P.H., assistant professor of Psychiatry; and Jan Moynihan, Ph.D., the Engel Professor of Psychosocial Medicine, Department of Psychiatry, and principal investigator at the Rochester Center for Mind-Body Research.

Progressive Memory Loss: Shoring up Support for Alzheimer’s Patients, Families

It often starts out modestly, almost imperceptibly – a few glitches in recall, trouble remembering a name, maybe – and then can progress to a truly debilitating disease. Sometimes one that requires intense, round-the-clock care that stretches family members and loved ones thin.

As the demand for Alzheimer’s and other memory care services continues to grow (an estimated 25,000 people in the Finger Lakes region suffer from the disease – the most common form of dementia – and that number will likely triple by 2050, as the population ages), URMC recently announced a novel program that pulls together support from all angles. Known as the Memory Care Program, a cross-specialty team of neurologists, psychiatrists, geriatricians, neuropsychologists, social workers, nurses, and marriage and family therapists staff the clinic.

“Truly effective treatment requires a coordinated approach, gathering a team of clinicians that can help address the many facets of these diseases,” says URMC neurologist Dr. Fred Marshall, who directs the new program.

And it’s precisely because of this deep and diverse team that the same clinic, all under one roof, can deliver a comprehensive evaluation of each new patient,  provide guidance on medications and coping strategies,  educate patients and families about a broad variety of resources and support available in the community, and more. To appreciate the full breadth of the new program’s services,  tune into the video below.

The new Memory Care  Program – made possible by a $1 million anonymous gift to the Medical Center (as part of the University of Rochester’s $650 million “Meliora Challenge”) – anticipates following up to 3,000 patients, and plans to recruit new faculty and expand capacity as demand grows.

Know someone with Alzheimer’s? You can find even more information about URMC’s program at www.memorycare.urmc.edu, or by calling 585-273-5454.

Go Fish! Do Omega-3 Supplements Deserve a Spot in Your Medicine Cabinet?

A new report making waves this month says the jury’s still out on whether those big, fish-oil soft gels offer much benefit for persons already living with heart disease.

The latest analysis, which reviewed just over a dozen smaller studies, found that taking the supplements – or not – made little difference in whether 20,000 chronic heart disease patients suffered heart attacks or strokes.

But don’t toss your fish pills just yet, says URMC cardiologist Dr. Robert Block. There’s more to consider. Below, he helps make sense of the latest science – and its short-comings.

Scripts: Historically, have cardiologists advised cardiac patients (say, those with high cholesterol) to take fish-oil capsules – and if so, based on what research?

Block: It’s important to note that a fair number of older studies – many of which were conducted before the mainstream adoption of today’s aggressive medicines, like statins and beta-blockers – were quite conclusive. They suggested fish oil supplements indeed played an important role of protecting patients with heart failure.

Take the GISSI (Gruppo Italiano per lo Studio dells Sopravvivenza nell’Infarto Miocardico) trial, for instance, which found that these pills lowered the risk of fatal cardiovascular events by 10 percent for cardiac patients. So, conceivably, it could be that more recent trials (in which the bulk of patients were already taking powerful medications) might not accurately appreciate the role that fish oil actually plays – especially for people never diagnosed with heart disease to begin with.

To that end, many cardiologists do recommend fish oil supplements – or better yet, eating more real fish – since the known side-effects (other than the occasional potential for a fishy burp!) are negligible. What’s more, fish oil does not interact with other medications – a big problem we see with many prescription drugs.

Scripts: Some people assume that “supplements,” in general, are just as good of a substitute for consuming the real food. But does this study possibly suggest that the part of the benefit of fish oil, in its most natural form (that is, in actual fish!), comes because fish are eaten in place of other less-healthy meats?

Block: Certainly, fish are a wonderful dietary staple. The health benefits are well-documented, and the most current, 2010 Dietary Guidelines for Americans advise all of us (even pregnant women) to eat more servings of fish. And, even while the data supporting fish oil supplements is less cut -and-dried, the American Heart Association nevertheless maintains an official recommendation that patients with the metabolic syndrome (pre-diabetes) should eat more fish – or take fish-oil supplements.

