Tuesday, September 30, 2008

Persons With Serious Mental Illness Face Higher Prevalence of Obesity

Obesity is a public health crisis within the general population; however, overweight and obesity issues are even more prevalent in persons with serious mental illness, according to a new report, scheduled to be released on October 3, 2008 by the National Association of State Mental Health Program Directors (NASMHPD).
Findings and recommendations from the report appear in the September 22 issue of Mental Health Weekly, making the journal the first major media outlet to inform the public of this new technical report.
NASMHPD calls the crisis "an epidemic within an epidemic," and say they hope the new report will go a long way toward improving the systems that provide care and treatment to the SMI population.

READ MORE @ MARKET WATCH

Monday, September 29, 2008

U.S. Kids Take More Psychotropic Drugs Than Europeans

American children are three times more likely to be prescribed psychotropic medications for conditions such as ADHD and bipolar disease than European children are, a new study finds.

Differences in regulatory practices and cultural beliefs about the benefit of medication for emotional and behavioral problems may explain this dramatic difference, the U.S. researchers added.

"There is significantly greater use of atypical antipsychotics and SSRI-type antidepressants for child mental health treatment in U.S. than in Western Europe," said lead researcher Julie Zito, from the pharmaceutical health services research department in the School of Pharmacy at the University of Maryland. "Since most of the use is 'off-label' -- without adequate evidence of benefits and risks, close monitoring should be considered when these medications are used."

The report was published in the Sept. 24 online edition of Child and Adolescent Psychiatry and Mental Health.

READ MORE @ FORBES

Sunday, September 28, 2008

Antidepressants 'may harm sperm'

Drugs taken by millions of men to alleviate depression may affect their fertility, say US scientists.

A small number of healthy men given the antidepressant paroxetine for four weeks had far higher levels of sperm with damaged DNA.

The results, reported in New Scientist magazine, do not necessarily mean these men would have serious problems becoming a father.

However, a UK fertility specialist said they were a "cause for concern".

Paroxetine, sold as Seroxat or Paxil, is one of the most commonly prescribed antidepressants in the UK.

This is the second study by a team of researchers at Cornell Medical Center in New York which points to a possible effect on sperm quality.

READ MORE @ BBC

Friday, September 26, 2008

Understanding preemption, Part II

This is Part 2 of a letter to the editor that discusses preemption in the health industry, citing Dr. Bruce West in a Health Alert newsletter from August of this year.

To the Editor:

"The list of drugs known in advance to be dangerous with sometimes lethal side effects, is long indeed. There have been a dozen just in the last few years - always with the drugmakers' attempts to obscure, cover up, mask, lie, and hide the truth before it is finally revealed to the public in a court case. It is all routine.

READ MORE @ MARSHALL INDEPENDENT

Thursday, September 25, 2008

Understanding preemption

To the Editor:

If a company created a product which caused injury and/or death, would you be outraged and demand corrective action, i.e. lawsuit, etc.?

I would, and I believe you would also. Do the tobacco companies come to mind? Of course, many states redirected funds into areas foreign to their original agreement with the court, but who cares, they are the government. Right?

Well, when it comes to your health, loosen up, because the drug industry wants to be exempt from damage awards due to injuries or death caused by their drugs, medical devices, etc. It is referred to in law circles as preemption!

To come to a more comprehensive understanding of what this entails, I refer you to what Dr. Bruce West said in his Health Alert newsletter, dated August 2008, Volume 25, Issue 8, pp. 1-2. This will be a two part letter, due to length.

READ MORE @ MARSHALL INDEPENDENT

Wednesday, September 24, 2008

Statins Increase Risk Of Postoperative Delirium In Elderly Patients, Study Suggests

The use of statins is associated with a 28% increased risk of postoperative delirium in elderly patients, found University of Toronto professor Dr. Donald Redelmeier and colleagues in a retrospective cohort analysis involving more than 280 000 patients.

