Psychiatry / Psychology
When one antidepressant doesn’t work, another may
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For people suffering from depression that doesn’t respond to treatment with one type of antidepressant, switching to a different type may be the best treatment, according to a new report.
Relatively new antidepressants such as Prozac and Zoloft, for example, are called selective serotonin reuptake inhibitors or SSRIs. In recent clinical trials, only about a third of depressed patients achieved remission with SSRI treatment, the authors explain, but there is little consensus among psychiatrists about the best treatment for patients when an SSRI doesn’t work.
To look into this, Dr. George I. Papakostas from Harvard Medical School, Boston, and his associates conducted an analysis of four clinical trials that compared a switch to a second SSRI versus a non-SSRI antidepressant for SSRI-resistant major depression.
Group urges heart test before kids get ADHD drugs
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Children with attention deficit hyperactivity disorder should get their hearts checked before starting treatment with Ritalin or other stimulant drugs, experts recommended on Monday.
The American Heart Association called for these children to undergo an electrocardiogram, a test that detects and records the heart’s electrical activity, before taking such drugs.
The group said it is not clear that these medications increase a child’s risk of sudden cardiac death, but issued the new recommendations out of an abundance of caution.
Psychologist develops post-operative care for heart patients in Bermuda
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31 March 2008: A psychologist at the University of Liverpool is helping to create a potentially life-saving post-operative care service for heart patients in Bermuda.
The service, being developed in conjunction with the Bermuda Heart Foundation, will help support patients who have been fitted with an Implantable Cardioverter Defibrillator (ICD). ICDs are used to treat irregular heart beats, which can lead to heart attacks. If the heart rhythm increases in speed the ICD delivers low-voltage electrical impulses to the heart in an attempt to correct the rhythm.
Health care services in Bermuda are unable to offer the implants so patients are referred to Baltimore and other cities in the US where the ICD can be fitted. Patients returning to Bermuda after surgery have no post-operative care available to support them with any emotional or physical effects.
JOEM Presents Special Report on Depression in the Workplace
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Depression affects more than six percent of the working population. When people with bipolar disorder and other forms of depression are included, the true rate is even higher. But only half of workers suffering from depression receive any form of treatment, and less than half of these receive care consistent with current treatment guidelines according to new studies released by the American College of Occupational and Environmental Medicine (ACOEM) in its April Journal of Occupational and Environmental Medicine. This special issue of JOEM, the official publication of ACOEM, presents an update on workplace depression, highlighting the need for an integrated, evidence-based approach to managing this common, chronic, and often recurrent disorder.
The 15 papers in the issue, prepared by experts in their fields, are presented as part of the ACOEM Depression in the Workplace Project, a joint venture of the ACOEM Occupational Mental Health Committee and the ACOEM Health and Productivity Section. Project co-directors Drs. Garson M. Caruso and T. Larry Myette will host a special session Wednesday, April 16, 2008, on Depression in the Workplace during the American Occupational Health Conference, to be held at the Marquis Marriott Hotel in New York City, April 13-16.
Having defined the scope of the problem, the new papers discuss some promising approaches to improving the management of workplace depression. For example, programs to improve coping and stress management skills, identify employees at risk, and promote early treatment may help to prevent or lessen the severity of depression.
Early neglect predicts aggressive behavior in children
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Children who are neglected before their second birthday display higher levels of aggressive behavior between ages 4 and 8, according to a University of North Carolina at Chapel Hill study, published today in the journal Pediatrics.
Early child neglect may be as important as child abuse for predicting aggressive behavior, researchers say. Neglect accounts for nearly two-thirds of all child maltreatment cases reported in the United States each year, according to the Administration for Children and Families.
“The lack of attention devoted to the problem of neglect – the so-called ‘neglect of neglect’ – is a long-standing concern in the child welfare field,” said study co-author Jon Hussey, research assistant professor of maternal and child health in the UNC School of Public Health and a fellow at the Carolina Population Center. “Despite being more common than abuse, we know relatively little about the impact of neglect on children.”
Significant dementia risk attributable to small blood vessel damage
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Autopsy data of 221 men and women found that the brains of one-third of individuals who had dementia before death showed evidence of small, cumulative blood vessel damage that can arise from hypertension or diabetes.
Dr. Thomas Montine and colleagues analyzed the brain tissue of select volunteers from the Adult Changes in Thought (ACT) study, wherein 3,400 adult participants (65+) in the Seattle region agreed to undergo neurological and psychological tests every two years until their death
Wine drinking may cut women’s dementia risk
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Women who drink wine are less likely to develop dementia over time than their teetotaling peers, while drinking hard liquor may actually boost dementia risk, Swedish researchers report.
“There may be components in wine besides (alcohol) that protect against dementia,” Dr. Lauren Lissner of Goteborg University, the study’s senior author, told Reuters Health via e-mail. “Our findings are consistent with several previous reports.”
Lissner and her team looked at 1,462 women who ranged in age from 38 to 60 between 1968 and 1969 and were followed up to 2002, by which time 164 had been diagnosed with dementia. The women reported their alcohol consumption at the beginning of the study and three more times during the course of the study.
Insomnia may boost future depression risk
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Insomniacs are at increased risk of developing major depression, results of a 20-year study demonstrate.
The findings also suggest that while insomnia frequently accompanies depression, it may not be just a symptom of depression as is commonly thought, but a separate condition, Dr. Dr. Daniel J. Buysse of the University of Pittsburgh School of Medicine and colleagues say.