But certainly, you raise a fair point – consuming nutrient-rich foods in their natural form is important, because theoretically, because it represents a smart trade-off: Chances are good that your fish-based meals are replacing other less-good-for-you protein sources, like pork or red meats.

Scripts: Many of the studies wrapped into this latest analysis didn’t follow patients for the long-term. Isn’t it possible that, especially for patients who have not developed heart disease, there still is some longitudinal benefit from supplements?

Block: Absolutely! This is a major limitation of the study, and a point that’s getting a good deal of press attention. When it comes to preventive cardiology, we’re keenly focused on long-term health risks – looking ahead 30 to 50 years, rather than shorter periods like these trials are studying.

What’s more, sample size really matters – and is often overlooked by the public. Frankly, many of the studies wrapped into this most recent meta-analysis (a “study of studies”) were probably too small to detect the modest but important risk-reduction role supplements likely play.

Scripts: So bigger, longer-term studies are warranted – that makes sense. But, are all fish-oil supplements created equal?

Block: Supplements definitely vary in quality – and of course, cost. Take Lovaza, for instance; it’s an FDA-approved prescription drug composed of about 85 percent EPA and DHA, the most important fatty acids in fish, and is commonly prescribed for diabetics and obese folks with high triglycerides (a major cause of pancreatitis—a very serious health issue).

On the other hand, cheaper, over-the-counter options generally pack only 30 to 60 percent EPA and DHA. Many people at high-risk for cardiovascular disease take them (including me) because they feel better doing so, and are banking on their potential for longer-term health benefits.

Of course, it’s important to note that improving heart health isn’t the only thing omega-3 fatty acids have been lauded for.  Other studies have found fish-oil supplements to reduce joint pain and stiffness, boost the effects of anti-depressants, and play an important, brain-building role in the womb (aiding babies’ neurological and visual development). So, it’s important that we take new studies in stride, looking closely at their design and asking how each fits into the bigger picture of all the science that’s gone before – as well as the science that’s currently underway.

Dr. Block specializes in the care of patients with high blood cholesterol levels. If you’ve been diagnosed with unhealthy cholesterol levels, and are you looking for help getting them under control, call URMC’s Lipid Clinic at URMC at (585) 341-7700.

Is ‘The Change’ Really to Blame for Memory Woes?

No, you’re not imagining it. New research out of the University of Rochester Medical Center and the University of Illinois published in the journal Menopause this month, offering some concrete evidence proof that the “brain fog” striking some women in their late 40s and 50s is indeed real.

While the findings come as no surprise to the millions of women who’ve had bouts of forgetfulness as hormone levels wane, the science provides a fascinating glimpse into which aspects of memory might actually be affected – and begs big questions as to why. To learn more, we spoke with URMC study leader and neuropsychologist Dr. Miriam Weber.

Scripts: When it comes to memory troubles and menopause, we often automatically think of trouble with recall – say, making a “mental note” to pick up a gallon of milk on the way home from work. But this study suggests that this particular type of memory isn’t at issue, and the problem might actually lie with “working memory” (e.g., our ability to manipulate new information, like calculating a “30 percent off” sale price), or with our ability to keep focus amid challenging tasks. Do we have any idea why this might be – or what tricks women can use to compensate, staying sharp?

Weber: That’s a great question. We don’t know precisely why so many menopausal women seem to having difficulty in these areas; we’ve long assumed that it’s related to hormonal fluctuations, but data from this particular study doesn’t provide clear answers.

To compensate, though, most women would do well to minimize multi-tasking. By really homing in and focusing their attention on one thing at a time, they might be more successful in helping their brains encode the new information. Since our data suggests that women’s complaints aren’t associated with a true retention problem (e.g., remembering that gallon of milk), if they can successfully encode it, they should be able to hold onto it. So, tricks might be to pay careful attention, get rid of distractions, and practice repeating the new information a few times. Of course, day planners and sticky notes can’t hurt, either!

Scripts: Did any women in the study seem to escape the “memory fog?” Did the degree of memory troubles vary much among participants?

Weber: Yes. About a third of the women in our study sample didn’t have significant memory complaints, and their having fewer complaints played out in our tests – they performed better on working memory and attention tasks.

