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In 1999, when Jacks McNamara, a thoughtful, dark-haired artist from Oakland, was a 19-year-old junior at Brown University, she had a sudden breakdown. McNamara came out of the hospital convinced there must be a better way; over the next several years she connected with others who shared her thinking. The Icarus Project, an entirely peer-run organization with more than 15,000 members worldwide, is part of a growing, sometimes controversial, cause known as the Recovery Movement, or Mad Pride. In a departure from groups like Alcoholics Anonymous, the Icarus Project doesn't push a particular brand of self-help.
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Join tens of thousands of doctors, health professionals and patients who receive our newsletters. New research has found that smokers who had a stroke in a brain region called the insular cortex were more likely to quit smoking than those who had strokes in other regions of the brain.
Active smokers who had strokes in the insular cortex region of the brain were more likely to quit smoking than smokers who had strokes in other regions of the brain. Smokers who had strokes in the insular cortex also did not experience as many withdrawal symptoms as those who had strokes in other regions of the brain. This new research takes the form of two studies that are published in the journals Addiction and Addictive Behaviors, respectively. According to the Centers for Disease Control and Prevention (CDC), cigarette smoking is the leading cause of preventable disease and death in the US, accounting for more than 480,000 deaths every year.
Due to the addictive qualities of nicotine, it can be difficult to quit smoking once it has become a habit. At present, prescription drugs that are used to help people quit smoking work by disrupting "reward" pathways in the brain that respond to nicotine. Previous studies have suggested that the insular cortex region of the brain could play a significant role in the cognitive processes that enable drug use. To investigate, the researchers set out to discover whether smokers who had suffered damage to the insular cortex from a stroke were more likely to quit smoking than smokers with acute damage to other regions of the brain. The two studies measured two different indicators of smoking cessation likelihood: how severe their cravings were during hospitalization from their stroke and whether or not they resumed smoking following their stroke.
A total of 156 patients with stroke were assessed in the study, all of whom were active smokers.
After measuring multiple aspects of withdrawal during hospitalization, the researchers found that the patients who had strokes in the insular cortex experienced fewer and less severe withdrawal symptoms compared with the patients whose strokes occurred in other brain regions.
The researchers also followed up the patients 3 months after their strokes, assessing their self-reported smoking status and any abstinence from nicotine products.
They found that while 37% of patients with strokes in other parts of the brain had quit smoking, 70% of the patients with strokes in the insular cortex had.
Although the studies involved a relatively small number of patients who experienced damage to the insular cortex, the researchers believe these findings support the potential role of this area of the brain in maintaining smoking and nicotine abstinence. Previously, Medical News Today reported on a study investigating a new type of anti-smoking therapy.
University of Rochester Medical Center news release, accessed 8 September 2015 via EurekAlert. Additional source: CDC, Current cigarette smoking among adults in the United States, accessed 8 September 2015.


