Saturday, October 31, 2009

Surgery, Illness Not Linked to Mental Decline in Seniors New findings contradict previous reports of increased risks of dementia

Illness and surgery don't contribute to long-term cognitive decline in seniors and don't accelerate progression of dementia, researchers say.

The findings of a new study, published in the November issue of Anesthesiology, challenge the widely held belief that elderly patients suffer major deterioration in mental function after surgery.

"The concerns surrounding postoperative cognitive decline (POCD) following surgery certainly will not evaporate following publication of this study," researcher Michael S. Avidan, of the Washington University School of Medicine, said in a news release from the American Society of Anesthesiologists. "The important message to take from these findings is that persistent cognitive deterioration following surgery might not be a major public health problem. The decision to proceed with surgery should presently be made based on a person's general health and the specific risks and benefits of the procedure."

For the study, Avidan and colleagues looked at 575 patients tested annually at Washington University's Alzheimer Disease Research Center. At the start of the study, 361 patients had very mild or mild dementia and 214 were dementia-free. The patients were divided into three groups -- those who'd undergone non-cardiac surgery, those with illness, and those with neither.

READ MORE @ U.S. NEWS & WORLD REPORT

Friday, October 30, 2009

Patients with long-term diseases to be assessed for depression

GPs must assess people with chronic diseases to see whether they are suffering from depression, under new guidelines.

GPs must assess all patients with long-term diseases such as cancer to see whether they are suffering from depression, under new guidelines published today.

Too many doctors and patients assume that fatigue and weight loss are a result of the disease or the medicines they are taking, according to experts who formulated the guidelines for the National Institute for Healthcare and Clinical Excellence (NICE).

Depression affects one in six people at some point, but is three times more common in people with chronic diseases than in the rest of the population.

John Hindle, a consultant physician with the Betsi Cadwaladr University local health board, who was on the guideline development group, said that improving people's mood may even make them physically better.

"We should give everybody with physical disease the opportunity to be asked about the symptoms of depression," he said.

GPs should be asking two key questions, the guidelines say: during the last month, has the patient been bothered by feeling down, depressed or hopeless in the last month or by having little interest or pleasure in doing things?

READ MORE @ THE GUARDIAN

Thursday, October 29, 2009

Weight Gain Associated With Antipsychotic Drugs

Young children and adolescents who take the newest generation of antipsychotic medications risk rapid weight gain and metabolic changes that could lead to diabetes, hypertension and other illnesses, according to the biggest study yet of first-time users of the drugs.

The study, to be published Wednesday in The Journal of the American Medical Association, found that 257 young children and adolescents in New York City and on Long Island added 8 to 15 percent to their weight after taking the pills for less than 12 weeks.

The patients, ages 4 to 19, added an average of one to one-and-a-half pounds a week.

“The degree of weight gain is alarming,” said Dr. Wayne K. Goodman, head of a Food and Drug Administration advisory panel on the drugs last summer and chairman of psychiatry at Mount Sinai School of Medicine in Manhattan. “The magnitude is stunning,” he said.

Although the drugs’ influence on weight and metabolism had been previously detected, Dr. Goodman, who was not involved in the study, said the speed and magnitude of the effects found in the study were greater than previously reported — findings he said were made possible by looking exclusively at new patients.

READ MORE @ NY TIMES

Wednesday, October 28, 2009

Prescribing drugs 'off-label': an ethical prescription

More than one in five of the prescriptions U.S. doctors write for 160 common drugs is for a use other than that approved by the Food and Drug Administration. The practice is perfectly legal, though patients are largely in the dark about what "indications" or uses the FDA has approved for different prescription medications. (You can, however, always check the FDA-approved product labels for a prescription drug here.).

These "off-label uses" have not been scrutinized by the FDA for safety and effectiveness. It's not legal for drug companies actively to promote a drug for "off-label" purposes. But the practice means big money for drug makers, and some do it anyway (just last month, Pfizer agreed to plead guilty to promoting off-label uses for some of its medications and was fined $2.3 billion by the Justice Department, according to the Justice Department website).

So, while it's legal, the practice is controversial.

That leaves doctors, who often feel immense pressure to offer something--anything--to relieve a patient's suffering, in uncharted ethical waters. In some cases, the "off-label" use of a drug might be just the treatment the patient needed. But it might just as likely be a waste of time and money--or worse, pose unpredictable dangers to the patient. When "everybody's doing it" (and, yes, even physicians say stuff like that sometimes), what's a physician to do?