Ontario's Institute for Clinical Evaluative Sciences (ICES) looked at elderly patients who underwent elective surgery in Ontario and who had received 2 or more prescriptions for statins in the year before surgery, including at least one prescription in the 90 days preceding surgery. Many patients took multiple medications, underwent abdominal, musculoskeletal or urogenital surgery which had a mean duration of about 115 minutes.

Delirium, in addition to causing anxiety in patients and families, contributes to longer hospital stays, a prolonged need for intensive care, and can disrupt and delay care.

READ MORE @ SCIENCE DAILY

Tuesday, September 23, 2008

Inside Medicine: Doctors torn by end-of-life philosophies

Doctors and the American public are afraid to let people die – and even help them do so – with comfort and dignity.

That has become clear to me over my 20 years of practice and through the stories that my colleagues have shared with me.

One doctor e-mailed me about his patient, a woman of 80, who found herself dying of emphysema. Despite being tethered to green oxygen cylinders and having her face constantly enmeshed in clear plastic face masks, she was continually short of breath.

Talking was very difficult and walking even short distances was out of the question. Faced with a terminal illness, she chose hospice care rather than spend her last days in a hospital.

She asked for a pill to end her life. The doctor told her she was depressed (which, given her situation, she might well have been). He offered antidepressant medications. She refused – "no more treatments."

READ MORE @ SACRAMENTO BEE

Monday, September 22, 2008

No longer depressed, or on meds

Doctors show new interest in mind-body therapies for mental illness and are using everything from herbs to meditation and massage to treat depression without medication.

Henry Quant was just 5 years old and bedridden with chronic fevers when he began taking pills for anxiety and depression.

His mother knew that the drugs helped, but they made her nervous.

"The really scary part," Elizabeth Quant said, "is we don't know what these do long term."

This summer, under the watchful eye of his physician, Henry, now 7, replaced his antidepressants with vitamins and learned some stress-relief exercises to calm himself.

READ MORE @ MINNEAPOLIS STAR TRIBUNE

Sunday, September 21, 2008

The Tyranny of Diagnosis

Not long ago, while surfing online for one disease, I got sidetracked by another: cryptogenic cirrhosis.

I have cared for patients with cryptogenic cirrhosis. It is a common cause of liver-related illness and death in the United States, and symptoms can range from jaundice, bleeding and confusion to life-threatening hemorrhage, coma and death.

The cause of the disease, as the name implies (from the Greek “krypt,” or hidden, and “genesis,” or origin), has long been unknown. Every one of my patients with cryptogenic cirrhosis has heard the same thing from their doctors, including myself: “We have no idea why you are so sick.”

For these patients, cryptogenic cirrhosis is not a diagnosis but a non-diagnosis.

READ MORE @ NY TIMES

Saturday, September 20, 2008

Medical Panel Disproves Psychiatric Theory - Finding No Evidence of Schizophrenia as Genetic Disease

After 25 years of psychiatric research attempting to single out a genetic component to verify the medical existence of schizophrenia, a panel of medical researchers from Australia, France and the United States concluded that no such genes exist, nullifying the genetic theory that psychiatrists have passed off as factual despite any conclusive evidence.

The study entitled “No Significant Association of 14 Candidate Genes with Schizophrenia in a Large European Ancestry Sample: Implications for Psychiatric Genetics,” published in the American Journal of Psychiatry found there is no significant association of schizophrenia with hereditary markers previously thought to be indicative of it.

“Research has never shown any link between genes and schizophrenia,” said Mary Boyle, emeritus professor of clinical psychology from the University of East London. “There has been a vast amount of time and money spent. Yet nothing has come from it. If people want to continue this research, good luck to them. But my worry is that they are being given public funding.”

READ MORE @ PR URGENT

Friday, September 19, 2008

Psychiatrist And Neuroscientist Says Antipsychotics Cause Brain Shrinkage

I've been writing about the dirtiest little secret of antipsychotics for some time now, namely that they cause brain shrinkage in some (I'm assuming it's not all) patients and animal studies, so it was rather bracing yesterday to read this New York Times interview with Nancy Andreasen, a neuroscientist and psychiatrist at the University of Iowa who does nervous system research on people diagnosed with schizophrenia with MRIs.

