Risk of Major Depression on Elderly

ScienceDaily (Dec. 22, 2009) — University of Rochester Medical Center researchers have pinpointed the prime factors identifying which elderly persons are at the highest risk for developing major depression.

The researchers, led by Jeffrey M. Lyness, M.D., professor of Psychiatry at the Medical Center, reported their findings in an article in the December issue of The American Journal of Psychiatry.

Preventive treatments for people in the high-risk group hold promise for providing the greatest health benefit at the lowest cost, the researchers concluded.

“People with low-level depressive symptoms, who perceive that they have poor quality social support from other people, and with a past history of depression, were at particularly high risk to develop new major depression within the one-to-four year time period of the study,” Lyness said. “This is good news, as we in the field are just learning how to prevent depression in particular high-risk groups. Future work will be able to test whether any of a variety of treatments — perhaps psychotherapy, perhaps medication, perhaps other things such as exercise — will help to prevent depression in persons suffering from the risks we identified in this study.”

More than 600 people who were 65 years of age or older took part in the study. They were recruited from private practices and University-affiliated clinics in internal medicine, geriatrics and family medicine in Monroe County, N.Y. Only participants without an active diagnosis of major depression were included in the analyses.

Annual follow-up in-person interviews were conducted for up to four years. Information obtained from telephone contacts and annual medical chart reviews supplemented the interviews. Thirty-three participants, or about 5.3 percent, developed an episode of major depression during the study period.

In their analysis, the researchers concluded the “number needed to treat,” an epidemiological measure used in determining the effectiveness of a medical intervention, was five. This means the fully effective preventive treatment of five individuals presenting the indicators would prevent one new case of major depression.

In an editorial in the journal, Warren D. Taylor, M.D., associate professor of Psychiatry at Duke University Medical Center, agreed the number needed to treat was low and indicated cost effectiveness.

“Given the compli­cations of depression in an elderly population, a preventive approach for this at-risk population may be quite important to not only prevent psychological suffering but to also avoid the deleterious effects of depression on comorbid medical illness,” Taylor wrote.

The researchers concluded “the present study may inform current clinical practice by fostering early detection and interven­tion critical to improving patient outcomes for depression.”

In addition to Lyness, authors of the article include: Wan Tang, Ph.D., research assistant professor of Biostatistics, Xin Tu, Ph.D., professor of Biostatistics and of Psychiatry, Yeates Conwell, M.D., professor of Psychiatry, and Qin Yu, Ph.D., research associate at the University of Pennsylvania.

Adapted from materials provided by University of Rochester Medical Center.

http://www.sciencedaily.com/releases/2009/12/091217115828.htm

Could Acetaminophen Ease Psychological Pain?

ScienceDaily (Dec. 22, 2009) — Headaches and heartaches. Broken bones and broken spirits. Hurting bodies and hurt feelings. We often use the same words to describe physical and mental pain. Over-the-counter pain relieving drugs have long been used to alleviate physical pain, while a host of other medications have been employed in the treatment of depression and anxiety. But is it possible that a common painkiller could serve double duty, easing not just the physical pains of sore joints and headaches, but also the pain of social rejection?

A research team led by psychologist C. Nathan DeWall of the University of Kentucky College of Arts and Sciences Department of Psychology has uncovered evidence indicating that acetaminophen (the active ingredient in Tylenol) may blunt social pain.

“The idea — that a drug designed to alleviate physical pain should reduce the pain of social rejection — seemed simple and straightforward based on what we know about neural overlap between social and physical pain systems. To my surprise, I couldn’t find anyone who had ever tested this idea,” DeWall said.

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Binge-eating: Self-help or Therapy?

 Self-help on par with therapy for binge-eaters

 

NEW YORK (Reuters Health) – Dec 18, 2009 – “Out of control” binge eaters who get help from a therapist do better in the short-term than people who use self-help techniques, new research shows.

But in the long-term, self-help and therapist-led or therapist-assisted approaches seem to have about the same effectiveness, Dr. Carol B. Peterson of the University of Minnesota in Minneapolis and her colleagues found.