READ MORE @ LOS ANGELES TIMES

Tuesday, October 27, 2009

Antidepressants 'work instantly'

Antidepressants get to work immediately to lift mood, contrary to current belief, UK researchers say.

Although patients may not notice the effects until months into the therapy, the team say they work subconsciously.

The action is rapid, beginning within hours of taking the drugs, and changes negative thoughts, according to the Oxford University researchers.

These subtle, positive cues may add up over time to lift the depression, the American Journal of Psychiatry reports.

It may also explain why talking therapies designed to break negative thought cycles can also help.

Psychiatrist Dr Catherine Harmer and her team at Oxford University closely studied the reactions of 33 depressed patients and 31 healthy controls given either an antidepressant or a dummy drug.

The depressed patients who took the active drug showed positive improvements in three specific measures within three hours of taking them.

These patients were more likely to think about themselves in a positive light, rather than dwelling on their bad points, the researchers said.

They were also more likely to see the positive in others. For example, if they saw a grumpy person they no longer internalised this to think that they must have done something wrong to upset the person.

READ MORE @ BBC NEWS

Monday, October 26, 2009

Purging the stigma of mental illness

Joseph Rochford, associate professor of psychiatry at McGill and a director at the Douglas Hospital, hopes the hospital's Mini-Psych School will help debunk myths surrounding people suffering from mental disorders.

"Molecular biologists and geneticists are like the engineers who develop a new Formula One racing car. We're the ones who test drive it and then go back and say 'this is how it behaves.' "

That's Joseph Rochford, associate professor of psychiatry at McGill University and director of the Douglas Hospital Research Centre, on what a behaviour pharmacologist does.

The head of the neurophenotyping centre at the Douglas Institute studies how drugs used for treating mental disorders affect behaviour.

Starting this week, Rochford - also the director of academic affairs - will launch the Douglas's Mini-Psych School by giving the first session on the myths of mental illness. The purpose of the six-week course is to educate and sensitize the public to mental health issues.

READ MOEW @ MONTREAL GAZETTE

Sunday, October 25, 2009

New Pfizer unit to take on autism

Diane Stephenson of Groton has three tangible reasons for wanting to know as much as possible about autism.

Stephenson, associate research fellow at Pfizer Inc.'s Groton laboratories who helped start an autism research unit there earlier this year, has two nephews and a niece with the neurological disorder, which is often accompanied by language difficulties, behavioral problems, sleep interruptions, poor eye contact and low social skills.

Her sister's son Thomas, 23, has never spoken a word. And two of her brother's children, Clarise, 5, and Craig, 2, also have been diagnosed with autism.

Autism is believed to be caused by a combination of environmental and genetic factors, but there is little doubt the disorder tends to run in families. Stephenson said couples who have one autistic child are 30 times more likely than others to have a second with the same disorder.

"Everyone wants a cure," said Stephenson, who has worked at the Groton labs for six years. "I felt there was something I could do."

So Stephenson, along with Pfizer colleague Howie Mayer, who has two children with autism, worked behind the scenes for a year with the idea of forming a separate research unit focusing on autism. They later added another colleague, Larry Fitzgerald, as the group put the finishing touches on its proposal, contacting key experts outside Pfizer who had a grasp on the latest breakthroughs in autism research.

READ MORE @ HARTFORD COURANT

Saturday, October 24, 2009

Increase In Long-term Antidepressant Drug Use, UK Study Reveals

A dramatic rise in antidepressant prescriptions issued by GPs has been caused by a year on year increase in the number of people taking antidepressant drugs on a long-term basis, according to researchers from the University of Southampton.


In a paper, published in the printed edition of British Medical Journal (BMJ), scientists found that despite a drop in the number of new patients diagnosed with depression over 11 years, the number of prescriptions doubled.

"We estimate that more than 2 million people are now taking antidepressants long-term over several years, in particular women aged between 18 and 30," comments Tony Kendrick, a professor in Primary Medical Care of the University's School of Medicine, who led the study.

The number of prescriptions issued per patient rose from 2.8 in 1993 to 5.6 in 2004.