READ MORE @ FURIOUS SEASONS

Thursday, September 18, 2008

Obama & McCain Agree On One Thing: Generics

You’re not surprised, are you? In any event, expanding the use of low-cost generics, including versions of biologics, would be near the top of their health care agendas, according to their advisers, who were speaking at a conference for the generic industry.

“We know that expanding the use of generics and eliminating barriers to that goal must be a centerpoint of any health reform effort,” Dora Hughes, a health care adviser for Obama, according to the Associated Press. And McCain adviser Douglas Holtz-Eakin echoed the sentiment: “Controlling health care costs has to be the imperative of any effective health care reform.”

READ MORE @ PHARMALOT

Wednesday, September 17, 2008

Army Use of Psychiatrists in Interrogations Called Unethical

U.S. military psychiatrists may be asked to assist in interrogations of detainees, in apparent conflict with American Psychiatric Association and American Medical Association policies, said a researcher here.

In 2006, both associations endorsed policy statements forbidding psychiatrists and other physicians from being present at interrogations or advising on techniques to be used on individual detainees. (See: APA: Stay Out Of Interrogations, Psychiatrists Urged and AMA: Prisoner Interrogation Unethical for Physicians, Declares AMA Panel)

"Yet documents recently provided to me by the U.S. Army in response to requests under the Freedom of Information Act make clear that the Department of Defense still wants doctors to be involved and continues to resist the positions taken by medicine's professional associations," wrote Jonathan H. Marks, M.A., B.C.L., of Penn State University, in the Sept. 11 issue of the New England Journal of Medicine.

READ MORE @ MEDPAGE TODAY

Tuesday, September 16, 2008

Study rejects cost-effectiveness of CBT for adolescents

Cognitive behavioural therapy (CBT) for clinically depressed adolescents is not cost effective, researchers have found.

For those with moderate to severe major depression, the addition of CBT to drug therapy and active clinical care does not improve wellbeing enough to justify the cost, researchers have found.

The research team at the National Institute for Health Research Health Technology Assessment (NIHR HTA) compared the clinical benefits and cost-effectiveness of two treatments for depression.

READ MORE @ MANAGEMENT PRACTICE

Monday, September 15, 2008

The Bipolar Puzzle

When Claire, a pixie-faced 6-year-old in a school uniform, heard her older brother, James, enter the family’s Manhattan apartment, she shut her bedroom door and began barricading it so swiftly and methodically that at first I didn’t understand what she was doing. She slid a basket of toys in front of the closed door, then added a wagon and a stroller laden with dolls. She hugged a small stuffed Pegasus to her chest. “Pega always protects me,” she said softly. “Pega, guard the door.”

James, then 10, had been given a diagnosis of bipolar disorder two years earlier. He was attending a therapeutic day school in another borough and riding more than an hour each way on a school bus, so he came home after Claire. Until James’s arrival that April afternoon, Claire was showing me sketches she had drawn of her Uglydolls and chatting about the Web site JibJab, where she likes to watch goofy videos. At the sound of James’s footsteps outside her bedroom door, she flattened herself behind the barricade. There was a sharp knock. After a few seconds, James’s angry, wounded voice barked, “Forget it,” and the steps retreated.

READ MORE @ NY TIMES

Sunday, September 14, 2008

Study of Newer Antipsychotics Finds Risks for Youths

A new government study published Monday has found that the medicines most often prescribed for schizophrenia in children and adolescents are no more effective than older, less expensive drugs and are more likely to cause some harmful side effects. The standards for treating the disorder should be changed to include some older medications that have fallen out of use, the study’s authors said.

The results, being published online by The American Journal of Psychiatry, are likely to alter treatment for an estimated one million children and teenagers with schizophrenia and to intensify a broader controversy in child psychiatry over the newer medications, experts said.