Binge eaters often eat large amounts of food while feeling a loss of control over their eating. It is different from the binge-purge syndrome of bulimia because binge eaters do not purge afterward by vomiting or taking laxatives. Binge eating disorder is contributing to the rise in obesity.

While medications can help reduce bingeing episodes among people with the disorder, psychotherapy is the most effective approach to treatment, Peterson and colleagues note in a report in the latest issue of the American Journal of Psychiatry. Self-help interventions have also shown promise.

Peterson’s team compared the effectiveness of various group therapy approaches by randomly assigning 259 adults with binge eating disorder to 20 weeks of therapist-led, therapist-assisted, or self-help group therapy, or to a waiting list.

After treatment, just over half of people who had therapist-led group treatment were abstaining from bingeing, compared to a third of those in the therapist-assisted groups, 18 percent in the self-help groups, and 10 percent in the waiting list group. The frequency of binge eating was also lower in the therapist-led or assisted groups compared to the self-help group or the waiting list group.

When the researchers followed up 6 and 12 months after treatment ended, they found no difference in bingeing abstinence rates or binge eating frequency among the groups.

However, the study participants who got help from therapists were more likely to stick with the treatment for 20 weeks; 88 percent of people in the therapist-led groups and 81 percent of those in the therapist-assisted groups completed 20 weeks of treatment, compared to 68 percent of people in the self-help groups.

“The presence of a therapist may enhance short-term abstinence and reduce the likelihood of dropout,” Peterson and her team say. But self-help groups may be helpful when therapists aren’t available, they add.

“These findings suggest that self-help group treatment may be a viable alternative to therapist-led interventions in some settings,” Dr. Walter Kaye of the University of California San Diego writes in an editorial accompanying the study.

“It should be noted, however, that the power of such treatments may be limited since many patients continued to have substantial degrees of binge behaviors at 12-month follow-up,” Kaye notes.

SOURCE: American Journal of Psychiatry, December 2009.

http://health.yahoo.com/news/reuters/us_binge_eaters.html

Antidepressants may have risks after menopause

NEW YORK (Reuters Health) – Dec 16, 2009 – Older women who take an antidepressant seem to have a small but noteworthy increased risk of stroke and death compared to older women not on an antidepressant medication, a new study shows.

But given that depression itself is a well-established risk factor for early death, heart disease and other ills, the study’s author told Reuters Health, women who need to take these medications shouldn’t see the new findings as a reason to quit.

“Women should not stop taking the medications based on this one study,” Dr. Jordan W. Smoller of Massachusetts General Hospital in Boston said in an interview. “What our study does is give patients and doctors a little bit more information about the risk-benefit calculation for older women.”

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Psychotherapy Offers Obesity Prevention for ‘at Risk’ Teenage Girls

ScienceDaily (Dec. 15, 2009) — A team of scientists at the Uniformed Services University of the Health Sciences and the National Institutes of Health has piloted psychotherapy treatment to prevent excessive weight gain in teenager girls deemed ‘at risk’ for obesity.

The study, published in the International Journal of Eating Disorders, found that girls who participated in Interpersonal Psychotherapy may be better able to prevent their BMI from increasing over the course of a year compared to girls who took traditional health education classes.

The research team, led by Dr. Marian Tanofsky-Kraff, aimed to target youth considered at high-risk of obesity because they were already above average weight and because they reported episodes of loss of control eating or binge eating. Both higher weight and loss of control eating are linked to excessive weight gain in children and young people.

Interpersonal Psychotherapy (IPT) focuses on improving interpersonal relationships by targeting the underlying social and interpersonal difficulties that influence individuals to engage in loss of control eating. The therapy has been shown to help both depressed adults and youth and, also to help tackle binge eating in adults. In adult studies, decreases in binge eating may lead to modest weight loss and less regain over time compared with those who continue to binge eat. Thus, decreasing binge eating is an attractive target for preventing obesity in at-risk youth.