Prescription Pricing Authority data shows that more than 30 million prescriptions for SSRIs (selective serotonin reuptake inhibitors) such as Prozac and Seroxat, are now issued per year, twice as many as the early 1990s. Researchers at the University of Southampton found 90 per cent of people diagnosed with depression are now taking SSRIs either continuously or as repeated courses over several years.

RED MORE @ SCIENCE DAILY

Friday, October 23, 2009

Why antidepressants don't work for so many Northwestern research finds drugs aim at wrong target

More than half the people who take antidepressants for depression never get relief.

Why? Because the cause of depression has been oversimplified and drugs designed to treat it aim at the wrong target, according to new research from the Northwestern University Feinberg School of Medicine. The medications are like arrows shot at the outer rings of a bull's eye instead of the center.

A study from the laboratory of long-time depression researcher Eva Redei, presented at the Neuroscience 2009 conference in Chicago this week, appears to topple two strongly held beliefs about depression. One is that stressful life events are a major cause of depression. The other is that an imbalance in neurotransmitters in the brain triggers depressive symptoms.

Both findings are significant because these beliefs were the basis for developing drugs currently used to treat depression.

Redei, the David Lawrence Stein Professor of Psychiatry at Northwestern's Feinberg School, found powerful molecular evidence that quashes the long-held dogma that stress is generally a major cause of depression. Her new research reveals that there is almost no overlap between stress-related genes and depression-related genes.

READ MORE @ EUREKALERT

Thursday, October 22, 2009

Texas Lawsuit Blames Antipsychotic Seroquel for Woman’s Diabetes

Taking Seroquel to treat a mental disorder caused a Texas woman to develop diabetes and she wouldn’t have taken the drug if she knew of the risks, according to a lawsuit filed in Texas federal court.


Misty Peters claims she took the atypical antipsychotic drug, which is approved for treating schizophrenia and bipolar disorder but also is widely used by physicians to treat other unapproved “off-label” conditions, according to a report in the Southeast Texas Record.

Peters’ product liability lawsuit, filed last week in the Beaumont Division of the Eastern District of Texas, accuses Seroquel’s maker, Astra Zeneca Pharmaceuticals, and others of promoting the drug’s benefits and downplaying its risks while knowing it could cause users to develop diabetes and other medical problems.


Seroquel Linked to Diabetes, Other Blood-Sugar Disorders
Seroquel was approved by the Food and Drug Administration in 1997 as a member of a newer class of drugs called atypical antipsychotics. The drugs, which control levels of dopamine in the brain, are billed as being just as effective as older antipsychotic drugs like Haldol with fewer side effects, but more recent research has found a link between taking Seroquel and developing diabetes and other blood-sugar disorders.

READ MORE @ ATORNEY AT LAW

Wednesday, October 21, 2009

In praise of 'electroshock'

What does it feel like to be profoundly depressed?

“Sometimes you feel like your head is going to explode,” Richard Braudo explains. “There were times I was so depressed, I was comatose. You can reach the point where you don't want to live – the pain is too much.”

Mr. Braudo knows. His diagnosis: treatment-resistant bipolar affective disorder.

The Toronto lawyer and management consultant has survived 30 bouts of severe depression, each lasting many months, not to mention a couple of suicide attempts.

But, at the age of 55, he has finally achieved “stable wellness.”

Mr. Braudo credits electroconvulsive therapy for his recovery. He has undergone 10 courses of ECT since 1991, the last about 18 months ago – the longest period, by far, in his adult life that he has gone without a bout of depression.

He has chosen to tell his story to help counter the negative public image of ECT as barbaric and painful and to underscore that prescription drugs are not the be-all and end-all for people with psychiatric illnesses.

READ MORE @ GLOBE AND MAIL

Tuesday, October 20, 2009

MENTAL DISORDERS DON'T HINDER HEADACHE TREATMENT

Contrary to long-standing thinking, medications may offer comparable headache relief to those with and without mental disorders.

For an especially miserable time, mix recurring headaches with depression, anxiety or both. But people in such a fix have cause for optimism, courtesy of a team led by psychologist Bernadette Heckman of Ohio University in Athens.

Drug treatments for headaches work just as well for patients with these psychiatric disorders as for those with no such problems, Heckman and her colleagues report in the November Pain.

Researchers and clinicians generally assume that the presence of one or more psychiatric ailments worsens headache symptoms and thus the prospects for successful treatment. Heckman and her colleagues conducted one of the few prospective studies to test that conviction.

