UNDERSTANDING MENTAL ILLNESS

This may be of assistance as you journey through my blog…

DEPRESSION

Problems and misfortunes are a part of life. Everyone experiences unhappiness, and many people may become depressed temporarily when things don’t go as they would like. Experiences of failure commonly result in temporary feelings of worthlessness and self-blame, while personal losses cause feelings of sadness, disappointment and emptiness. Such feelings are normal, and they usually pass after a short time. This is not the case with depressive illness.What are the signs of depressive illness? 

Depression becomes an illness, or clinical depression, when the feelings described above are severe, last for several weeks, and begin to interfere with one’s work and social life. Depressive illness can change the way a person thinks and behaves, and how his/her body functions. Some of the signs to look for are:~~ feeling worthless, helpless or hopeless,
~~ sleeping more or less than usual,
~~ eating more or less than usual,
~~ having difficulty concentrating or making decisions,
~~ loss of interest in taking part in activities,
~~ decreased sex drive,
~~ avoiding other people,
~~ overwhelming feelings of sadness or grief,
~~ feeling unreasonably guilty,
~~ loss of energy, feeling very tired,
~~ thoughts of death or suicide.
 

STIGMA: Definition

Source:  YourDictionary.com

stigma (stig′mə)

noun pl. stigmas -·mas, stigmata stig·ma′ta (stig′mə tə; stig mät′ə, -mat′ə)

1. something that detracts from the character or reputation of a person, group, etc.; mark of disgrace or reproach
2. a mark, sign, etc. indicating that something is not considered normal or standard

Living with a mental illness is trying enough, yet we must also contend with mental illness stigma

Is Cognitive Therapy In Schizophrenia of Value?

ScienceDaily (June 26, 2009) — Research co-led by an academic at the University of Hertfordshire, concludes that cognitive behavioural therapy (CBT) is of no value in schizophrenia and has limited effect on depression.

Professor Keith Laws, at the University’s School of Psychology, is one of the lead authors on a paper entitled: Cognitive behavioural therapy for major psychiatric disorder: does it really work? A meta-analytical review of well-controlled trials, which has just been published online in the journal Psychological Medicine. The paper reviews the use of CBT in schizophrenia, bipolar disorder and major depression.

The results of the review suggest that not only is CBT ineffective in treating schizophrenia and in preventing relapse, it is also ineffective in preventing relapses in bipolar disorder.

The review also suggests that CBT has only a weak effect in treating depression, but it has a greater effect in preventing relapses in this disorder.

The authors focused particularly on methodologically rigorous trials that compared CBT to a ‘psychological placebo’ and also investigated the impact of ‘blinding’, i.e. whether or not the people who assessed the patients knew if they were receiving active treatment or not. Both factors are considered essential before a drug treatment is approved for use in psychiatric disorders.

The authors noted that not a single trial employing both blinding and psychological placebo has found CBT to be effective in schizophrenia and surprisingly few well-controlled studies of CBT in depression.

“The results of this review are important because in March NICE re-approved CBT for use in all people with schizophrenia. The Government is also investing millions of pounds to provide CBT for depression and anxiety in 250 dedicated therapy centres across England,” said Professor Laws. “Yet the evidence here is that the effectiveness of this form of therapy may be less than previously thought, to the point of being non-existent in schizophrenia.”

Adapted from materials provided by University of Hertfordshire, via AlphaGalileo.

http://www.sciencedaily.com/releases/2009/06/090625074512.htm

Earlier depressive mood linked with preterm birth

NEW YORK (Reuters Health) – June 25, 2009 – Both black and white women with symptoms of depressive mood prior to becoming pregnant have increased risk for preterm birth; but black women have twice the risk as white women, researchers report in the Journal of Women’s Health.

“The black-white disparity in preterm birth may be in part a consequence of different exposures to depressive mood prior to pregnancy,” Dr. Amelia R. Gavin, at the University of Washington in Seattle, told Reuters Health.

However, previous investigations of this association were inconclusive, leading Gavin and colleagues to assess links between race, preterm birth, and prepregnancy depressive mood among 555 women who were 24 years old on average when they gave birth.

The researchers used data collected from 1990 through 1996 for a larger long-term investigation of heart disease risk, in which the women had participated.

In the current study, 18.1 percent of the 249 black women gave birth prior to 37 weeks gestation. This preterm birth rate was more than twice the 8.5 percent rate seen among the 306 white women.

Prepregnancy depressive mood was also more prevalent among black versus white women – 9.4 versus 7.2 percent. Depression scale examinations conducted in 1990 to 1991, showed black women with higher depressive mood scores than white women – 13.0 versus 9.5.

Furthermore, black women’s risk for preterm birth remained more than twice that of white women’s risk when Gavin’s team allowed for other factors associated with preterm birth, such as body weight and sociodemographic characteristics.

“Reproductive outcomes must be viewed in light of women’s health over the entire life-course, as well as during pregnancy,” Gavin said.

These current findings suggest “the experience of cumulative health disadvantages or ‘weathering,’” may play a role in increased risk for preterm birth, Gavin notes.

She and colleagues, therefore, suggest replication of this study in a larger population of women.

SOURCE: Journal of Women’s Health, June 2009.

http://www.reuters.com/article/healthNews/idUSTRE55O6B120090625

Things That Trigger Migraines

Common causes among women

By Diana Kohnle

(HealthDay News) — June 25, 2009 – While migraines and their causes vary from person to person, researchers have identified some common triggers.

The National Women’s Health Information Center offers this list:

• Too much sleep, or not enough shut-eye.
• Missing meals.
• Overstimulated senses, including noises that are too loud, scents that are too strong, or lights that are too bright.
• Hormonal changes.
• Stress.
• Changes in the weather.
• Drinking red wine or changes in caffeine intake.
• Aspartame, an artificial sweetener.
• Food additives such as tyramine, monosodium glutamate (MSG) or nitrates.

http://www.nlm.nih.gov/medlineplus/news/fullstory_86082.html

Irritability Considered When dx BP In Children

Irritability Should Be Considered When Diagnosing Bipolar Disorder In Children

ScienceDaily (June 25, 2009) — A new study from Bradley Hospital and The Warren Alpert Medical School of Brown University, as well as two other institutions, adds to mounting evidence that clinicians consider irritability as a symptom when diagnosing pediatric bipolar disorder.