Depression is a well known risk factor for insomnia, and people with depression often report difficulty sleeping, Buysse and his team point out in the journal Sleep. And while some investigators have suggested that insomnia could, conversely, increase depression risk, few studies have looked at this issue over time.
Youth’s social problems contribute to anxiety and depression
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Socially successful children tend to have fewer symptoms of anxiety or depression, while children with problems such as anxiety and depression tend to have difficulties forming relationships and being accepted by friends. However, it is difficult to determine whether the anxiety and depression lead to the social problems, or vice versa. New research suggests that social problems are more likely to contribute to anxiety and depression than the reverse. The research also shows that this is particularly likely during the transition from adolescence into young adulthood.
The study, conducted by researchers at the University of Vermont and the University of Minnesota, appears in the March/April 2008 issue of the journal Child Development.
Using data from Project Competence, which has followed a group of 205 individuals from middle childhood (ages 8 to 12) over 20 years into young adulthood, the researchers used detailed interviews with participants and reports from their parents, teachers, and classmates to create measures of so-called internalizing problems (anxiety, depressed mood, being withdrawn) and social competence (how well one functions in relation to other people, particularly with respect to getting along with others and forming close relationships).
Brain trauma doesn’t predict post-concussion syndrome
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Mild traumatic brain injury is often followed by “post-concussion syndrome” but does not predict the condition, according to Australian researchers.
For unknown reasons, 5 to 10 percent of people who experience a concussion have symptoms that persist beyond six weeks. These people are diagnosed with post-concussion syndrome.
“Post-concussion syndrome has been a controversial diagnosis in both civilian and military populations,” Dr. E. Arthur Shores of Macquarie University in Sydney told Reuters Health
Treatment promising for alcohol dependence
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An extended-release version of the anti-addiction medicine naltrexone reduces drinking in alcohol-dependent patients within two days of being injected, according to a new study.
Naltrexone blocks opioid receptors and is approved for use in alcohol-dependent patients. To improve adherence, “an intramuscular, injectable, extended-release formulation of naltrexone has been developed,” Dr. Domenic A. Ciraulo, of Boston University School of Medicine, and colleagues explain in the Journal of Clinical Psychiatry.
The researchers tested injectable naltrexone XR in some 600 actively drinking, alcohol-dependent men and women who were given one of two doses of the drug or an inactive placebo every 4 weeks for 24 weeks. The participants also received 12 sessions of standardized, low-intensity psychosocial therapy.
Geneticist First to Connect a Gene Central to Neuron Formation to Autism
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Eli Hatchwell, M.D., Ph.D., Associate Professor of Pathology at Stony Brook University Medical Center, and colleagues have found that a disruption of the Contactin 4 gene on chromosome 3 may be linked to autism spectrum disorder (ASD). What causes ASD, a developmental disorder of the central nervous system, is largely unknown. Dr. Hatchwell’s finding suggests that mutations affecting Contactin 4 may be relevant to ASD pathogenesis, and thus a potential biomarker for some individuals with the disorder. Details of the study are reported in the early online edition of the Journal of Medical Genetics.
According to the Centers for Disease Control and Prevention, the prevalence of ASD in the United States may be as high as 1 in 150 children. The disorder is divided into five subtypes, including autism proper. Pathogenesis of ASD may be environmental and/or biological. Experts suspect that many genes may play a role in the etiology of ASD.
Treating Depression: What You Should Know
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What is depression?
Depression is a serious illness that affects your mood. Most people with depression feel sad or empty. It is probably caused by changes in the chemicals the brain uses to send messages from one nerve cell to another.
Who gets it?
Depression is common. Anyone of any age, sex, or race can get it. As many as 10 to 14 percent of patients who go to see their doctor have depression. Some people get it when stressful life events happen or because of a medical illness. Sometimes depression happens even when things seem to be “going right.” Many people get genes from their parents that make them more likely to become depressed.
Variations of Stress Response Gene Appear To Be Predictive of Risk of PTSD
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Adults who experienced child abuse and have variations of a gene related to stress response appear to be at greater risk of posttraumatic stress disorder symptoms as adults, according to a study in the March 19 issue of JAMA, a theme issue on Genetics and Genomics.
Rebekah G. Bradley, Ph.D., of the Emory University School of Medicine, Atlanta, presented the findings of the study at a JAMA media briefing at the National Press Club in Washington, D.C.
“Posttraumatic stress disorder (PTSD) is a debilitating stress-related psychiatric disorder, with prevalence rates of at least 7 percent to 8 percent in the U.S. population, and with much higher rates among combat veterans and those living in high-violence areas. Initially viewed as a potentially normative response to traumatic exposure, it became clear that not everyone experiencing trauma develops PTSD. Thus, a central question in research on PTSD is why some individuals are more likely than others to develop the disorder in the face of similar levels of trauma exposure,” the authors write. They add that it is becoming clear that there are critical roles for pre-disposing genetic and environmental influences in determining the psychological risk to the traumatized individual, with child abuse appearing to provide significant risk for the development of PTSD.
Some memory loss common in dementia-free elderly
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In 2002, more than 5 million older Americans had cognitive impairments that did not reach the threshold for dementia, according to research findings published in the Annals of Internal Medicine this week. These impairments include some loss of memory and thinking ability.
The findings also indicate that about 12 percent of individuals progress from cognitive impairment to dementia each year.
“Cognitive impairment both with and without dementia can be a problem in late life, but the number of individuals affected by these conditions in the U.S. is unknown,” Dr. Brenda Plassman, from Duke University Medical Center in Durham, North Carolina, told Reuters Health.