“Contrary to conventional clinical wisdom, many patients with psychiatric disorders responded favorably to headache treatment,” Heckman says.

The team found that, during six months of treatment at any of four outpatient headache clinics, rates of improvement in headache frequency and intensity were about the same for patients with depression, anxiety, a combination of the two or no psychiatric disorders.

In a comment published with the new study, psychologist Todd Smitherman of the University of Mississippi in Oxford and psychiatrist Donald Penzien of the University of Mississippi Medical Center in Jackson say that the new findings “give us pause to reconsider our earlier predictions” that people with mental disorders respond poorly to headache treatment.

READ MORE @ SCIENCE NEWS

Monday, October 19, 2009

Men on Tricyclic Antidepressant More Likely to Think of Suicide

All antidepressants may not be created equal when it comes to worsening of suicidal ideation during treatment, researchers found.

Men taking nortriptyline (Aventyl, Pamelor) were 2.4 times more likely to have an increase in suicidal thoughts than were those taking escitalopram (Lexapro), Nader Perroud, MD, of King's College London, and colleagues reported online in BMC Medicine.

Nortriptyline, a tricyclic antidepressant, was also associated with a 9.8-fold higher risk of new onset of suicidal ideation compared with the selective serotonin reuptake inhibitor (SSRI) in the prospective open-label trial.

The reason behind the difference may be that nortriptyline acts predominantly on the noradrenergic system, which, when overactive, is associated with anxiety and agitation.
Because "suicidal ideation is more common in agitated and irritable types of depression," the researchers said, "it is possible that nortriptyline may induce or worsen suicidal thoughts in some male subjects possibly through an induction of this more agitated type of depression."

Another possibility is that nortriptyline is less effective against mood symptoms, they noted.

All antidepressants now carry black box warnings of suicidality risk, particularly in children and young adults, and especially early in treatment, but whether this risk differs between agents or by gender has been debated.

READ MORE @ MEDPAGE TODAY

Sunday, October 18, 2009

'ECG for the mind' could diagnose depression in an hour

An innovative diagnostic technique invented by a Monash University researcher could dramatically fast-track the detection of mental and neurological illnesses.

Monash biomedical engineer Brian Lithgow has developed electrovestibulography which is something akin to an 'ECG for the mind'. Patterns of electrical activity in the brain's vestibular (or balance) system are measured against distinct response patterns found in depression, schizophrenia and other Central Nervous System (CNS) disorders.

The vestibular system is closely connected to the primitive regions of the brain that relate to emotions and behaviour, so Lithgow saw the diagnostic potential of measuring and comparing different patterns of electrovestibular activity.

Working with psychiatry researchers at Monash University's Alfred Psychiatry Research Centre (MAPrc) in Melbourne, Australia, he tested volunteers and found distinct response patterns, or "biomarkers", that distinguished different CNS diseases from each other and from regular electrovestibular activity.

READ MORE @ EUREKALERT"

Saturday, October 17, 2009

Should Michigan repeal immunity law for drug industry? Even after a felony plea, residents can't sue

Recently we learned that the Department of Justice will fine Pfizer $2.3 billion in civil and criminal penalties for its illegal marketing of the drugs Bextra, Zyvox, Geodon and Lyrica. This is not only the largest penalty ever levied against a drug company. It is the largest penalty ever levied against any company in American history.

That is saying something.

Pfizer and its subsidiary entities -- the former Upjohn and Pharmacia -- not only promoted these drugs for uses that were not approved by the FDA. They also marketed the drugs for uses that were explicitly rejected by the FDA, primarily because of safety concerns. To the degree that patients were killed or injured as a result, Pfizer's off-label marketing scheme amounts to negligent homicide.

That is probably why Pfizer was compelled to plead guilty to felony charges, which is also unprecedented in such contexts. In most instances, companies plea-bargain to misdemeanor admissions, fines are levied, and that is the end of it.

READ MORE @ DETROT FREE PRESS

Friday, October 16, 2009

Response to Nortriptyline and Paroxetine Linked to Level of Neuropsychological Impairment in Patients With Parkinson's Disease: Presented at ANA

The use of nortriptyline and paroxetine in the treatment of depression does not affect cognitive functioning in patients with Parkinson's disease (PD); however, the higher the baseline performance on measures of executive functioning, speed of processing, and verbal memory, the better the response to antidepressant treatment, according to results presented here at the American Neurological Association (ANA) 134th Annual Meeting.