Reporting in the July issue of the Journal of the American Academy of Child and Adolescent Psychiatry, researchers say a small percentage of children with bipolar disorder experience manic episodes without extreme elation – one of the hallmarks of the disorder – and are diagnosed based on irritable mood alone.

“Diagnosing children with bipolar disorder is challenging. One of the chief controversies is whether irritability should be included among the criteria for this diagnosis because it can also overlap with a number of other psychiatric disorders, such as attention deficit hyperactivity disorder,” says lead author Jeffrey Hunt, MD, a child psychiatrist and training director at Bradley Hospital. “Our findings confirm that while irritable-only mania is uncommon, it does exist – particularly in younger children – and should be considered in a bipolar diagnosis.”

Bipolar disorder is characterized by dramatic mood swings from euphoria, elation and irritability – the manic phase of the disorder – to severe depression. Bipolar disorder often begins in late adolescence or early adulthood, although it can develop as early as the preschool years. Recent studies have shown that the number of children and teens being treated for bipolar disorder has grown dramatically in the last decade. Although it is unclear what has caused this increase, experts believe it may be due in part to more aggressive diagnoses by physicians and a greater awareness of pediatric bipolar disorder in the medical community.

Hunt and colleagues studied 361 children between the ages of 7 and 17 with bipolar disorder participating in the multi-site Course and Outcome of Bipolar Illness in Youth (COBY) study at Bradley Hospital and Alpert Medical School, the University of Pittsburgh and the University of California-Los Angeles. COBY is the largest and most comprehensive study of children and adolescents with bipolar disorder to date.

Researchers quantified the frequency and severity of manic symptoms of each participant, including whether irritability and elation were present. Based on this data, the group was then reclassified into three subgroups: elation-only, irritable-only and both elated and irritable.

Approximately 10 percent of children fell into the irritable-only category, while elated-only constituted about 15 percent. Nearly three-quarters experienced both elation and irritability. The irritable-only participants were significantly younger in age than the other two groups; however, there were no other sociodemographic differences between the groups. There were also no significant differences in terms of bipolar subtype, rate of psychiatric comorbidities, severity and duration of illness, and family history of mania and other psychiatric disorders. However, depression and alcohol abuse in second-degree relatives occurred more frequently in the irritable-only subgroup.

“The fact that the irritable-only and elation-only subgroup had similar clinical characteristics and family histories of bipolar disorder provides support for continuing to consider episodic irritability in the diagnosis of pediatric bipolar disorder,” says Hunt, who is an assistant professor of psychiatry and human behavior at Alpert Medical School. Hunt is also training director of the child and adolescent fellowship and triple board residency programs.

The authors say continual, long-term follow-up of this study sample will help clarify whether the presence or predominance of elation or irritability at baseline will predict future clinical outcomes.

Adapted from materials provided by Lifespan, via EurekAlert!, a service of AAAS.

http://www.sciencedaily.com/releases/2009/06/090624152943.htm

Smoking More Than Five Cigarettes A Day May Provoke Migraine Attacks

ScienceDaily (June 24, 2009) — Tobacco acts as a precipitating factor for headaches, specifically migraines, new research suggests. This is indicated in a study which shows that smokers have more migraine attacks and that smoking more than five cigarettes a day triggers this headache. The work has appeared in the Journal of Headache and Pain.

The influence of tobacco as a precipitating, non-causal factor of migraine attacks has produced contradictory data in scientific literature. The limited research prior to the work published in The Journal of Headache and Pain indicated that smoking could improve migraines by reducing anxiety, one of the factors that triggers an attack.

“This study is groundbreaking in Spain as there are few studies on this topic, and all are very biased. This is due to the complexity and need for prior training of the participants”, Julio Pascual, one of the authors of this research and doctor at the Neurology Unit of Marqués de Valdecilla, University Hospital (Santander), explains to SINC.

One advantage of this study is that the sample used, 361 medicine students from the University of Salamanca, were fully aware what a migraine was. The experts, who enquired about the presence or absence of migraine (and its characteristics) and whether or not they smoked, guaranteed the reliability of the results obtained, as most surveys for this type of study are done over the phone, randomly and in people without knowledge of the illness.

The results show that 16% of students fulfilled migraine criteria, while 20% smoked. The percentage of smokers was higher (29%) in those who were also migraine sufferers and migraine frequency in those students who were migraine sufferers and smokers was clearly higher than in those who were non-smokers and migraine sufferers.

According to Pascual, “smoking is a precipitating factor of this type of headache, as the prevalence of active smokers is one third higher in migraine sufferers and there is a direct relationship between the number of cigarettes consumed and the frequency of migraine attacks”.

The researchers stressed the importance of the dosage. The results of the interviews reveal that the migraine sets in after five daily cigarettes. Furthermore, although the percentage of those who smoked was higher in people with migraines, they smoked less than those who did not suffer migraines.

SITTING IN JUDGMENT

Who am I to judge someone?   Who are they to judge me?

Dictionary:  Judgment: the ability to judge, makes a decision, or form an opinion objectively, authoritatively, and wisely, esp. in matters affecting action; good sense; discretion: a man of sound judgment.

Stigma: a mark of disgrace or infamy; a stain or reproach, as on one’s reputation; a mental or physical mark that is characteristic of a defect or disease: the stigmata of leprosy.

In my opinion, judgment intertwines with stigma.  Why do we judge?

I have voiced previously about my personal experience with both judgment and stigma, in the instance of a family member.  Not long after my hospitalization with major depression, my brother-in-law severed ties with my spouse and me, fearing for his children (or so he claimed).  Each Christmastime thereafter my name was omitted from the Christmas card; only my spouse’s name appearing.  I did nothing immoral or sinful, yet I was judged due to my illness of depression.  That was a case of both judging and stigma of mental illness.

Riding the bus home last Friday, was a true example of judging/stigma. 

A very large woman boarded the already crowded bus, and of course, no one offered her a seat.  I was seated almost to the rear of the bus, aside this young woman.  Immediately, this woman turns to me and says “wow, she is huge, disgusting, you would think she would take better care of herself”.  I retorted back “who are we to judge?”  She gave me a very dirty look.  I also overheard insulting comments behind me about this woman, “imagine her poor husband”, and “she must eat at McDonalds four times per day”; unfair remarks.  Stigma and unfair judgment.