Prescription rates for the newer drugs, called atypical antipsychotics, have increased more than fivefold for children over the past decades and a half, and doctors now use them to settle outbursts and aggression in children with a wide variety of diagnoses, despite serious side effects.

A consortium of state Medicaid directors is currently evaluating the use of these drugs in children on state Medicaid rolls, to ensure they are being prescribed properly.

READ MORE @ NY TIMES

Saturday, September 13, 2008

Medicare: A Bush Disaster That My Life Depends on

I began needing drugs to stay alive one day in the early 1990s, though I did not realize it at the time. I was still a decade away from officially becoming an old person by US government standards, although I'd already started getting my mailings from AARP. I had spent the afternoon in the Plaza Hotel bar in New York City, meeting with an actor who'd said he wanted to make a film from a book I'd written. (To no one's surprise, it never happened.) I'd had a few bourbons without eating anything, and afterward I stopped off at a falafel place. Then I began to vomit blood.

I went to the doctor. He gave me the first of what was to become a series of yearly tests, snaking a fiber-optic device down my throat to look at my upper digestive tract. He announced that I had Barrett's syndrome, a dangerous precancerous condition in the cells of the lower esophagus, caused by years of acid reflux. But fortunately for me, the doctor said, there was a pill, still relatively new at the time, that could save me from a terrible fate -- a little purple pill. With that, I became one of the millions of people who take Prilosec and a crop of other prescription drugs for acid reflux, stomach ulcers, and heartburn.

READ MORE @ ALTERNET

Friday, September 12, 2008

Teen depression: No genes required - Depressed moms can raise their children’s risk for depression via nurture alone

Some youngsters get depressed in the absence of any genetic legacy of the mood disorder, a new investigation finds.

Researchers report that having a depressed mother substantially ups a teenager’s likelihood of becoming depressed, even if he or she was adopted and shares no genes with the mother.

This finding provides the first direct evidence that purely environmental factors can promote depression in the children of depressed women, says a team led by psychologist Erin Tully of the University of Minnesota in Minneapolis.

Having a depressed father does not increase depression susceptibility in either adopted or non-adopted teens, Tully and her colleagues report in the September American Journal of Psychiatry.

Two other investigations, both published in the same journal, further emphasize nurture’s role in depression. They show that successful treatment of depressed mothers — either with medication or psychotherapy — spurs emotional gains in their depressed children.

“There is an environmental liability of maternal depression that cannot be accounted for by genes but that almost certainly interacts with genetic factors to create depression risk in children,” Tully says.

Depression can impair a mother’s parenting skills, cause marital conflict, and disrupt a youngster’s ties to peers and school — and these outcomes can in turn spread depression from mother to child, Tully suggests.

SCIENCE NEWS

Thursday, September 11, 2008

Untapped Potential Of Antidepressants For Cancer

A comprehensive review of current scientific literature, published in the peer-reviewed journal ecancer, has suggested that antidepressants can help the human body fight cancer by boosting its own immune response, amongst other mechanisms.

Not only this but they can help with side effects from chemotherapy such as aiding sleep, stimulating appetite, combating pain and avoiding depression.

Antidepressants work by affecting levels of chemicals known as prostaglandins. These are ephemeral, infinitesimal signallers self-regulating every cell in the body, including those serving mood and immunity. When first discovered they were perceived as a master switch, but are now believed to regulate every component of cellular microanatomy and physiology, including those of the organelles, cytoskeleton, proteins, enzymes, nucleic acids and mitochondria.

READ MORE @ SCIENCE DAILY

Wednesday, September 10, 2008

Use of Antidepressant Medications Common Among People With No Psychiatric Illness: Presented at CPA

September 8, 2008 -- Use of antidepressant medications is common among individuals who do not have any identifiable Axis I psychiatric disorders, according to results of a study presented here at the 58 Annual Conference of the Canadian Psychiatric Association (CPA).