"This is one of the few studies to examine the impact of antidepressant treatment on cognition in PD patients with depression," said Roseanne D. Dobkin, PhD, University of Medicine and Dentistry of New Jersey, Robert Wood Johnson Medical School, Piscataway, New Jersey.

More than 1 million people are affected by PD in the United States alone. It is the second most common neurodegenerative disease in the country, said Dr. Dobkin on October 10.

"Depression is one of the most common nonmotor symptoms of PD, affecting as many as half of these patients," she added.

READ MORE @ DOCTOR'S GUIDE"

Thursday, October 15, 2009

Older antidepressant spurs more suicidal thinking in men than newer medication

The largest clinical trial to date comparing an older, tricyclic antidepressant with a newer antidepressant of the selective serotonin reuptake inhibitor (SSRI) class has found that the emergence of suicidal thinking was almost 10 times more common in men taking the older drug than in those taking the newer medication.

The study also found that for men and women taking either medication, suicidal thinking was spread over the first six weeks of treatment, but peaked at roughly the fifth week before declining significantly after week six. Taking place at academic medical institutions across Europe, the trial, called Genome-Based Therapeutic Drugs for Depression--or GENDEP--gauged the responses to antidepressants of 811 persons ranging from 18 to 72 with depression.

READ MORE @ LOS ANGELES IMES

Wednesday, October 14, 2009

Novartis Enters Into Agreement for Exclusive US and Canadian Rights to Fanapt(TM), an FDA-Approved Oral Therapy for Schizophrenia

-- Fanapt (iloperidone), an antipsychotic therapy, is indicated in US for the acute treatment of schizophrenia in adults, set for US launch in early 2010

-- Addition of Fanapt will strengthen Novartis psychiatry portfolio and build on history in schizophrenia

-- Schizophrenia is a chronic, severe and disabling psychiatric disorder estimated to affect more than two million adults in the US and nearly 250,000 Canadians

-- Rights to Fanapt acquired from Vanda Pharmaceuticals Inc. for upfront payment of USD 200 million; Vanda eligible for milestones and sales royalties

Novartis Pharma AG has entered into an agreement for exclusive US and Canadian rights to Fanapt(TM) (iloperidone), a new oral medication that is approved by the US Food and Drug Administration (FDA) for the acute treatment of adults with schizophrenia. Novartis plans to launch Fanapt in the US in early 2010.
As part of the agreement with Vanda Pharmaceuticals Inc., Novartis will have exclusive commercialization rights to the oral formulation of this medicine in the US and Canada as well as exclusive rights to develop and commercialize a long-acting injectable (or "depot") formulation of this medicine for these markets.
Schizophrenia is a severe psychiatric disorder that is estimated to affect more than 2 million adults in the US and nearly 250,000 Canadians. Fanapt belongs to a class of medication for schizophrenia known as atypical antipsychotics.

READ MORE @ PR NEWSWIRE

Tuesday, October 13, 2009

Dementia's effects vary with cause

Dementia is an illness characterized by significant impairment of one or more areas of higher cognitive functioning, such as memory or ability to calculate. Dr. Mel Daly, a geriatrician at Greater Baltimore Medical Center Greater Geriatrics Group, discusses symptoms and treatment for dementia.

•About one in five people over age 80 have some form of dementia. Close relatives of people with early onset (before age 60) Alzheimer's disease have a greater chance of getting the disease. Those with genes from a group called ApoE are at increased risk for developing Alzheimer's disease. All persons with Down syndrome will eventually get Alzheimer's if they live long enough, and about half of patients with Parkinson's disease will develop a dementia similar to Alzheimer's. Head trauma or repeated blows to the head are also risk factors.

•Chronic alcoholism often results in dementia. Persons with high blood pressure, diabetes mellitus, cigarette smokers, high cholesterol levels, and atrial fibrillation are at risk for strokes that impair higher cognitive functioning.

Dementia can occur in patients with AIDS. Rarely, dementia is caused by other infections such as tertiary syphilis and viruses (Jacob-Creutzfeld disease).