Who made these people judges?  It is unknown what is happening in other people’s lives.  Perhaps they lost a family member, maybe surviving a divorce, surviving mental illness or another illness.  Even if it wasn’t any of those, what affect is it having on anyone else’s life anyways?  Why would it be up to someone else to pass a comment?  What about them; are they so perfect?  I think not. 

The way I try and live my life is, and live by these words; if it doesn’t directly affect me, then why should I judge another person?

Many years ago, a friend of mine was going through marital problems, was married a few times, and her family all but deserted her.   I believe they felt disgrace due to this.  It was her words that forever stuck in my head, “who are they to judge me – this is not affecting them”.  There were no children in the picture.  It think it’s nosy, opinionated people most times, who have to have their say.  They judge, and criticize and hurt.  And they repeat this practice over and over, causing riffs in families or friends.  Do they have self-esteem problems?

I’m not an angel, for I have done it myself; but I try to be aware of it as much as possible.  I think it’s almost required to have an opinion, who would want to go through life and not be opinionated.  But when it travels outside that realm and leaves a trail of judgment and hurt; then it’s gone too far.

Written by:  ME

FDA panel weighs antipsychotic drug use in kids

ADELPHI, Maryland (Reuters) – June 09, 2009 – U.S. advisers began considering on Tuesday whether the makers of three blockbuster antipsychotic drugs should be allowed to promote them for children and teens with schizophrenia or bipolar disorder.

Eli Lilly and Co’s Zyprexa, AstraZeneca’s Seroquel and Pfizer’s Geodon are approved for adults and already used to treat children. But the companies need Food and Drug Administration approval before they can advertise them specifically for youths as young as 10.

Winning FDA clearance for wider use may boost sales, which already top a combined $10 billion annually.

Reviewers at the FDA agree the medicines appear effective for treating symptoms, Dr. Thomas Laughren, director of its psychiatry drugs division, told a panel of outside experts. The agency wants the advisers to consider the risks of weight gain, sleepiness and other reactions before deciding whether to recommend approval in younger patients, he said.

Side effects “are of particular concern in pediatric patients primarily because these are lifelong disorders, and these children would face many decades of taking these drugs,” Laughren said.

The drugs are members of a family called atypical antipsychotics. Two similar medicines, Johnson & Johnson’s Risperdal and Bristol-Myers Squibb Co’s Abilify, already are approved to treat youths with bipolar disorder or schizophrenia.

The medicines under review already are widely used. Zyprexa is Lilly’s top-selling drug, with sales of $4.7 billion. Seroquel is the second-best-selling product for AstraZeneca, with 2008 sales of $4.5 billion. Sales of Pfizer’s Geodon topped $1 billion in 2008.

Laughren said it was “important to acknowledge that both schizophrenia and bipolar disorder are serious illnesses in pediatric patients” and place burdens on families. Schizophrenia causes hallucinations, delusions and disorganized thoughts, while bipolar disorder causes dramatic mood swings from manic episodes to depression.

AstraZeneca data showed children “are susceptible to the same risks seen of (Seroquel) for adults,” Liza O’Dowd, a vice president of the company, told the panel. The risks “can be monitored and managed” and are described in the drug’s prescribing instructions, she said.

Lilly and Pfizer were scheduled to speak to the panel later on Tuesday. In summaries released before the meeting, both companies said their drugs’ risks were acceptable, given their benefits for treating serious mental illnesses.

The FDA advisers were expected to vote Wednesday on whether the medicines were effective and acceptably safe for various age groups. The agency will make the final decision, but usually follows panel recommendations.

AstraZeneca and Lilly are seeking approval for treating acute episodes of both schizophrenia and bipolar mania. Pfizer’s application asks for approval only in bipolar disorder.

(Reporting by Lisa Richwine; Editing by Lisa Von Ahn)

CHRONIC DEPRESSION – WORK PERFORMANCE

How Much Does Chronic Depression With Medical Disorders Affect Work Performance?

ScienceDaily (June 18, 2009) — An Australian study shows that affective disorders comorbid with medical, somatic illnesses have a major impact on health-related quality of life and disability with more pronounced effects in dysthymic disorder than in major depressive disorder. Differences in the time course of both conditions might contribute to this finding.

The results support the need for an improved identification and treatment of affective disorders in patients with somatic illnesses.

A group of Australian researchers investigated in medical disorders the effects of comorbid dysthymic disorder as compared to major depressive disorder (MDD) on health-related quality of life (HR-QoL) and disability days in the general population. In a population-based study 4,181 individuals were assessed for the presence of dysthymic disorder and depression, utilizing the Composite International Diagnostic Interview. Each participant received a thorough medical examination to assess the presence of comorbid somatic conditions. HR-QoL was evaluated using the Medical Outcomes Survey Short-Form 36 (SF-36) and disability days were provided by self-report.

Descriptive statistics, analysis of variance and multivariable logistic regression were used. Comorbidity with illnesses from a maximum of 6 somatic disease groups was more prevalent in persons with dysthymic disorder (78.7%) than in those with MDD (70.4%). Persons with dysthymic disorder had a significantly lower mental health summary score in the SF-36 and more disability days than those with MDD. The physical health summary scores were not significantly different between participants with dysthymic disorder and MDD (after Bonferroni correction), suggesting that limitations in physical functioning due to comorbid medical conditions were similar in both affective disorder groups.

The results of this investigation show that affective disorders comorbid with medical, somatic illnesses have a major impact on HR-QoL and disability with more pronounced effects in dysthymic disorder than in MDD. Differences in the time course of both conditions might contribute to this finding. The results support the need for an improved identification and treatment of affective disorders in patients with somatic illnesses.

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Adapted from materials provided by Journal of Psychotherapy and Psychosomatics, via AlphaGalileo.

http://www.sciencedaily.com/releases/2009/06/090616182601.htm

FDA Warnings & Depression Diagnosis

FDA Warnings Led To Unintended Changes In Depression Diagnosis, New Report Finds

ScienceDaily (June 16, 2009) — Government warnings about suicidality among children taking antidepressants appear to be associated with unintended and persistent changes in the diagnosis and treatment of depression in children and adults, according to a new report.

