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

Most Hospital Patients Don’t Know What Meds They’re Taking

THURSDAY, Dec. 10 (HealthDay News) — A small study finds that even adults who know what medicines they take at home can’t accurately name the drugs they’re getting in the hospital.

Forty-four percent of patients believed they were receiving a medication in the hospital that was not actually prescribed. A patient who normally receives a blood pressure medicine, for example, may have thought the medicine was continued when, in fact, it was not.

 Ninety-six percent of patients failed to recall one or more of the medicines that they had been prescribed during their stay, according to the study, which is published Dec. 10 in the Journal of Hospital Medicine.

 “I don’t think that’s surprising at all. I think that that’s the natural consequence of the way in which hospital culture is designed. Patients are given their medicines and they take their medicines,” said study author Dr. Ethan Cumbler, an assistant professor of medicine at the University of Colorado Denver and director of the University of Colorado Hospital Acute Care for the Elderly Service.

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Most Antidepressants Miss Key Target

Most Antidepressants Miss Key Target of Clinical Depression, Study Finds

ScienceDaily (Dec. 9, 2009) — A key brain protein called monoamine oxidase A (MAO-A) — is highly elevated during clinical depression yet is unaffected by treatment with commonly used antidepressants, according to an important study published in the Archives of General Psychiatry. The study has important implications for our understanding of why antidepressants don’t always work.

Researchers at the Centre for Addiction and Mental Health (CAMH) used an advanced brain imaging method to measure levels of the brain protein MAO-A. MAO-A digests multiple brain chemicals, including serotonin, that help maintain healthy mood. High MAO-A levels excessively remove these brain chemicals.

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Smoking kills 5 million every year

By MARIA CHENG, AP Medical Writer – Wed Dec 9, 2009

LONDON – Tobacco use kills at least 5 million people every year, a figure that could rise if countries don’t take stronger measures to combat smoking, the World Health Organization said Wednesday.

In a new report on tobacco use and control, the U.N. agency said nearly 95 percent of the global population is unprotected by laws banning smoking. WHO said secondhand smoking kills about 600,000 people every year.

The report describes countries’ various strategies to curb smoking, including protecting people from smoke, enforcing bans on tobacco advertising, and raising taxes on tobacco products. Those were included in a package of six strategies WHO unveiled last year, but less than 10 percent of the world’s population is covered by any single measure.

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Antidepressant May Change Personality

Antidepressant May Change Personality While Relieving Symptoms

ScienceDaily (Dec. 7, 2009) — Individuals taking a medication to treat depression may experience changes in their personality separate from the alleviation of depressive symptoms, according to a report in the December issue of Archives of General Psychiatry, one of the JAMA/Archives journals.

Two personality traits, neuroticism and extraversion, have been related to depression risk, according to background information in the article. Individuals who are neurotic tend to experience negative emotions and emotional instability, whereas extraversion refers not only to socially outgoing behavior but also to dominance and a tendency to experience positive emotions. Both traits have been linked to the brain’s serotonin system, which is also targeted by the class of antidepressants known as selective serotonin reuptake inhibitors (SSRIs).

Tony Z. Tang, Ph.D., of Northwestern University, Evanston, Ill., and colleagues studied the effects of one particular SSRI, paroxetine, in a placebo-controlled trial involving 240 adults with major depressive disorder. A total of 120 participants were randomly assigned to take paroxetine, 60 to undergo cognitive therapy and 60 to take placebo for 12 months. Their personalities and depressive symptoms were assessed before, during and after treatment.

All participants experienced improvement in their symptoms of depression. However, even after controlling for these improvements, individuals taking paroxetine experienced a significantly greater decrease in neuroticism and increase in extraversion than those receiving cognitive therapy or placebo. “Patients taking paroxetine reported 6.8 times as much change on neuroticism and 3.5 times as much change on extraversion as placebo patients matched for depression improvement,” the authors write.