READ MORE @ BALTIMORE SUN

Monday, October 12, 2009

Clemson bioengineer uses nanoparticles to target drugs

Clemson bioengineer Frank Alexis is designing new ways to target drugs and reduce the chances for side effects.

Pharmaceutical commercials can cause the unsettling feeling that if the disease doesn't kill, the cure will, what with a drug's long list of side effects and warnings. Many therapeutic drugs administered by pill, cream, syringe, IV or liquid can be a hit or miss delivery system. Researchers report that only 1 of 100,000 molecules of an intravenous drug make it to the intended spot in the body.

"The big issues for making medicines more effective are getting drugs to where they are needed and keeping them from breaking down as they circulate through the body," said Alexis. "A way to improve targeting a drug and preventing it from being passed out of the body is putting it in envelopes — putting the drug inside something to protect it until it's at the right spot."

The envelopes Alexis uses are nanoparticles. Think of an M&M, with the nanoparticle being the hard outer candy shell and the chocolate being the medicine. The goal would be the same as for an M&M — to melt in the right place.

Nanotechnology operates on the molecular level. It involves engineering materials on such a small scale that the results can be seen only with electron and atomic force microscopes. Nano-engineers take advantage of natural forces — positive and negative electrical charges, attraction and repulsion, surface texture — to have materials self assemble.

READ MORE @ CLEMSON UNIVERSITY NEWSROOM

Sunday, October 11, 2009

FDA Eases Rules on Access to Investigational Psychotropic Drugs

The FDA’s new rule on “expanded access programs” would allow pharmaceutical companies to give seriously ill patients broader access to investigational drugs outside of clinical trials. A limited number of expanded access programs were created in the past under sketchy FDA rules; the 2 new allied rules—one on the conditions drug companies must meet to create a program, the other on how they can charge for the drugs—ostensibly give pharma a wider berth. Moreover, psychotropic drugs can be provided under the clarified policy.

When the FDA was considering changes to its policy (in part prompted by a lawsuit), it contended with the issue of whether the use of psycho-tropic drugs fits in the definition of “serious medical condition”—with which a patient must be afflicted before a drug company can make an investigational agent available outside a clinical trial. The health insurance industry made an effort to convince the FDA to exclude mental health conditions from serious medical conditions.

In her comments to the FDA after the agency proposed a rule in March 2007, Karen Ignagni, president and CEO of America’s Health Insurance Plans (AHIP), pressed the agency to include a definition in the final rule that said, “A serious disease or condition is one which is persistent, substantially disabling, progressive, and likely to result in death within 6 to 12 months.” She noted that schizophrenia and chronic depression are among the conditions that “cause disabling health effects and suffering for a period of time without death occurring prematurely or in a matter of months.” AHIP was concerned about exposure of its insurance company members to wide claims from policy holders for reimbursement for expensive, investigational drugs obtained through expanded access programs, which might multiply because of the FDA rule liberalization.

READ MORE @ PSYCHIATRIC TIMES

Saturday, October 10, 2009

Antidepressant Use in Children With Cancer What We Now Know (and Need to Know) About the Use of Antidepressants

In 2007, cancer was diagnosed in 10,400 children and adolescents under the age of 15 years.1 While cancer remains the second leading cause of death in children, increasing numbers of children with cancer are surviving into adulthood.2 Over the past 30 years, 5-year survival rates for children with cancer have significantly improved, from 59% in 1975 to 1977 to 80% in 1996 to 2004.3 Pediatric cancer, increasingly considered a chronic rather than an acute condition, is an intense emotional and physical experience for patients and their families.4

Comprehensive psychiatric assessment of these children is complicated by symptoms of medical comorbidities that overlap mental health conditions. Few resources exist to guide clinicians in the psychiatric treatment of children with cancer. This article describes the sparse research from small clinical studies on the extent of psychiatric treatment in children with cancer and evidence from outcome studies of medication use in these children. Minimal knowledge on the role of antidepressants in such children motivated us to examine the question in a broad population-based approach.