“In October 2003 the Food and Drug Administration (FDA) issued a Public Health Advisory about the risk of suicidality for pediatric patients taking antidepressants; a boxed warning, package insert and medication guide were implemented in February 2005,” the authors write as background information in the article. “The warning was extended to young adults aged 18 to 24 years in May 2007. Immediately following the 2003 advisory, unintended declines in case finding and non–selective serotonin reuptake inhibitor substitute treatment were shown for pediatric patients, and spillover effects were seen in adult patients, who were not targeted by the warnings.”

To determine whether these unintentional consequences have persisted, Anne M. Libby, Ph.D., and colleagues at the University of Colorado Denver’s School of Medicine analyzed patterns in a national integrated managed care claims database from July 1999 through June 2007. During this time period, 91,748 children (ages 5 to 18), 70,311 young adults (ages 19 to 24) and 630,748 adults (ages 25 to 89) were diagnosed with depression.

Pregnancy and Bipolar Disorder

Managing Pregnancy and Bipolar Disorder

Women with chronic medical illnesses, including bipolar disorder, often desire to have children but are concerned about the impact of a pregnancy on their illness and about the potential effects of the medications that they take on their child. In a recent issue of the American Journal of Psychiatry, researchers summarized what is known from the research literature about this important issue.1 Their findings are summarized below.

Because bipolar disorder emerges during young adulthood and persists throughout the lifespan, women of childbearing age are at risk for this illness. Pregnancy and delivery can influence the symptoms of bipolar disorder: pregnant women or new mothers with bipolar disorder have a sevenfold higher risk of hospital admission and a twofold higher risk for a recurrent episode, compared with those who have not recently delivered a child or are not pregnant.

Careful planning for pregnancy can help women with bipolar disorder optimally manage their illness to minimize their symptoms and avoid risks to the fetus. Experts suggest it is important to avoid sudden changes in medication during pregnancy, because such changes may increase side effects and risks to the fetus, and also increase the risk of relapse of the illness before or after the woman gives birth.

Sleep May Be Important In Regulating Emotional Responses

ScienceDaily (June 12, 2009) — According to a research abstract that will be presented on June11, at Sleep 2009, the 23rd Annual Meeting of the Associated Professional Sleep Societies, sleep selectively preservers memories that are emotionally salient and relevant to future goals when sleep follows soon after learning. Effects persist for as long as four months after the memory is created.

Results indicate that the sleeping brain seems to calculate what is most important about an experience and selects only what is adaptive for consolidation and long term storage. Across long delays of 24 hours, or even three–to-four months, sleeping soon after learning preserved the trade-off (compared to waiting an entire day before going to sleep).

According to lead author, Jessica Payne, PhD, of Harvard Medical School in Boston MA, It was surprising that in addition to seeing the enhancement of negative memories over neutral scenes, there was also selectivity within the emotional scenes themselves, with sleep only consolidating what is most relevant, adaptive and useful about the scenes. It was even more surprising that this selectivity lasted for a full day and even months later if sleep came soon after learning.

“It may be that the chemical and physiological aspects of sleep underlying memory consolidation are more effective if a particular memory is ‘tagged’ shortly prior to sleeping,” said Payne.

The study included data from 44 college students between the ages of 18 and 22 who encoded scenes with neutral or negative objects on a neutral background and were tested on memory for objects and backgrounds 24 hours later. Half of the participants were randomly assigned to the ’sleep first’ group, which trained and tested on the scenes between the hours of 7 and 9 p.m. while the other half was assigned to the ‘wake-first’ group which trained and tested on the scenes between the hours of 9 and 11 a.m. Four months later, participants were once again tested on their memory of the scenes.

Negative, but not neutral objects were better remembered in the sleep-first than wake-first group. Backgrounds associated with negative, but not neutral objects were more poorly remembered in the sleep-first compared to the wake-first group. Thus, while negative object memory was enhanced in the sleep-first group compared to the wake-first group, memory for the backgrounds on which they were presented was impaired in the sleep-first group compared to the wake-first group. This pattern persisted four months later, with emotional objects being preferentially retained in the sleep-first group only.

Payne said that sleep is beneficial for memory and that we remember things best when we ’stagger’ our learning episodes across time.

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Adapted from materials provided by American Academy of Sleep Medicine.

http://www.sciencedaily.com/releases/2009/06/090611071359.htm

Symptoms Of Depression In Obese Children Linked To Elevated Cortisol

ScienceDaily (June 11, 2009) — A new study connects abnormalities of the “stress” hormone cortisol with symptoms of depression in obese children, and confirms that obesity and depression often occur together, even in children. The results were presented at The Endocrine Society’s 91st Annual Meeting in Washington, D.C.

“There is evidence in adults that abnormal regulation of cortisol plays a role in both obesity and depression,” said the study’s lead author, Panagiota Pervanidou, MD, of Athens University Medical School in Athens, Greece. “Our study indicates that cortisol abnormalities may underlie obesity and depression starting in childhood.”

Cortisol is a steroid hormone that helps the body respond to stress but also has other functions, including converting fat, protein and carbohydrates into energy. Normally, levels of this hormone peak in the early morning, start to drop in late morning and reach their low point at night.

However, depressed adults have slightly elevated cortisol levels at night—”the endocrine equivalent of chronic stress,” Pervanidou said. This chronic elevation of cortisol contributes to development of the metabolic syndrome, which includes abdominal obesity and other risk factors for diabetes and cardiovascular disease.

In this new study, Pervanidou and colleagues measured cortisol five times a day in the saliva of 50 obese children and teenagers as well as in their blood in the morning. The 20 boys and 30 girls, ages 8 to 15 years, were patients in the Athens University pediatric obesity clinic and did not have a prior diagnosis of depression. All subjects completed the Children’s Depression Inventory (CDI), a questionnaire that assesses self-reported symptoms of depression.

Cortisol levels in the saliva in the afternoon and evening correlated positively with symptoms of depression, the authors reported. The more depressive symptoms that subjects reported, the higher the cortisol levels at those times.