"Anecdotal evidence suggests that many individuals in the general population may be taking antidepressants without possessing any indication for such treatment, according to accepted medical guidelines," said first author Jina Pagura, BSc(Hons), Department of Psychiatry, University of Manitoba, Winnipeg, Manitoba, Canada.

READ MORE @ DOCTOR'S GUIDE

Tuesday, September 9, 2008

List of medications with potential safety problems

Drugs under investigation by the Food and Drug Administration, what they are used for and the potential problem:
_R-Gene 10, a growth hormone, pediatric overdose due to labeling/packaging confusion.
_Suprane, an anesthetic, cardiac arrest.
_Cymbalta, for depression and other conditions, urinary retention.

READ MORE @ WASHINGTON POST

Monday, September 8, 2008

Judge OKs Zyprexa Class Action, Unseals Documents

A federal judge has granted class action status to a Zyprexa lawsuit that claimed Eli Lilly hid the drug’s serious side effects. The decision by Judge Jack B. Weinstein of Federal District Court in Brooklyn also unseals confidential documents relating to the antipsychotic medication. Eli Lily

The Zyprexa lawsuit in question was brought by insurance companies, pension funds and unions that want repaid for the money the they spent on the drug. The plaintiffs contend that Eli Lilly knew that Zyprexa had caused excessive weight gain and diabetes, and that the company marketed it for unapproved uses. In July, Judge Weinstein urged Lilly to settle, but the case will now proceed to a jury trial.

The judge also unsealed hundreds of pages of confidential documents that were produced by Eli Lilly in relation to a lawsuit filed by patients. They were placed under a protective court order soon after that suit was filed in 2004.

READ MORE @ NEWS INFERNO

Sunday, September 7, 2008

Cognitive and Global Outcome in Schizophrenia Patients Related to Course of Disease, Not Antipsychotic Type: Presented at ECNP

In patients with chronic schizophrenia, the type of antipsychotic treatment (typical or atypical) is not as important for long-term cognitive and social functioning, according to the results of a study presented here at the 21st European College of Neuropsychopharmacology Congress (ECNP).

Research in the field of neuropsychopharmacology has been indicating a beneficial influence of atypical antipsychotic treatment on cognitive function of patients with schizophrenia, but there have been contradictory findings as well.

"In our study, we compared the patients' functioning with their present medication," explained Agnieszka Kalwa, PhD student, Independent Pharmacotherapy Unit, Institute of Psychiatry and Neurology, Warsaw, Poland, at a poster presentation on September 2.

The study assessed the relationship between the type of current antipsychotic therapy and the cognitive, clinical, and global social outcome in 30 patients with a duration of disease ranging from 29 to 36 years.

READ MORE @ DOCTOR'S GUIDE

Saturday, September 6, 2008

Youth Suicides Continue to Rise in U.S. - One reason may be reluctance to prescribe antidepressants, study suggests

Suicides among U.S. children appear to be on the rise after a 15-year decline, and the trend may owe, in part, to fewer teens being prescribed antidepressants, a new study suggests.

Researchers thought a spike in youth suicides in 2004 may have been an anomaly. But the new study found the increase in suicides continued during 2005.

Looking at suicide trends among youngsters over a 15-year period, Jeff Bridge, from Nationwide Children's Hospital in Columbus, Ohio, found the rates of suicide among youths aged 10 to 19 were higher in 2004 and 2005 than would have been expected, based on suicide rate trends from 1996 to 2003.

"This is significant, because pediatric suicide rates in the U.S. had been declining steadily for a decade until 2004, when the suicide rate among U.S. youth younger than 20 years of age increased by 18 percent, the largest single-year increase in the past 15 years," said Bridge, an investigator in the Center for Innovation in Pediatric Practice.