“We conducted this study to address the dramatically increased rates of obesity in children and adolescents,” said Tanofsky-Kraff. “‘IPT for Binge Eating Disorder is based on the assumption that binge eating occurs in response to poor social functioning and the consequent negative moods.”

Thirty-eight girls, some with and others without loss of control eating, were selected for the trial, and were randomly designated to attend either IPT sessions or standard health education classes currently taught to teenagers. All the girls completed their courses and received follow up visits for the next year.

Girls who undertook IPT were more likely to stabilize or reduce their BMI than those who received the health education classes. BMI is a measure of body weight corrected for height, and is used to determine appropriate weight gain in growing children and teens.

“This pilot study has demonstrated that IPT is both feasible and acceptable to adolescent girls at risk of adult obesity and suggests that it may prevent excess weight gain,” concludes Tanofsky-Kraff. “If IPT proves to be effective, we may be able to prevent not only excessive weight gain, but the development of related adverse health conditions in a subset of susceptible youth.”

http://www.sciencedaily.com/releases/2009/12/091215121055.htm

The Autistic Brain

How the Autistic Brain Distinguishes Oneself from Others

ScienceDaily (Dec. 14, 2009) — Scientists at the University of Cambridge have discovered that the brains of individuals with autism are less active when engaged in self-reflective thought. The study published in the journal Brain provides new evidence for the neural correlates of self-awareness and a new window into understanding social difficulties in autism spectrum conditions.

In the new study, Michael Lombardo, Professor Simon Baron-Cohen and colleagues from the Autism Research Centre at the University of Cambridge used functional magnetic resonance (fMRI) imaging to measure brain activity of 66 male volunteers, half of whom have a diagnosis of an autism spectrum condition.

Lombardo asked the volunteers to make judgments either about their own thoughts, opinions, preferences, or physical characteristics, or about someone else’s, in this case the Queen. By scanning the volunteers’ brains as they responded to these questions, the researchers were able to visualise differences in brain activity between those with and without autism.

They were particularly interested in part of the brain called the ventromedial prefrontal cortex (vMPFC), known to be active when people think about themselves. “This area is like a self-relevance detector, since it typically responds most to information that is self-relevant,” Lombardo says.

Lombardo found this area of the brain was indeed more active when typical volunteers were asked questions about themselves compared to when they were thinking about the Queen. However, in autism this brain region responded equally, irrespective of whether they were thinking about themselves or the Queen.

According to Lombardo: “This new study shows that within the autistic brain, regions that typically prefer self-relevant information make no distinction between thinking about the self or another person. This is strong evidence that in the autistic brain, processing information about the self is atypical.”

Autism has long been considered a condition of extreme egocentrism. The word ‘autism’ comes from the Greek word ‘autos’, meaning ‘self’. However, recent research shows that individuals with autism are also impaired in thinking about themselves. Lombardo’s study helps explain this paradox: “On the surface these two observations seem like opposites, but they may converge on a common neurobiological explanation that the autistic brain responds less to information that is self-relevant,” Lombardo says.

The new evidence about the autistic brain will help researchers better understand the social difficulties of individuals with autism.

Lombardo added: “Navigating social interactions with others requires keeping track of the relationship between oneself and others. In some social situations it is important to notice that ‘I am similar to you’, while in other situations it might be important to notice that ‘I am different to you’. The atypical way the autistic brain treats self-relevant information as equivalent to information about others could derail a child’s social development, particularly in understanding how they relate to the social world around them.”

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

http://www.sciencedaily.com/releases/2009/12/091213214104.htm

Long-Acting Zyprexa Approved

MONDAY, Dec. 14 (HealthDay News) — Zyprexa Relprevv (olanzapine), a long-acting version of the antipsychotic drug Zyprexa, has been approved to treat schizophrenia in adults, maker Eli Lilly said Monday.

The single injection lasts up to four weeks, the drug maker said in a news release. Clinical studies involving 2,054 people found Zyprexa Relprevv effective in managing symptoms of schizophrenia, including hallucinations, delusions, apathy and social withdrawal.