This finding indicates that obesity and depression may not only be related to behavior but also may have a hormonal link, according to Pervanidou. Because obesity and depression often co-occur, she said that prevention and screening should focus on both disorders and should start in childhood.

“We recommend that obese children be screened for depression and anxiety, especially female adolescents, who have the highest risk,” she said. “In addition, children with a diagnosis of depression should be evaluated for disordered eating, because these patients frequently develop obesity or anorexia.”

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Adapted from materials provided by The Endocrine Society, via EurekAlert!, a service of AAAS.

http://www.sciencedaily.com/releases/2009/06/090611142520.htm

Cancer Diagnosis May Tax Physical, Mental Health

Treatment, too, affects quality of life, studies show

TUESDAY, June 9 (HealthDay News) — A cancer diagnosis can take a physical and mental toll in the years after treatment, a new study says.

Bryce B. Reeve of the U.S. National Cancer Institute and a team of researchers looked at the health-related quality of life of 1,432 people 65 years of age or older who were diagnosed with cancer of the prostate, breast, bladder or kidney, non-small cell lung cancer, colorectal cancer or non-Hodgkin lymphoma between 1998 and 2003. Similar data was examined for 7,160 similar people without cancer.

Up to two years after diagnosis, those with cancer reported decreased physical health compared with those of the same age who did not have cancer, the researchers found. People with prostate, colorectal and non-small cell lung cancer reported decreased mental health compared with people without cancer, they noted.

“We expect this study to provide a benchmark for capturing the burden of cancer on health-related quality of life and an evidence base for future research and clinical interventions aimed at understanding and remediating these effects,” Reeve’s team wrote.

The study appears in the June 9 online edition of the Journal of the National Cancer Institute.

In a second study of prostate cancer survivors published in the same issue, John L. Gore, of the University of California, Los Angeles, and his colleagues found that urinary incontinence was more common after prostatectomy than after brachytherapy or external beam radiation therapy.

Sexual dysfunction “profoundly” affected all treatment groups in the four years after treatment, the research team noted.

“These results may guide decision making for treatment selection and clinical management of patients with health-related quality-of-life impairments after treatment for localized prostate cancer,” they wrote.

Dr. Pamela J. Goodwin and colleagues noted in an accompanying editorial that both studies add to the understanding of quality-of-life issues in cancer patients but that each has limitations.

The first study did not include younger people with cancer or specifics about which cancer treatments resulted in the most significant decreases in quality of life, information that people could use to make decisions about treatment, the editorialists noted.

In the second study, the researchers did not address multimodality treatment, a growing trend for those who have aggressive prostate cancer, and the impact on quality of life, the writers pointed out.

“Further research is needed to better understand the short- and longer-term impact of cancer diagnosis and treatment on overall quality of life, especially as screening becomes more common, our anticancer treatments improve and patients live longer after a diagnosis of cancer,” they wrote.

SOURCE: Journal of the National Cancer Institute, news release, June 9, 2009

http://www.nlm.nih.gov/medlineplus/news/fullstory_85407.html

Severe Nightmares May Warn of Suicidal Symptoms

Treating sleep problems could aid suicide prevention, researchers suggest

TUESDAY, June 9 (HealthDay News) — Besides disturbing a good night’s sleep, nightmares might be linked to an increased risk of suicide, a new study suggests.

Researchers assessed 82 men and women, ages 18 to 66, who were awaiting an emergency psychiatric evaluation before being admitted to a community mental health hospital. They were asked about their nightmares, insomnia, depression and suicidal tendencies.

The study found that severe nightmares were independently associated with increased suicidal symptoms, even after the researchers accounted for the effects of depression.

“Sleep disturbances, especially nightmares, appear to be an acute warning sign and risk factor for suicide,” principal investigator Rebecca Bernert, a doctoral candidate in clinical psychology at Florida State University, said in a news release from the American Academy of Sleep Medicine.

“Given that poor sleep is amenable to treatment, and less stigmatized than depression and suicide, our findings could impact standardized suicide risk assessment and prevention efforts,” she said.

The findings were to be presented June 9 in Seattle at the annual meeting of the Associated Professional Sleep Societies.

Sleep complaints are among the top 10 warning signs of suicide, according to the U.S. Substance Abuse and Mental Health Services Administration.

SOURCE: American Academy of Sleep Medicine, news release, June 9, 2009

http://www.nlm.nih.gov/medlineplus/news/fullstory_85400.html

Adult type 1 diabetics have higher depression rates

NEW ORLEANS (Reuters Health) – June 08, 2009 – Adults with type 1 diabetes report more symptoms of depression and more often use anti-depressant medication than adults without type 1 diabetes, according to data released here at the 69th Scientific Sessions of the American Diabetes Association (ADA).

Different from type 2 diabetes, type 1 diabetes is diagnosed in children or in young adults and has a completely different mode of action. Type 1 diabetes, also referred to as insulin-dependent diabetes or juvenile diabetes, occurs when the pancreas does not produce enough insulin to control blood sugar levels. Eventually, the insulin-producing beta cells of the pancreas are completely destroyed and the body longer produces any insulin.

Dr. David Maahs, with the University of Colorado Health Science Center in Denver, and colleagues assessed the prevalence of depression and antidepressant medication use in 458 adults with type 1 diabetes and 546 adults without diabetes.

All of the subjects were enrolled in the CACTI (Coronary Artery Calcification in Type 1 Diabetes) study, which examined factors related to insulin resistance and calcification of the coronary arteries – a sign of heart disease — in type 1 diabetics without symptoms.

In the present analysis, depression was confirmed by a score of greater than 14 on the Beck Depression Inventory II (BDI-II) or by self-reports of current antidepressant use. Diabetes complications were also self-reported and included retinopathy, blindness, neuropathy, diabetes-related amputation, and kidney or pancreas transplantation.

The results showed that adults with type 1 diabetes were more than twice as likely as those without diabetes to have depression and almost three times as likely to have a clinically significant score on the BDI-II. Adult type 1 patients were also nearly twice as likely to be on antidepressant medications as nondiabetics (20.7 percent vs. 12.1 percent).

Overall, the prevalence of depression indicators in type 1 diabetics was 32.1 percent, compared with 16.0 percent in nondiabetics.

