Psychiatry / Psychology
Major study of opiate use in children’s hospitals provides simple steps to alleviate harm
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Hospitalized kids with painful ailments from broken bones to cancer are often dosed with strong, painkilling drugs known as opiates. The medications block pain, but they can have nasty side effects. Constipation, for instance, is one side effect that can cause discomfort and even extend a child’s hospital stay.
“No parent wants their child in the hospital any longer than necessary,” said Paul Sharek, MD, MPH, medical director for quality management and chief clinical patient safety officer at Lucile Packard Children’s Hospital at Stanford. Sharek is the primary author of a new study, detailing the first large multicenter trial in children to show a decrease in harm from pain medications. It shows how simple changes to hospital procedures can sharply reduce the harm children suffer from opiates. The study, a yearlong collaboration between 14 U.S. children’s hospitals, documented a 67 percent drop in harmful events caused by the pain relievers when these procedures were implemented.
“Our collaborative aim was to decrease adverse drug event rates by 50 percent,” Sharek said. “We far exceeded that, which was very exciting.”
Older problem gamblers may face greater suicide risk than younger counterparts, study finds
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Compared to their younger counterparts, older problem gamblers who ask casinos to bar them from returning are three to four times more likely to do so because they fear they will kill themselves if they don’t stop betting, according to a new study.
Researchers Lia Nower, JD, PhD, of the Rutgers University Center for Gambling Studies, and Alex Blaszczynski, Ph.D. of the University of Sydney, Australia, looked at 1,601 self-described problem gamblers who asked between 2001 and 2003 to be banned from Missouri casinos. The results of their study were published in the September issue of Psychology and Aging, published by the American Psychological Association.
Older adults – over age 55 in this study—reported gambling an average of 17 years before “self-exclusion” – more than twice the length of time reported by younger adults. All participants were asked to cite the main reason or reasons why they sought to be barred from casinos. Younger, middle-aged and older adults all gave as the primary reasons gaining control, needing help and hitting rock bottom. However, nearly 14 percent of older adults surveyed – a higher proportion than any other group – indicated they sought help because they wanted to prevent themselves from committing suicide.
Increase in Youth Suicide Rate Following Decade-Long Decline May Reflect Emerging Health Crisis
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A sudden and dramatic increase in pediatric suicides may reflect an emerging trend rather than a single-year anomaly. That’s the conclusion of new suicide research, conducted at The Research Institute at Nationwide Children’s Hospital and published in the September 3rd issue of the Journal of the American Medical Association (JAMA), which looked at pediatric suicide trends over a 10-year period.
Following a decade of steady decline, the suicide rate among U.S. youth younger than 20 years of age increased by 18 percent from 2003-2004 – the largest single-year change in the pediatric suicide rate over the past 15 years. Although worrisome, the one-year spike observed in 2003-2004 does not necessarily reflect a changing trend. Therefore, researchers examined national data on youth suicide from 1996-2005 in order to determine whether the increase persisted from 2004-2005, the latest year for which data are available.
Researchers estimated the trend in suicide rates from 1996-2003 using log-linear regression. Using that trend line, they estimated the expected suicide rates in 2004 and 2005 and compared the expected number of deaths to the actual observed number of deaths. Researchers found that although the overall observed rate of suicide among 10 to 19 year olds decreased by about 5 percent between 2004 and 2005 (the year following the spike) both the 2004 and 2005 rates were still significantly greater than the expected rates, based on the 1996-2003 trend.
Depression common among Rwandan youth who head households
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More than half of orphaned youth age 12 to 24 who head households in rural Rwanda meet criteria for depression, according to a report in the August issue of Archives of Pediatrics & Adolescent Medicine, one of the JAMA/Archives journals.
The combined effects of the 1994 genocide and the HIV epidemic give Rwanda one of the highest numbers of orphans in the world—an estimated 290,000 in 2005, according to background information in the article. “Most African orphans have been absorbed into informal fostering systems,” the authors write. “Such systems, however, are increasingly overwhelmed, and many orphans either head households or live on the street.”
Neil W. Boris, M.D., of the Tulane University School of Medicine, New Orleans, and colleagues assessed depressive symptoms in 539 youth in Rwanda who served as heads of households. Trained interviewers met with the youth (age 24 or younger, average age 20) and administered scales measuring symptoms of grief, depression, adult support and marginalization from the community. Questions about demographics, health, vulnerability and risky behaviors also were included.