The findings provide evidence against a theory known as the state effect hypothesis, which proposes that any personality changes during SSRI treatment occur only as a result of alleviating depressive symptoms, the authors note. Several alternative explanations could be considered. “One possibility is that the biochemical properties of SSRIs directly produce real personality change,” they write. “Furthermore, because neuroticism is an important risk factor that captures much of the genetic vulnerability for major depressive disorder, change in neuroticism (and in neurobiological factors underlying neuroticism) might have contributed to depression improvement.”

SSRIs are widely used to treat depression, but understanding of their mechanisms are limited, the authors conclude; they have also been shown effective in treating anxiety disorders and eating disorders, conditions for which high neuroticism and low extraversion may also be a risk. “Investigating how SSRIs affect neuroticism and extraversion may thus lead toward a more parsimonious understanding of the mechanisms of SSRIs,” they conclude.

The data set of this study came from a clinical trial supported by grants from the National Institute of Mental Health, Bethesda, Md. GlaxoSmithKline of Brentford, England, provided medications and placebo pills.

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

http://www.sciencedaily.com/releases/2009/12/091207164846.htm

News coverage of antidepressants for kids uneven

NEW YORK (Reuters Health) – Dec 07, 2009 – Media coverage of the warnings on antidepressants and children’s risk of suicidal behavior often failed to give the public the whole story, according to a study published Monday.

The study, by researchers at the Yale University School of Public Health, concludes that many print and TV news stories did not give enough information on the actions the U.S. Food and Drug Administration (FDA) took in 2003 and 2004 on pediatric antidepressant use.

Safety concerns about the medications first surfaced in 2003, when research linked the drug paroxetine (Paxil) to an increased risk of suicidal thoughts and behavior in children and teenagers.

After an investigation, the FDA in 2005 added a so-called “black box” warning — the agency’s strongest warning — on the use of all antidepressants in children and teens to draw attention to the possible risks. In 2007, it extended the warnings to adults between the ages of 18 and 24.

Many psychiatrists have criticized the warnings, saying that they scare people away from effective treatment for depression, which is the leading cause of suicide. And studies have suggested that the warnings triggered not only a drop-off in pediatric antidepressant use, but may also have contributed to an 8 percent rise in suicide among minors in 2004, the biggest one-year gain in 15 years.

Critics have also charged that media coverage of the FDA warnings played a primary role in the declining use of antidepressants in children.

For the new study, published in the journal Pediatrics, Drs. Colleen L Barry and Susan H. Busch analyzed the quality of media stories on the issue when it was at its height — after three separate FDA actions in 2003 and 2004.

Looking at 167 stories from major newspapers and TV networks, the researchers found that 98 percent correctly stated that pediatric antidepressant use was linked to suicidal thoughts and behavior, and not to the risk of suicide itself.

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Depression, peers top influences on youth violence

NEW YORK (Reuters Health) – Dec 07, 2009 – Kids who are depressed and have delinquents for friends may be the most likely to lash out violently at others, according to a new study in The Journal of Pediatrics.

The amount of time a youth spent watching violent TV or playing violent video games didn’t have anything to do with whether he or she would commit violent acts in real life, Dr. Christopher J. Ferguson of Texas A&M International University and his colleagues found.

Ferguson and his team also found that while kids whose parents were psychologically abusive to their intimate partners were more likely to engage in violence, being exposed to a parent’s physical abuse of a partner wasn’t a factor.

Overall, the researchers found, the factors that did increase the risk of violent behavior had pretty small effects. Based on the findings, they say, future research should probably look at groups of risk factors, rather than focusing on a single one.

A lot of media attention tends to get focused on individual factors, like playing violent video games, Ferguson noted, even when there’s no evidence that they’re connected with violent behavior.

He and his colleagues investigated the interplay among various risk factors for violent behavior by looking at 603 children 10 to 14 years old and their parents or guardians. Most of the children were Hispanic. Fifteen percent of the children said they had committed non-violent crimes, while 12 percent said they had taken part in violent criminal behavior.

As mentioned, the strongest risk factors for violent behavior were depression and having delinquent peers, the researchers found. Others included a parent’s psychological abuse of a partner, antisocial personality, negative relationships with adults, and family conflict.