The study also found an association between depression and complications of diabetes. Type 1 diabetics who reported at least one diabetes complication had significantly higher scores on the BDI-II than type 1 diabetics without any complications (10.7 vs. 6.4).

Untreated depression tends to become chronic or lead to relapses, the investigators noted in their poster presentation, and physicians should aim to rigorously screen type 1 diabetic patients for depression. In particular, screening should target patients with complications of diabetes since they are more likely to have depressive symptoms, Maahs and his associates recommend.

http://www.reuters.com/article/healthNews/idUSTRE5574T120090608

Relationship Found Between Napping, Hyperactivity, Depression And Anxiety

ScienceDaily (June 8, 2009) — Napping may have a significant influence on young children’s daytime functioning, according to a research abstract that will be presented on June 8 at Sleep 2009, the 23rd Annual Meeting of the Associated Professional Sleep Societies.

Results indicate that children between the ages of 4 and 5 who did not take daytime naps were reported by their parents to exhibit higher levels of hyperactivity, anxiety and depression than children who continued to nap at this age.

According to lead author Brian Crosby, PhD, postdoctoral fellow of psychology at Pennsylvania State University, previous studies have shown that poor or inadequate sleep is linked with symptoms of hyperactivity, anxiety and depression; researchers involved in this study were happy to demonstrate the potential importance of napping for optimal daytime functioning in young children, as napping is often overlooked in favor of nighttime or total sleep.

“There is a lot of individual variability in when children are ready to give up naps. I would encourage parents to include a quiet ‘rest’ time in their daily schedule that would allow children to nap if necessary.”

The study included data from 62 children between the ages of 4 and 5 who were classified as either napping (77 percent) or non-napping (23 percent) based on actigraphy data. Napping children napped an average of 3.4 days per week. Of the sample, 55 percent were white-non Hispanic and 53 percent were male. Caretakers reported their child’s typical weekday and weekend bedtime/rise time, napping patterns, family demographics, and completed a behavioral assessment of the child. Actigraphy data for each child was collected continuously for seven to 14 days.

Crosby hopes that findings of this study will encourage caregivers and other researchers to look at the ways napping impacts daytime functioning in children, as an optimal age to stop napping has not yet been determined.

Abstract Title: Napping and Psychosocial Functioning in Preschool Children

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Adapted from materials provided by American Academy of Sleep Medicine.

http://www.sciencedaily.com/releases/2009/06/090608071814.htm

Television Watching Before Bedtime Can Lead To Sleep Debt

ScienceDaily (June 8, 2009) — According to new research presented at Sleep 2009, the 23rd Annual Meeting of the Associated Professional Sleep Societies,* television watching may be an important determinant of bedtime, and may contribute to chronic sleep debt.

The study included data from 21,475 people aged 15 or older who completed the American Time Use Survey between the years 2003 and 2006. The study examined the activities participants undertook two hours before and after bed time. It found that television viewing was by far and away the dominant pre-sleep activity, accounting for almost 50% of pre-bed time.

According to the authors of the study, Mathias Basner, MD, MS, MSc, and David F. Dinges, PhD, of the University of Pennsylvania School of Medicine in Philadelphia, they were surprised to find that watching television seemed to be the most important time cue for the beginning of the sleep period, rather than hours past sunset or other more biological factors. So, in fact, TV may make people stay up late, while alarm clocks make them get up early, potentially reducing sleep time below what is physiologically needed.

Sleeping less than 7-8 hours daily impairs alertness and is associated with increased obesity, morbidity and mortality. Despite this fact, up to 40 percent of Americans sleep for less than the recommended time per night.

“Given the relationship of short sleep duration to health risks, there is concern that many Americans are chronically under-sleeping due to lifestyle choices,” said Dinges. Dr. Basner added that “According to our results, watching less television in the evening and postponing work start time in the morning appear to be the candidate behavioral changes for achieving additional sleep and reducing chronic sleep debt. While the timing of work may not be flexible, giving up some TV viewing in the evening should be possible to promote adequate sleep.”

Adapted from materials provided by American Academy of Sleep Medicine, via EurekAlert!, a service of AAAS.

http://www.sciencedaily.com/releases/2009/06/090608071941.htm

Sedatives May Increase Suicide Risk In Older Patients

ScienceDaily (June 4, 2009) — Sleeping tablets have been associated with a four-fold increase in suicide risk in the elderly. Researchers have shown that, even after adjusting for the presence of psychiatric conditions, sedatives and hypnotics were both associated with an increased risk of suicide.

Anders Carlsten and Margda Waern from Gothenburg University carried out a case control study to determine whether specific types of psychoactive drugs were associated with suicide risk in later life. According to Carlsten, “Sedative treatment was associated with an almost fourteen-fold increase of suicide risk in the crude analyses and remained an independent risk factor for suicide even after adjustment for the presence of mental disorders. Having a current prescription for a hypnotic was associated with a four-fold increase in suicide risk in the adjusted model”.

The researchers speculate that the drugs may raise suicide risk by triggering aggressive or impulsive behavior, or by providing the means for people to take an overdose. They also point out the possibility that these drugs may merely be markers for some other factor related to suicide risk, such as somatic illness, functional disability, alcohol use disorder, interpersonal problems, lack of social network or sleep disturbance. Carlsten said, “Persons with these problems might be more likely to seek health care and perhaps more likely to receive prescriptions for psychotropic drugs. However, given the extremely high prescription rates for these drugs, a careful evaluation of the suicide risk should always precede prescribing a sedative or hypnotic to an elderly individual”.

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Adapted from materials provided by BioMed Central, via EurekAlert!, a service of AAAS.

http://www.sciencedaily.com/releases/2009/06/090603195418.htm

Cancer & Mental Impairment

Antidepressant curbs cancer-related mental ills

NEW YORK (Reuters Health) – June 04, 2009 – People with cancer often suffer mental impairment, but it seems this can be alleviated by treatment with Paxil, an SSRI-type antidepressant, according to results of a National Cancer Institute-supported study.

The findings were reported this week at the American Society of Clinical Oncology’s annual meeting in Orlando.

“Cancer and its treatment impact important areas of cognitive function such as attention and memory, which are essential to patients’ effective psychosocial functioning and quality of life,” Dr. Pascal Jean-Pierre, from the University of Rochester, New York and colleagues point out in a meeting paper.