READ MORE @ U.S. NEWS & WORLD REPORT

Friday, September 5, 2008

Risks and benefits of antipsychotics in children and adolescents

Many of the psychiatric disorders observed in adults have their onset in childhood or adolescence. In fact some studies show that at least 20% of children and adolescents will fulfil a diagnostic criterion for a mental disorder before reaching adulthood. The presence of a major mental illness is certainly no less serious in children than in adults – in fact, childhood onset of several psychiatric disorders predicts a worse illness course. Early manifestations of mental disorders may substantially impact the child´s academic performance and achievement as well as his/her ability to develop age-appropriate social skills. Thus, appropriate identification and treatment of signs and symptoms of psychiatric illnesses during childhood and adolescence is critical for minimizing continued or additional psychiatric problems that put these children at risk later in life.

For many years old antipsychotics have been used for the treatment of conditions such as severe conduct disorders, Tourette syndrome, bipolar disorder and schizophrenia in children and adolescents. Treatment advances, particularly with the introduction of new-generation antipsychotic medications, have created a lot of expectations in the search for long-term, clinically effective treatments for this young population. The prescription of new-generation antipsychotics has become a widely accepted practice in the treatment of children and adolescents with psychotic disorders (Armenteros & David, 2006) and many other psychiatric conditions (Findling et al., 2005; Olfson et al., 2006). In fact, prescribing of new-generation antipsychotics has increased dramatically in recent years in the paediatric population (160% in the USA between 1990 and 2000) (Patel et al., 2005).

READ MORE @ EUREKALERT

Thursday, September 4, 2008

Brain's Serotonin May Explain Seasonal Mood Changes

Fluctuations in the actions of the serotonin transporter, which helps regulate the mood-altering neurotransmitter serotonin, may help explain seasonal affective disorder and related mood changes, researchers say.

In places where the weather changes with the seasons, people commonly feel happier and more energetic when the days are bright and sunny and more depressed and fatigued during the dark of winter. Scientists believe this is related to variations in brain levels of serotonin, a neurotransmitter involved in regulating functions such as mating, feeding, energy balance, and sleep.

READ MORE @ WASHINGTON POST

Wednesday, September 3, 2008

Variations In Antidepressant Prescribing Suggest Disparities In Provision Of Care

GPs prescribe lower volumes of antidepressants in areas with more Black or South Asian people, suggesting possible disparities in the provision of care.

The study, published in the September issue of the British Journal of Psychiatry, also reveals that higher volumes of antidepressants are prescribed by general practices in economically deprived areas, and by practices serving areas with a high prevalence of chronic illness.

Researchers from King's College London set out to explore the relationship between physical illness, social deprivation, ethnicity, practice characteristics and the volume of antidepressants prescribed in primary care.

READ MORE @ MEDICAL NEWS TODAY

Tuesday, September 2, 2008

Long-Term Antidepressant Treatment Without Active Management Hardly Induces Remission: Presented at ECNP

A Scottish study identified a group of patients in primary care who are on long-term and stable treatment with selective serotonin reuptake inhibitors (SSRIs). A substantial proportion of patients displayed prevailing residual depressive and anxiety symptoms as well as sleep problems in spite of their treatment.

Alan Wade, MD, CPS Clinical Research Centre, Glasgow, Scotland, presented the study at a poster session on September 1 here at the 21st European College of Neuropsychopharmacology (ECNP) Congress.

Patients who were prescribed standard doses of antidepressants by their general practitioners without active management due to repeat prescriptions were identified from prescribing records in the West of Scotland.

READ MORE @ DOCTOR'S GUIDE

Monday, September 1, 2008

Antidepressants in suicide prevention

Antidepressants are the cornerstone of treatment of depressive disorders in health care. Their efficacy in treating depression is undisputable, although it leaves room for improvement. However, recent reports also suggest that antidepressants might, in some rare cases, actually worsen suicidal tendencies instead of alleviating them. As a consequence, research has intensified to clarify this issue, and regulatory authorities in many countries have reconsidered their cost-benefit ratio. While there is no doubt that such potential side-effects of antidepressant therapy are a very serious issue, it is important to obtain a balanced view of all the clinical and epidemiological facts pertaining the effect of antidepressant therapy in relation to suicidal behaviour.

READ MORE @ EUREKALERT