 The brain disorder affects about 1.1 percent of the American population, or some 2.4 million people, Lilly said.

 Possible adverse reactions could include sedation (including coma) and delirium. Elderly people with dementia-related psychosis are at increased risk of death from the drug and should not take it, the company said.

http://health.yahoo.com/news/healthday/longactingzyprexaapproved.html

Early Treatment of Hearing, Vision Helps in Schizophrenia

FRIDAY, Dec. 11 (HealthDay News) — Identifying sight and hearing problems in teens who are in the early stages of schizophrenia may help doctors fully restore those senses and lessen the impact of the devastating thought disorder, U.S. researchers say.

A new study found that problems in basic sensory processing abilities cause many of the more complicated cognitive deficits in people with schizophrenia.

 “In people with schizophrenia, we know that visual and auditory sensory systems that functioned well in early childhood begin to break down during adolescence, years earlier than the onset of the more complex cognitive symptoms of schizophrenia,” Dr. Daniel C. Javitt, of the New York University School of Medicine, said in a news release.

 “We already know a lot about what people with this disorder can and cannot do,” Javitt said. “Our research focuses on understanding how the brain works and identifying specific biomarkers for cognitive impairment that will distinguish schizophrenia from Alzheimer’s and other diseases.”

 He and his team determined that impaired function of the visual and auditory systems makes it more difficult for people with schizophrenia to read, pay attention and understand social cues. The researchers also identified biomarkers in the brain that could help determine which patients would benefit from early intervention.

 The study was scheduled to be presented Dec. 9 at the annual meeting of the American College of Neuropsychopharmacology in Hollywood, Fla.

http://health.yahoo.com/news/healthday/earlytreatmentofhearingvisionhelpsinschizophrenia.html

Head and Neck Cancer Survivors Death Risk

Head and Neck Cancer Survivors Who Use Alcohol and Cigarettes Have Increased Death Risk

ScienceDaily (Dec. 11, 2009) — Cigarette smoking and alcohol consumption before head and neck cancer diagnosis strongly predicts the patient’s future risk of death, according to published studies. Now, results of a new study show a similar effect among those who continued these habits after cancer diagnosis.

“Most cancer survivors are counseled to quit smoking; despite this, many still smoke. In our study, 21 percent continued to smoke even after their cancer diagnosis, increasing their risk of death,” said researcher Susan T. Mayne, Ph.D. “Similarly, we found that continued drinking increases the risk of death.”

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Treating Cluster Headaches

Treating Cluster Headaches With High-Flow Oxygen Appears Effective

ScienceDaily (Dec. 10, 2009) — Patients with a cluster headache, which is characterized by bouts of excruciating pain usually near the eye or temple, were more likely to report being pain-free within 15 minutes of treatment with high-flow oxygen than patients who received a placebo treatment, according to a study in the December 9 issue of JAMA.

Cluster headache attacks typically last for 15 minutes to 3 hours untreated and have a frequency of 1 every other day for up to 8 attacks a day. Attacks usually occur in bouts, or clusters, lasting for weeks or months, separated by remissions lasting months or years, according to background information in the article. The current treatment for acute attacks of cluster headache is injection with the drug sumatriptan, but frequent dosing is not recommended because of adverse effects. Another treatment option is the inhalation of high-dose, high-flow oxygen, but its use may be limited because of the lack of a good quality controlled trial.

Anna S. Cohen, Ph.D., M.R.C.P., of the National Hospital for Neurology and Neurosurgery, London, and colleagues conducted a randomized, placebo-controlled trial of high-flow oxygen for the treatment of acute attacks of cluster headache. The study included 109 adults (ages 18-70 years). Patients treated four cluster headache episodes alternately with high-flow oxygen (inhaled oxygen at 100 percent, 12 L/min, delivered by face mask, for 15 minutes at the start of an attack) or placebo (high-flow air). Patients were recruited and followed up between 2002 and 2007. The final analysis included 57 patients with episodic cluster headache and 19 with chronic cluster headache.