The first autism disease genes
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The autistic disorder was first described, more than sixty years ago, by Dr. Leo Kanner of the Johns Hopkins Hospital (USA), who created the new label ´early infantile autism´. At the same time an Austrian scientist, Dr. Hans Asperger, described a milder form of the disorder that became known as Asperger Syndrome, characterised by higher cognitive abilities and more normal language function. Today, both disorders are classified in the continuum of ´Pervasive Developmental Disorders´ (PDD), more often referred to as Autism Spectrum Disorders (ASD).
The prevalence of (classic) autism in the general population is about 15-20 in 10.000, while all Autism Spectrum Disorders (ASD) affect about 60 in 10.000 children. Males are affected four times more often than females. In approximately 10% of cases, autism is associated with a recognized cause, such as Fragile X Syndrome, Tuberous Sclerosis or diverse chromosomal abnormalities (mean observed rates between 5-10%), but in a vast majority of cases, no known causes are associated with autism.
Family therapy helps relieve depression symptoms in bipolar teens
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Family-focused therapy, when combined with medication, appears effective in stabilizing symptoms of depression among teens with bipolar disorder, according to a report in the September issue of Archives of General Psychiatry, one of the JAMA/Archives journals.
Between one-half and two-thirds of patients with bipolar disorder develop the condition before age 18, according to background information in the article. “Early onset of illness is associated with an unremitting course of illness, frequent switches of polarity, mixed episodes, psychosis, a high risk of suicide and poor functioning or quality of life,” the authors write. “The past decade has witnessed a remarkable increase in diagnoses of bipolar disorder in children and adolescents and, correspondingly, drug trials for patients with early-onset disorder. There has been comparatively little controlled examination of psychotherapy for pediatric patients.”
Scientists’ Findings May Lead to New Drug-abuse Treatments
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Increased connections among brain cells caused by excessive drug use may represent the body’s defense mechanism to combat addiction and related behaviors, scientists at UT Southwestern Medical Center have found.
Previous studies have shown that repeated use of drugs such as cocaine, amphetamines and nicotine increase the number of anatomical structures called dendritic spines in brain regions associated with pleasure and reward. These dendritic spines represent sites where brain cells communicate with one another. Many scientists believe that this long-lasting brain rewiring underlies the similarly persistent behaviors of drug-taking and drug-seeking associated with addiction and relapse. The mechanism that controls this brain rewiring, however, and its relationship to addiction-related behaviors were previously unknown.
In a study appearing in the Aug. 28 issue of Neuron, researchers found that cocaine suppresses the activity of the protein MEF2 in mice. Because MEF2 normally reduces the number of brain connections, suppressing MEF2 leads to an increase in dendritic spine density. The researchers also found that when they enhanced MEF2 activity in the brain this blocked the drug-induced increase in dendritic spine density and increased addiction-related behavioral responses to cocaine.
Brain changes seen in former anorexics
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Young women who suffered from anorexia during their teen years have persistent changes in the structure of their brains, and deficits in cognition, if they haven’t fully recovered from the illness, according to Canadian investigators.
Dr. Debra K. Katzman at the University of Toronto, Ontario and her associates studied 66 young women, 21 years old on average, who had been treated for anorexia nervosa as adolescents. The group was compared with a “control” group of 42 healthy age-matched women.
For the former anorexia patients, the average interval from initial treatment to follow-up was 6.5 years. All subjects underwent a clinical examination, MRI brain scans, and cognitive evaluation.
College students often have suicidal thoughts
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A 2006 survey of roughly 26,000 college students in the US shows that over half have thought about suicide at least once during their lifetime.
Furthermore, 15 percent of students had seriously considered attempting suicide at some point in their lives and that over 5 percent actually had made one or more attempts, the Web-based survey, conducted by the National Research Consortium of Counseling Centers in Higher Education, found.
The findings were reported at the Annual Convention of the American Psychological Association in Boston.
Post-partum suicide attempt risks studied
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Although maternal suicide after giving birth is a relatively rare occurrence, suicide attempts often have long-lasting effects on the family and the infant. In a study published in the August 2008 issue of the American Journal of Obstetrics & Gynecology, researchers compared two populations of mothers and found that a history of psychiatric disorders or substance abuse was a strong predictor of post-partum suicide attempts.
Using the hospitalization and birth records from Washington State, USA, from 1992 to 2001, the researchers found that 335 women had been hospitalized for suicide attempts. Another 1420 women who had given birth but had not been hospitalized for a suicide attempt served as a control group.