Those who did have memory complaints, however, also tended to have more symptoms of depression, anxiety and sleep difficulties – but not worse hot flashes. What’s more, their cognitive performance troubles remained even after controlling for these other symptoms – meaning the cognitive troubles can’t simply be attributed to these other symptoms. It’s not “just” depression; something more is at play.

Scripts: Was it surprising that changing hormone levels seemed unlinked to actual memory troubles?

Weber: To be honest, we weren’t completely surprised. Other studies also have failed to show a relationship in this population.

That said, we think this might be due to how we are measuring the hormone. For instance, researchers typically measure at one point in time, rather than capturing cumulative exposure – which might be important. There is some suggestion that hormonal fluctuations, rather than the absolute level at any one time, are tied to depressive symptoms in women in the menopausal transition. So, vacillating levels might have implications for cognitive problems. It certainly would be of interest for future studies!

Scripts: We know your paper doesn’t address this issue specifically, but is there thought that, after menopause, women’s cognitive abilities stabilize and/or return to pre-menopause levels?

Weber: It’s certainly possible. Back in 2009, a study published in the journal Neurology found that, in a sample of nearly 2,000 women, some very mild cognitive declines in the late transition stage did indeed rebound to early levels post-menopause. So, that particular study seems to suggest that women might stabilize and/or see their capabilities return to pre-menopause levels. Our study will follow participants for five years, so we eventually hope is to be able to shine light on this, too.

Scripts: So, what’s the big takeaway message for women?

Weber: The most important thing to realize is that there really are some cognitive changes that occur during this phase in a woman’s life. If a woman approaching menopause feels she is having memory problems, no one should brush it off or attribute it to a jam-packed schedule.

That said, it’s really important to note that any difficulties experienced are not incapacitating! She should be able to function just fine, though she might be working a little harder at it than she has in the past. Women should take comfort in knowing that their concerns are common, and that the currently available data suggests that these difficulties might actually be short-lived.

To learn more about the study, click here.

Too Tangled Up in Preparations to Enjoy the Season?

As a child, a blanket of fresh-fallen snow or the buttery scent of warm sugar cookies was all it took to arouse that delicious sense of wonder.

Somehow, as an adult, that thrill is harder to come by. Maybe it’s because, rather than snuggling up and watching the Charlie Brown special, you’re pulling late-nighters to dutifully manufacture cookie trays, shovel driveways, unravel knotted lights, and battle paper-cuts (and sore backs) during gift-wrapping marathons.

But does it have to be that way? Do hectic preparations have to dominate the weeks leading up to the celebration? What if, rather than focusing on the “big finish” or making a future moment perfect, we slowed down and made a point to intentionally enjoy the season, stress and shopping and all?

Practicing mindfulness – a fancy way of saying “being in the moment” or “tuning in” – can be a solution, says URMC internist Dr. Michael Krasner. An expert on the art (and science!) of intentionally “appreciating the journey,” Krasner travels worldwide training physicians as to how they can bring “intention, attention and reflection” to their clinical practice (thereby reducing stress, heading off burnout, and improving patient care).

But can his insights apply to your holiday hubbub?

Definitely. Granted, you can’t buck those time-intensive traditions altogether (bah, humbug!), but Dr. Krasner says we can find ways to enjoy the planning, and the season, itself. In this week’s clip he offers some practical tips for unwinding, including:

(1)    Setting the tone. Lighting a spicy fragranced candle or whipping up a special hot drink before setting to work on a wrapping or baking bonanza makes a big difference.  This cheerful tone helps to make those must-do chores part of the fun – rather than something to rush through.

(2)   Making it social. Not only do you split the work when you invite pals to tag along – but you transform a task you’ve been avoiding into a special gathering.

(3)    Slowing down. To avoid the post-holiday let-down, let up on the gas. Pause to enjoy aromatic sensation of baking, the textures and colors of fancy wrapping supplies, the glitter of the lights in your neighborhood. If you want to treasure vivid memories of the season, you have to slow down, like a child, and take time to wonder afresh at its beauty.

To learn more about Dr. Krasner’s work training physicians to be mindful, click here.