Based on the findings, Ferguson said it probably makes sense to target programs to prevent youth violence at “depressed kids who are hanging out with other kids who are probably in the same boat.”

The good news, he added, is that youth violence has been going down in the US since the late 1960s. “Things are improving for youth globally for the most part, contrary to what most people think today,” Ferguson said.

SOURCE: The Journal of Pediatrics, December 2009.

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

Cigarette Smoking Increases Colorectal Cancer Risk

ScienceDaily (Dec. 3, 2009) — New study results strengthen the evidence that people who smoke cigarettes over a long period of time have an increased risk for developing colorectal cancer, even after adjusting for other risk factors.

“This provides one more reason not to smoke, or to quit as soon as possible,” said senior author Michael J. Thun, M.D., M.S., vice president emeritus, epidemiology and surveillance research at the American Cancer Society. “Colorectal cancer should be added to the list of cancers caused by smoking.”

Findings are published in the December issue of Cancer Epidemiology, Biomarkers & Prevention, a journal of the American Association for Cancer Research, as part of a special focus on tobacco.

Thun and colleagues tested the association between long-term cigarette smoking and colorectal cancer after adjusting for multiple other factors that are generally associated with risk, including screening. From 1992 through 2005 the researchers followed almost 185,000 participants aged 50 to 74 years old; participants described their behaviors and medical conditions.

Participants who smoked cigarettes for 40 or more years, or who did not quit before age 40, had a 30 percent to 50 percent increased risk of developing colon or rectal cancer during the follow-up, even in analyses that adjusted for 13 other potential risk factors, according to Thun. After 13 years of follow-up, the researchers identified 1,962 cases of invasive colorectal cancer.

While previous large studies conducted in long-term smokers showed similar results, Thun stated that this study is the first to control for screening and all of the suspected risk factors for colorectal cancer, such as alcohol consumption, physical inactivity and consumption of red or processed meat.

“These findings contributed to the evidence recently reviewed by the International Agency for Research on Cancer (IARC) in October of this year,” Thun said. “IARC upgraded the evidence that smoking causes colorectal cancer from ‘limited’ to ‘sufficient’.”

This IARC reclassification brings the number of cancer organ sites causally related to cigarette use to 17, which includes cancers of the oral cavity, pharynx, nasopharynx, nasal cavity and paranasal sinuses, larynx, lung, esophagus (both squamous cell and adenocarcinoma), stomach, colorectum, liver, pancreas, kidney (both renal cell and transitional cell carcinoma), urinary bladder and lower urinary tract, uterine, cervix, and myeloid leukemia.

Adapted from materials provided by American Association for Cancer Research.

http://www.sciencedaily.com/releases/2009/12/091203090103.htm

Extreme caution with antidepressant Norpramin

WASHINGTON (Reuters) – French drugmaker Sanofi-Aventis SA has warned that its antidepressant Norpramin should be given with extreme caution to patients with a history of certain heart problems, the U.S. Food and Drug Administration said on Wednesday.

The label for Norpramin (desipramine hydrochloride tablets USP) will also warn that seizures precede abnormal heart rhythms and death in some patients. The heart conditions include a family history of sudden death, abnormal heart rhythms, and heart conduction disturbances.

The company’s letter to FDA and health professionals also said an overdose of Norpramin has shown a higher death rate than overdoses of other tricyclic antidepressants.

http://www.nlm.nih.gov/medlineplus/news/fullstory_92576.html

Makers of Powerful Painkillers Present Safety Plans

FRIDAY, Dec. 4 (HealthDay News) — The makers of 24 different prescription painkillers on Friday presented federal regulators with plans to curb the abuse of these opioid drugs.

The pharmaceutical companies have been under pressure from U.S. Food and Drug Administration officials to find a way to stop the hundreds of fatal overdoses that occur with these medications each year, the Associated Press reported.

 Executives from Johnson & Johnson, King Pharmaceuticals and other drug makers proposed using patient medication guides, letters to doctors and additional physician training to end the misuse and inappropriate prescribing of painkillers, according to the wire service.