After adjusting for fetal or infant death and other variables, women who had been previously hospitalized for psychiatric disorders were more than 27 times as likely to attempt suicide as women without this medical history. Women with a history of substance abuse were six times as likely to attempt suicide, while psychiatric hospitalization and substance abuse together increased the risk by 11 times.
US teens often watch extremely violent movies
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A telephone survey of 6,522 teens, between 10 and 14 years of age, reveals that, overall, up to 48 percent have watched a movie with extreme graphic violence. However, in certain subgroups, such as black males, rates over 80 percent were seen.
Concerns have been raised about the harmful effects of exposure to violent media, Dr. Keilah A. Worth and colleagues note in the journal Pediatrics, yet data regarding the occurrence of such exposure among teens is lacking.
In the new study, Worth, from Dartmouth Medical School in Lebanon, New Hampshire, assessed exposure to 40 movies that were rated R for violence by the Motion Picture Association of America, UK 18 by the British Board of Film Classification, and were determined to have extreme violence by trained content coders.
Estrogen Relieves Psychotic Symptoms in Women With Schizophrenia
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When combined with antipsychotic medications, the estrogen estradiol appears to be a useful treatment in women with schizophrenia, according to a report in the August issue of Archives of General Psychiatry, one of the JAMA/Archives journals.
The link between estrogen and mental illness was recognized more than a century ago, according to background information in the article. However, scientific evidence regarding estrogen as a therapy for mental illness has only recently emerged. “Epidemiologic observations of sex differences in the onset and course of schizophrenia prompted exploration of estrogen’s role in schizophrenia,” the authors write.
Jayashri Kulkarni, M.B.B.S., M.P.M., F.R.A.N.Z.C.P., Ph.D., of The Alfred and Monash University and The Alfred Hospital, Melbourne, Australia, and colleagues conducted a randomized, double-blind study involving 102 women of child-bearing age with schizophrenia. For 28 days, 56 women were randomly assigned to receive 100 micrograms of estradiol daily via a skin patch and 46 women received a placebo skin patch in addition to their regular medications. Psychotic symptoms, which include delusions and hallucinatory behavior, were assessed weekly with a commonly used scale.
Mechanism for postpartum depression found in mice
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Researchers have pinpointed a mechanism in the brains of mice that could explain why some human mothers become depressed following childbirth. The discovery could lead to improved treatment for postpartum depression. Supported in part by the National Institute of Mental Health, of the National Institutes of Health, the study used genetically engineered mice lacking a protein critical for adapting to the sex hormone fluctuations of pregnancy and the postpartum period.
“For the first time, we may have a highly useful model of postpartum depression,” said NIMH Director Thomas R. Insel, M.D. “The new research also points to a specific potential new target in the brain for medications to treat this disorder that affects 15 percent of women after they give birth.”
“After giving birth, female mice deficient in the suspect protein showed depression-like behaviors and neglected their newborn pups,” explained Istvan Mody, Ph.D., of the University of California at Los Angeles, who led the research. “Giving a drug that restored the protein’s function improved maternal behavior and reduced pup mortality.”
Hypnosis shown to reduce symptoms of dementia
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A scientist at the University of Liverpool has found that hypnosis can slow down the impacts of dementia and improve quality of life for those living with the condition.
Forensic psychologist, Dr Simon Duff, investigated the effects of hypnosis on people living with dementia and compared the treatment to mainstream health-care methods. He also looked at how hypnosis compared to a type of group therapy in which participants were encouraged to discuss news and current affairs.
They found that people living with dementia who had received hypnosis therapy showed an improvement in concentration, memory and socialisation compared to the other two treatment groups. Relaxation, motivation and daily living activities also improved with the use of hypnosis.
Obsessive compulsive disorder linked to brain activity
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Cambridge researchers have discovered that measuring activity in a region of the brain could help to identify people at risk of developing obsessive compulsive disorder (OCD).
As the current diagnosis of OCD is based on a clinical interview and often does not occur until the disorder has progressed, this could enable earlier more objective detection, and intervention.
The scientists, funded by the Medical Research Council and Wellcome Trust, have discovered that people with OCD and their close family members show under-activation of brain areas responsible for stopping habitual behaviour. This is the first time that scientists have associated functional changes in the brain with familial risk for the disorder. Their findings are reported in the 18 July edition of Science.