The researchers found that 78 percent of the patients who received oxygen reported being pain-free or to have adequate relief within 15 minutes of treatment, compared to 20 percent of patients who received air. For other outcomes, such as being pain-free at 30 minutes or a reduction in pain up to 60 minutes, treatment with oxygen was superior to air. There were no serious adverse events related to the treatments.

“To our knowledge, this is the first adequately powered trial of high-flow oxygen compared with placebo, and it confirms clinical experience and current guidelines that inhaled oxygen can be used as an acute attack therapy for episodic and chronic cluster headache,” the authors write.

“This work paves the way for further studies to optimize the administration of oxygen and its more widespread use as an acute attack treatment in cluster headache, offering an evidence-based alternative to those who cannot take triptan agents.”

Adapted from materials provided by JAMA and Archives Journals, via EurekAlert!, a service of AAAS.

http://www.sciencedaily.com/releases/2009/12/091208162644.htm

Antiepileptic Drugs Not Linked to Suicide Among Those With Bipolar Disorder

ScienceDaily (Dec. 10, 2009) — Despite government warnings about an increased risk of suicidal thoughts and actions while taking antiepileptic drugs, these medications do not appear to be associated with increased risk of suicide attempts in individuals with bipolar disorder, and may have a possible protective effect, according to a report in the December issue of Archives of General Psychiatry, one of the JAMA/Archives journals.

Antiepileptic drugs are life-saving for those with seizure disorders and are also used to treat many other conditions, including mood disorders and nerve pain, the authors write as background information in the article. The 11 antiepileptic drugs include gabapentin, pregabalin, topiramate and carbamazepine. “On Jan. 31, 2008, the Food and Drug Administration issued an alert regarding increased risk of suicidal thoughts and behavior related to use of antiepileptic drugs,” the authors write. “On July 10, 2008, a Food and Drug Administration scientific advisory committee voted that, yes, there was a significant positive association between antiepileptic drugs and suicidality but voted against placing a black box warning on antiepileptic drugs for suicidality.”

Individuals with bipolar disorder — often treated with antiepileptic drugs — have a higher risk of attempted and completed suicide than the general population. “That makes this a population of interest in detecting the effect on suicide risk of antiepileptic drugs compared with a no-treatment control group,” the authors write. Robert D. Gibbons, Ph.D., of the University of Illinois at Chicago, and colleagues studied a cohort of 47,918 patients with bipolar disorder who had at least one year of data before and after their diagnosis in a national database of medical claims.

A total of 13,385 patients received one of 11 antiepileptic drugs and 25,432 received neither antiepileptic medications nor lithium. After treatment, those taking antiepileptic medication had similar rates of suicide attempts (13 per 1,000 patients per year) as those taking lithium (18 per 1,000 patients per year) or those who did not receive treatment (13 per 1,000 patients per year).

Among those taking antiepileptic drugs, the rate of suicide attempt was significantly lower after treatment (13 per 1,000 patients per year) than before treatment (72 per 1,000 patients per year). In patients who were not receiving treatment with another antiepileptic, an antidepressant or an antipsychotic medication, taking any antiepileptic mediation appeared protective against suicide attempts relative to no pharmacologic treatment (three per 1,000 suicide attempts per patient per year vs. 15 per 1,000 per patient per year).

“Our analysis also reveals that there is a selection effect, in that the pretreatment suicide attempt rate is five times higher than the rate in untreated patients,” the authors write. “If pretreatment suicide attempt rates reflect the severity of illness, it is the more severely impaired patients who receive treatment with an antiepileptic drug or lithium. Nevertheless, the post-treatment suicide attempt rate is significantly reduced relative to their elevated pretreatment levels to the level found at or below patients not receiving treatment. This finding suggests a possible protective effect of antiepileptic drug treatment on suicidality.”

Adapted from materials provided by JAMA and Archives Journals, via EurekAlert!, a service of AAAS.

http://www.sciencedaily.com/releases/2009/12/091207164852.htm