In February, FDA officials sent letters to 16 companies ordering them to design risk-management plans for their drugs. The drug makers presented their joint proposal to the agency after several months of discussion.

 The painkillers in question include morphine, oxycodone and methadone.

 This marks the first time the agency has required a risk-management plan for an entire class of drugs, the AP reported.

 However, the problem is significant: a 2007 survey found 5.2 million people in the United States reported using prescription painkillers inappropriately.

 Such drugs are typically approved for people requiring round-the-clock treatment for moderate to severe chronic pain, such as cancer patients.

But, significant harm can occur if patients are uninformed about how to properly take the drugs, doctors inappropriately prescribe the drugs, or if legitimate prescriptions get into the hands of people other than the intended patient, Dr. John Jenkins, director of the FDA’s Office of New Drugs, part of the Center for Drug Evaluation and Research, said during a news conference back in February.

 Jenkins said then that the agency was taking this step to implement “a relatively massive new program,” because “the rates of misuse and abuse [of opiates] have risen over the past decade.” He also said the FDA was better able to address the problem, because the Food and Drug Administration Amendments Act of 2007 gave the agency the authority to regulate opioids.

 This is “our attempt to try and ensure that the benefits of the products outweigh their risks,” Jenkins said in February.

 In addition to patient misuse, the FDA has documented many cases of physicians prescribing the potent painkillers for people with migraines, an unapproved use. The FDA said patients also sometimes chew extended-release pills that are designed to be swallowed, causing an accidental overdose of the drug.

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

Bullies May Intimidate Siblings Also

THURSDAY, Dec. 3 (HealthDay News) — School bullies are also likely to bully their brothers and sisters at home, according to an Italian study that included 195 children between the ages of 10 and 12.

The participants — all with a sibling no more than four years older or younger than them — were asked whether they bullied or were bullied at school or at home. The findings were published online Nov. 30 in the British Journal of Developmental Psychology.

 “We found that children with older male siblings were the most victimized group,” study author Ersilia Menesini said in a news release from the British Psychological Society. “It was also the case that significantly more boys than girls told us that they bullied their sibling — who was most likely to be younger than them. It’s likely that this form of sibling bullying is all about maintaining a position of dominance.”

 But for girls, “bullying is mainly related to a poor quality of sibling relationship and not to birth order. In fact, high levels of conflict and low levels of empathy were significantly related to sibling bullying and sibling victimization,” Menesini said.

 The researchers also found a significant association between bullying and victimization at school and home. Children who bullied siblings were likely to bully schoolmates, while children bullied at home were likely to be bullied at school.

 “It is not possible to tell from our study which behavior comes first, but it is likely that if children behave in a certain way at home, bullying a sibling for instance, if this behavior goes unchecked they may take this behavior into school,” Menesini said.

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

The Center for Mental Health Services has more about bullying.

New Safety Concern Related to Antipsychotic Treatment

ScienceDaily (Dec. 2, 2009) — Overall, antipsychotic medications are reasonably effective, and fairly well tolerated treatments for mood and psychotic disorders. However, treatment with a number of antipsychotic medications is associated with weight gain, and for some, hyperglycemia and hyperlipidemia. In the current issue of Biological Psychiatry, published by Elsevier, researchers discuss this cluster of metabolic side effects and how it may contribute to the risk for diabetes, hypertension, and other medical disorders associated with heart disease. This is of particular concern because there is a higher cardiovascular mortality among the severely mentally ill compared to the general population.

Researchers already know that differences exist between antipsychotics in their effect on clinical measures associated with cardiovascular risk, namely weight, lipids and glucose. Systemic inflammation has recently emerged as an important marker of cardiovascular risk, but the effects of antipsychotics on inflammatory markers in the blood have not been extensively studied until now.

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Fear of Anxiety May Lead to Depression

Some become so worried about what might happen that they develop other symptoms, researchers find

TUESDAY, Dec. 1 (HealthDay News) — Fear of anxiety may push “above-average” worriers into depression, a new study suggests.