“Both depression and cancer-related cognitive dysfunction share the same networks in the brain,” Jean-Pierre explained in an interview with Reuters Health, Therefore, he and his colleagues looked into Paxil treatment in close to 800 cancer patients aged 22 to 87 years.

The researchers found “significant differences” between the participants’ reports of memory problems after their first round of chemotherapy (before Paxil) and after four cycles of chemo and treatment with Paxil.

Paxil had a significant beneficial effect on cancer-related mental impairment. Even after taking depression out of the equation, “we still saw a significant effect of Paxil on cognitive function,” Jean-Pierre told Reuters Health.

“This was an exploratory analysis,” he cautioned, “so future studies need to replicate these findings, but the results do show that using SSRIs and other psychostimulants might be an approach to cancer-related cognitive dysfunction.”

He concluded, “It’s worth moving forward and investigating this further.”

http://www.reuters.com/article/healthNews/idUSTRE5536L220090604

YOU’RE FIRED

 

 

When you first hear those two words, you automatically think of losing your job.  I thought I would take it one step further and think back to some of the times I’ve actually been ‘fired’ in other situations.

I will begin with my career position.  The ‘firing’ took place during my first year, in what would be a slippery slide into the world of deep major depression.  I was employed with this company for five years as an accounting supervisor, however, numerous hospitalizations, months off at home recuperating and the return to work following, just did not pan out.  In the end, I was basically ‘fired’. 

As soon as they received the much awaited doctor’s letter, upon what would be my final office return, they shoved a severance package envelope at me, and escorted me to the door  This came after the “you were a valuable asset to the company”.  I was so ill back then, however, in hindsight I wish I would have fought harder for a better compensation package.

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One of the saddest times in my life, was being ‘fired’ by my close friends.  Felt like a kick in the stomach.  I had four extremely dear friends, and during my first few admissions to hospital they would visit regularly.  When home on passes, we would get together for lunch, and chats; but as the years passed, so did they.  No phone calls returned and no more visits when further hospital admissions.  It’s as if they wanted no more to do with me.

It all fell back on me in my thinking.  I was the cause of this ‘firing’.  Maybe this; maybe that.  Maybe I shouldn’t have acted so glum-like, maybe not described what it really felt like to be depressed, maybe joined in on a joke or conversation or maybe I just wasn’t the old ME.  And then it hit me….why should I have to apologize for being ill.  An illness?  Apologizing for an illness?  What other illness would have you doing this?

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I was ‘fired’ by a boyfriend, whom I dated for 3 years.  The bomb dropped after an enjoyable dinner out, and what I thought was a pleasant evening; although vibes were there.  But, everything appeared to be running smoothly in the relationship, then unexpectedly on the way home, the old “it’s not you, it’s me” blurts out.  Out of the blue, I was ‘fired’.  Sitting there in the passenger seat, virtually dumbfounded, I asked myself, “What the hell did I do wrong” in this relationship?

Astounding how everything automatically fell back to me.  In any event; I was ‘fired’, and never saw the guy again.

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Now firing can work the other way; and I had the upper hand:

I ‘fired’ a couple of my psychiatrists.  I’ve described these pdocs in previous posts.  The first I had for numerous years; an arrogant SOB, who had little time and I was getting nowhere with.  I’m convinced he really cared that I ‘fired’ him; he most likely doesn’t even recognize I’m not even a patient of his any longer!

The second pdoc fell asleep on me during our second session.  I did take this personally at first, then thought – no – he is the one with the problem.

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And lastly, for a point in time during my illness, when the blackest, muddiest moments of depression would not let up; I believed life had ‘fired’ me.  I felt adrift, discouraged and very suicidal.  Suicide is not the answer, however, when you are able to actually touch the black, depressive fog between your finger tips; you identify that death is nearby anyways.  So many days I would ask myself, “What did I do that was so wrong in my life to deserve this black life of depression”.  Life’s ‘firing’ is the worst ‘firing’ of all.

I feel so lucky that I’m not in the ‘firing’ line with my illness, yet feel sometimes it’s just around the corner.

STIGMA – And Mental Illness

What is stigma?

When someone appears to be different than us, we may view him or her in a negative stereotyped manner. People who have identities that society values negatively are said to be stigmatized.

Stigma is a reality for people with a mental illness, and they report that how others judge them is one of their greatest barriers to a complete and satisfying life. Society feels uncomfortable about mental illness. It is not seen like other illnesses such as heart disease and cancer.

Due to inaccuracies and misunderstandings, people have been led to believe that an individual with a mental illness has a weak character or is inevitably dangerous. Mental illness can be called the invisible illness. Often, the only way to know whether someone has been diagnosed with a mental illness is if they tell you. The majority of the public is unaware of how many mentally ill people they know and encounter every day. One in five people will experience a mental illness at some point in his or her lifetime and mental illness affects people of all ages, in all kinds of jobs and at all educational levels.

Why does stigma surround mental illness?
We all have an idea of what someone with a mental illness is like, but most of our views and interpretations have been distorted through strongly held social beliefs. The media, as a reflection of society, has done much to sustain a distorted view of mental illness. Television or movie characters who are aggressive, dangerous and unpredictable can have their behavior attributed to a mental illness. Mental illness also has not received the sensitive media coverage that other illnesses have been given. We are surrounded by stereotypes, popular movies talk about killers who are “psychos” and news coverage of mental illness only when it related to violence. We also often hear the causal use of terms like “lunatic” or “crazy,” along with jokes about the mentally ill. These representations and the use of discriminatory language distort the public’s view and reinforce inaccuracies about mental illness.

What are the effects of stigma?
If you became physically ill, you would go to a doctor. Once you got better you would expect to get on with life as usual. Life, however, does not always fit back into place for people diagnosed with a mental illness. Everyone has the right to fully participate in his or her community, but individuals struggling to overcome a mental illness can find themselves facing a constant series of rejections and exclusions.

Due to stigma, the typical reaction encountered by someone with a mental illness (and his or her family members) is fear and rejection. Some have been denied adequate housing, loans, health insurance and jobs due to their history of mental illness. Due to the stigma associated with the illness, many people have found that they lose their self-esteem and have difficulty making friends. The stigma attached to mental illness is so pervasive that people who suspect that they might be mentally ill are unwilling to seek help for fear of what others may think. Spouses may be reluctant to define their partners as mentally ill, while families may delay seeking help for their child because of their fears and shame.