Please use one of the following formats to cite this article in your essay, paper or report:MLAMcIntosh, James. For any corrections of factual information, or to contact our editorial team, please see our contact page. Please note: Any medical information published on this website is not intended as a substitute for informed medical advice and you should not take any action before consulting with a health care professional.
We discuss the many different ways to quit smoking, from smoking cessation products to help wean you off nicotine to counselling, support groups and organized programs. Once the initial target dose or blood level is achieved, medication adjustments may be considered within 1 to 2 weeks if there is insufficient improvement. The agent(s) used to successfully control a manic episode are typically continued for maintenance purposes. In the absence of persistent psychosis, adjunctive antipsychotics used for acute control may be slowly tapered after a reasonable period of mood stability is achieved. Maintenance treatment should be continued for at least 6 to 12 months after complete remission of a manic episode before assessing the need for ongoing treatment.
While lithium’s exact mechanism of action is unknown, its ability to modulate various aspects of brain chemistry is consistent with many current models of the pathogenesis of bipolar disorder.
In addition, lithium interacts with G-protein and second messenger systems leading to downstream effects on DNA transcription, which may serve to explain its long-term therapeutic effects. Lithium is rapidly absorbed in the gastrointestinal tract, is not protein bound, and distributes throughout total body water with peak serum concentrations at 1 to 2 hours after administration (4 to 5 hours for slow-release preparations).
Lithium is usually started at 300 mg, 2 or 3 times daily, and gradually increased 300 to 600 mg every 1 to 5 days based on response to treatment, blood levels, and tolerability. Formerly an outgoing, involved student, McNamara grew so obsessed with thoughts of corporate conspiracies and the end of the world that she stopped going to class. After her insurance company stopped paying for her care, she transferred to a nonprofit hospital, where she was diagnosed with bipolar disorder.
In 2002 she cofounded the Icarus Project, an alternative support group for people struggling with mental illness.
Meetings, in places as diverse as Minneapolis and Richmond, are lively, lacking any firm structure, and dark humor is a constant. The research has led scientists to conclude this region could be crucial in treating addiction. While smoking rates have fallen in recent years, from approximately 21 of every 100 adults in 2005 to 18 of every 100 adults in 2013, cigarette smoking is still behind 1 in every 5 deaths in the US. Unfortunately, this form of treatment has a high rate of smoking relapse, with an estimated success rate of up to 30% after 6 months. It is unclear, however, as to whether changes in this region of the brain have any effect on drug use. The researchers determined the locations of their strokes using magnetic resonance imaging (MRI) and computed tomography (CT) and divided the patients into those whose strokes occurred in the insular cortex (38 patients) and those whose strokes occurred elsewhere (118 patients).
In the study, researchers assessed a bacterial enzyme that consumes nicotine "like a little Pac-Man" that may be able to prevent the drug from reaching the brain. When feasible, dose adjustments of the initial medication(s) should be attempted before the addition of another medication to minimize adverse effects, drug interactions, and unnecessarily complicated treatment regimens—all of which may exacerbate adherence problems.
Thus, the most commonly recommended treatments mirror those used for acute management and include lithium, valproate, and second-generation antipsychotics.


If benzodiazepines are used for acute stabilization, they should also be slowly discontinued when symptoms are resolved.
Given the high relapse rates with discontinuation, however, it is generally recommended that maintenance therapy continue indefinitely. Lithium exerts multiple biochemical effects at a variety of targets owing to its relatively simple nature. In her mind, life resembled a dystopian science fiction movie, and she often couldn't remember what day it was.
She rang in the millennium watching TV in the dreary patients' lounge—and spent the next ten days in treatment as doctors gave her a series of symptom checklists and tried to determine the right medication. Members may take turns one-upping each other over the records they've broken while depressed (30 straight days of not getting dressed trumps 20 days of not answering the phone). The Watch OWN app is free and available to you as part of your OWN subscription through a participating TV provider. At times, however, the combination of lithium plus valproate will more effectively control acute symptoms. In addition, risperidone long-acting injectable formulation (alone or in combination with lithium or valproate) may be considered for patients with a history of poor oral absorption or inadequate adherence. Maintenance ECT may be continued after a successful acute treatment course at the lowest possible frequency, if symptoms are not adequately controlled with medication(s) and psychotherapy. If lithium is discontinued, it should be done by a slow taper over several weeks to decrease the risk of relapse.
Because of its similarity to other cations (eg, Na+, K+, Ca++, Mg+), lithium can alter ion channels and pumps in cell membranes.
Its typical half-life in a healthy adult is about 24 hours, and steady-state serum levels are usually achieved in 4 to 5 days. If dose adjustments are made, a lithium trough (10 to 12 hours after the last dose) level should be drawn 5 to 7 days after the change to properly reflect the new steady-state concentration.
She often felt marginalized, belittled, and misunderstood by these psychiatrists, none of whom provided the trauma therapy she thought she needed (and that might have plumbed her history of sexual abuse and assault).
The Oakland chapter convenes at a crafters' collective to bring an inspiring, creative energy to sessions.
This strategy is usually done in a sequential fashion rather starting both medications simultaneously. At times, combined treatments may enhance efficacy but often at the cost of a greater adverse effect burden. It is also implicated in the modulation of neurotransmitters and neuropeptides such as lithium-induced decreases in beta-adrenergic receptor number, beta-adrenergic activity through inhibition of thyroid hormone, dopamine receptor supersensitivity, and glutamate-mediated calcium signaling; and increases in serotonin release. In this context, the results of the BALANCE study indicate that lithium alone is more likely to prevent relapse than valproate alone.14 However, it is unclear whether lithium alone is as effective in preventing relapse as the combination of lithium and valproate.
In addition, psychotherapy to address residual mood symptoms and comorbid conditions such as substance use disorders is critical to achieving and maintaining a successful outcome.



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