“Anxiety sensitivity has been called a fear of fear,” study author Andres Viana, a graduate student in psychology at Penn State, said in a news release. “Those with anxiety sensitivity are afraid of their anxiety because their interpretation is that something catastrophic is going to happen when their anxious sensations arise.”

Viana and colleagues analyzed questionnaires completed by 94 volunteers, average age 19, who were moderate to high worriers. The questionnaires assessed worry, generalized anxiety and depression.

The responses showed that anxiety sensitivity significantly predicted depression symptoms. The researchers also found that two of the four issues that comprise anxiety sensitivity — the “fear of cognitive dyscontrol” and the “fear of publically observable anxiety symptoms” — specifically predicted depression symptoms. The two other issues — the “fear of cardiovascular symptoms” and the “fear of respiratory symptoms” — weren’t significant predictors of depression.

“What we found was that the fear of the cognitive sensations typical of anxiety, like the inability to concentrate, was related to depression. And we also found that the link exists in people who are afraid of symptoms that could potentially have social implications or symptoms of anxiety that may be subject to negative evaluation,” Viana said.

The study findings are published in the December issue of the Journal of Anxiety Disorders.

Several studies have linked anxiety sensitivity to depression, which suggests that treating anxiety sensitivity may help prevent and treat depression, Viana said.

http://www.nlm.nih.gov/medlineplus/news/fullstory_92486.html

Fears and Facts About Antidepressants

Along with counseling, antidepressants are a common part of treatment for depression. And they are usually effective. Six out of 10 people treated with antidepressants feel better with the first one they try. If the first antidepressant medication doesn’t help, the second or third often will. Most people eventually find one that works for them. Yet many people who could benefit from an antidepressant never try one, often because of fears and misconceptions about them, experts say.

Here are eight common fears about antidepressants, as well as facts that can help you decide if an antidepressant might be right for you.

Fear: Antidepressants make you forget your problems rather than deal with them.

Fact: Antidepressants can’t make you forget your problems, but they may make it easier for you to deal with them. Being depressed can distort your perception of your problems and sap you of the energy to address difficult issues. Many therapists report that when their patients take antidepressants, it helps them make more progress in counseling.

Fear: Antidepressants change your personality or turn you into a zombie.

Fact: When administered correctly, antidepressants will not change your personality. They will help you feel like yourself again and return to your previous level of functioning. (If a person who isn’t depressed takes antidepressants, they do not improve that person’s mood or functioning.) Rarely, people experience apathy or loss of emotions while on certain antidepressants. When this happens, switching to a different antidepressant may help.

Fear: Taking an antidepressant will make me gain weight.

Fact: Like all drugs, antidepressants have side effects, and weight gain can be a common one of many of them. Some antidepressants may be more likely than others to cause weight gain; others may actually cause you to lose some weight. If this is a concern, talk with your doctor.

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Alcoholism treatment: Can diet aid recovery?

Mayo Clinic psychiatrist Daniel Hall-Flavin, M.D. answers: 

Because people with alcoholism tend to eat poorly, a common-sense approach to good nutrition is an important part of alcoholism treatment. But there’s no credible scientific evidence that any specific nutritional approach is a cure for alcoholism or even a critical part of the recovery process.

Alcoholism is a complex illness influenced by genetic, psychological and social factors. When you become addicted to alcohol, irreversible biological changes occur in your brain, which impair your ability to control your use of alcohol. Even if you’ve been sober for years, a return to drinking can rapidly lead to impaired control and the biological, psychological and social consequences of alcoholism.

Research has shown that there’s no clear “alcoholic personality” that predisposes you to alcoholism. But addiction is very much a mental health problem — and, like all mental health problems, has physical as well as psychological components to it.

Replacement of some specific vitamins and minerals may be important in treating nutritional deficiencies in some individuals. However, the most effective approach to alcoholism treatment involves reducing the shame and isolation that accompanies addiction, treating co-existing medical and psychiatric conditions, directly addressing the craving of alcohol, and creating sober, viable, social support networks.

http://www.mayoclinic.com/health/alcoholism-treatment/AN01561

www.mayoclinic.com is an excellent source for health related information