How do we erase stigma?
We can battle stigma when we have facts. We all have times when we feel depressed, get unreasonably angry or over-excited. We even have periods when we think that everything and everybody is out to get us and that we can’t cope. For someone with a mental illness these feelings become enveloping and overwhelming. There is no particular way to develop a mental illness. For some people, it occurs due to genetic factors in their family. Other causes may relate to environment stressors such as experiences or severe child abuse, war, torture, poverty, loss, isolation, neglect or abandonment. Mental illnesses can also occur in combination with substance abuse.

Any questions can be directed to your Mental Health Association.

Information source for this article: http://mentalhealthworks.ca/ Mental Health Works.

Downsizing Emergency Departments = Crisis

Downsizing Emergency Departments May Create Dangerous Loss Of ‘Surge Capacity’ For Crisis Situations

ScienceDaily (June 3, 2009) — Factors that lead to emergency department overcrowdings, ambulance diversions and other incidents that endanger patient safety have been revealed. A new study has shown that reductions in the number of hospital beds and downsizing or closure of emergency departments may create a dangerous loss of ’surge capacity’.

Amir Khorram-Manesh, from the Prehospital and Disaster Medicine Centre, Gothenburg, Sweden, worked with Annika Hedelin and Per Örtenwall to study all data concerning ‘hospital-related incidents’ in Sweden’s Region Västra Götaland between January 2006 and December 2008. He said, “Disasters seldom occur, but if they strike, a fast and effective response from healthcare services is expected. The incidents we document, where emergency hospitals, for different reasons, could not operate at their normal capacity are a matter of concern for patient safety as well as disaster response preparedness”.

The researchers found increasing numbers of ‘incidents’ over the three years studied. Bed shortages in intensive care and ordinary wards were the most common, followed by technical dysfunctions in the radiology department. They blame cost-cutting reductions in the size and staffing of emergency departments and increased pressure to treat people on an out-patient basis for the rise. Khorram-Manesh said, “Although these measures seem to be logical steps taken to improve healthcare effectiveness and reduce costs, they also, in a negative way, affect the surge capacity of a hospital”.

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Adapted from materials provided by BioMed Central, via EurekAlert!, a service of AAAS.

http://www.sciencedaily.com/releases/2009/06/090602192555.htm

Some Antidepressants May Thwart Tamoxifen’s Effect on Breast Cancer

Women should seek alternatives to SSRIs for hot flashes, studies suggest

June 1, 2009 - (HealthDay News) — Common antidepressants that many breast cancer survivors use to dampen the hot flashes caused by taking tamoxifen may actually boost the odds of the disease’s return, new research warns.

The finding was presented this weekend at the American Society of Clinical Oncology’s annual meeting, in Orlando, Fla.

But to muddy the waters further, a second study found that the antidepressants did not impair tamoxifen’s cancer-fighting powers.

Nevertheless, authors from both reports are recommending that women who have had breast cancer explore other ways to treat hot flashes.

Outside experts agreed.

“Women should talk to their medical oncologist about what antidepressant they’re and what hormone therapy they’re on, and make sure they’re not one of the ones we’re worried about,” said Dr. Kelly Marcom, a breast oncologist with the Duke Comprehensive Cancer Center and director of the Duke Hereditary Cancer Clinic, in Durham, N.C.

Many breast cancer survivors take the drug tamoxifen to reduce their odds for recurrence. But tamoxifen often causes hot flashes, a side effect that can be controlled with selective serotonin reuptake inhibitor (SSRI) antidepressants such as paroxetine (Paxil) or fluoxetine (Prozac). Besides working on the neurotransmitter serotonin, these drugs inhibit an enzyme called 2D6, necessary to convert tamoxifen into its main active metabolite, endoxifen.

Women who have a gene mutation preventing the formation of 2D6 do not reap the same benefits from tamoxifen as women without the mutation, the researchers noted. Moreover, drugs that inhibit the formation of 2D6 may result in lower levels of endoxifen, although the clinical implications of that remain unclear.

The U.S. Food and Drug Administration is still weighing whether or not to add a caution about the gene variation to the tamoxifen label.

In one of the studies, Medco, a U.S. pharmacy benefits management company, reviewed the medical records of 10.7 million members of a health plan. That analysis turned up 945 women taking tamoxifen and 353 taking tamoxifen plus an SSRI/2D6 inhibitor, most commonly Prozac and Paxil.

Both groups of women, whose average age was in the early 50s, had followed similar treatment courses.

Women taking both drugs had a 13.9 percent chance of their breast cancer returning over two years, vs. just 7.5 percent of those receiving tamoxifen alone; that translates into an almost twofold increase in risk.

The second study, conducted by researchers at Leiden University Medical Center in the Netherlands, collected information on almost 2,000 breast cancer patients using tamoxifen, 215 of whom had used an SSRI/2D6 inhibitor at some point during their tamoxifen treatment.

That study found no increased risk of a breast recurrence in women taking both drugs. However, the authors pointed out, the number of women taking both drugs was small — good enough reason for women and doctors to search for other options to combat hot flashes.

The Medco findings should serve as a warning but not a confirmation of any real danger to patients, one expert said.

“It’s a study that is very difficult to interpret because it’s really not complete enough information,” said Dr. Claudine Isaacs, director of the clinical breast cancer program at Georgetown’s Lombardi Comprehensive Cancer Center in Washington, D.C. “It raises a concern about this, and there’s a scientific rationale to be concerned about. We can’t say anything conclusively but there are options, other types of antidepressants, other types of medications, that don’t have that impact. The cautious thing to do is to choose other medications while trying to sort this out.”

Marcom agreed. He also noted that breast cancer-inhibiting medications called aromatase inhibitors, which include letrozole (Femara) and exemestane (Aromasin), “are one possible alternative to tamoxifen. There are also genotyping issues — how different individuals metabolize the various drugs. This is not standard of care but it can be checked.”

http://www.nlm.nih.gov/medlineplus/news/fullstory_85008.html