Psychopathology

One area of interest in caring for children with cancer is the prevalence of psychiatric diagnoses. Assessment of psychiatric disorders in these children from either research or community settings is difficult because of the complex medical and emotional presentation of illness.5,6 DSM-IV criteria for mood disorders, for example, include both somatic and cognitive symptom criteria, and clinicians must decide which symptoms are caused by the illness and treatment and which are related to a separate psychiatric diagnosis.7

In addition, doctors and nurses may overestimate psychosocial distress and symptoms in children and adolescents with cancer.6 Assessment tools for psychiatric disorders are not often validated in children with medical illnesses, which may lead in part to the varying research prevalence of psychiatric disorders in this population.8

Reports of psychiatric illness in children with cancer range from a high of 17% to rates that do not differ significantly from those for the general population.9 Specific cancers and their treatments may also contribute to the variable rates of depression. Without more precise estimates that generalize to large youth populations, it is unclear whether children with cancer are at higher risk for a psychiatric disorder than children who are not medically ill.

READ MORE @ PSYCHIATRIC TIMES

Friday, October 9, 2009

Psychiatric Symptoms May Predict Internet Addiction In Adolescents

Adolescents with psychiatric symptoms such as attention-deficit/hyperactivity disorder (ADHD), social phobia, hostility and depression may be more likely to develop an Internet addiction, according to a report in the October issue of Archives of Pediatrics & Adolescent Medicine, one of the JAMA/Archives journals.

Although the Internet has become one of the most significant information resources for adolescents, addiction to the Internet can negatively impact school performance, family relationships and adolescents' emotional state, according to background information in the article. "This phenomenon has been described as Internet addiction or problematic Internet use and classified as a possible behavior addiction," the authors write. Previous studies report that 1.4 percent to 17.9 percent of adolescents are addicted to the Internet in both Western and Eastern societies; therefore, there have been suggestions to add Internet and gaming addictions to the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders. "Identification of the risk factors for Internet addiction is therefore of clinical significance for the prevention of, and early intervention into, Internet addiction in adolescents."

READ MORE @ SCIENCE DAILY

Thursday, October 8, 2009

Government under pressure to publish antipsychotic review

10 leading dementia organizations, including the Alzheimer’s Research Trust, are demanding that the government publishes its long-delayed review into the widespread misuse of antipsychotic – or ‘chemical cosh’ – drugs.

Earlier this year, an Alzheimer’s Research Trust-funded study published in Lancet Neurology found that antipsychotic drugs double risk of death for many patients if used over a three year period. As many as 100,000 people with dementia are routinely prescribed antipsychotics in UK care homes. This could mean 23,500 people dying prematurely, according to a 2008 report by Paul Burstow MP.

The issue will be discussed by Rebecca Wood, Chief Executive of the Alzheimer’s Research Trust, at a Conservative Party Conference fringe event on dementia research with Shadow Health Minister Stephen O’Brien MP, and the author of the Lancet Neurology study Prof Clive Ballard of King’s College London and Alzheimer’s Society (‘Dementia Decade: a cure by 2020?’, Wednesday, 12.45, Marquee 2, MICC, Manchester).

Rebecca Wood, Chief Executive of the Alzheimer’s Research Trust, said:

"While the Department of Health prevaricates, thousands of people are being put at risk through the misuse of antipsychotics. After so many delays, the government must take swift and decisive action."

READ MORE @ ALZHEIMER'S RESEARCH TRUST

Wednesday, October 7, 2009

From War to Home: Psychiatric Emergencies of Returning Veterans

Since the time of Homer, warriors have returned from battle with wounds both physical and psychological, and healers from priests to physicians have tried to relieve the pain of injured bodies and tormented minds.1 The "soldier’s heart" of the American Civil War and the shell shock of World War I both describe the human toll of combat that since Vietnam has been clinically recognized as posttraumatic stress disorder (PTSD).2 The veterans of Operation Iraqi Freedom (OIF) and of Operation Enduring Freedom (OEF) share with their brothers and sisters in arms the high cost of war. As of August 2009, there have been 4333 confirmed deaths of US service men and women and 31,156 wounded in Iraq. As of this writing, 796 US soldiers have died in the fighting in Afghanistan.3

Yet, there are also unique aspects of the combat experience of these veterans that influence their psychiatric presentations in acute settings.

First, far more of the troops (up to 45%) are reserve or National Guard rather than active duty compared with earlier wars.4 Their combat exposure, severity of PTSD, and impairments in interpersonal functioning are more similar to those experienced by career military.5 These individuals are most likely to appear in crises in community emergency departments (EDs); they may present with problems that may be different from veterans of previous wars or from soldiers in active military duty.

Typical presenting symptoms are marital stress from unexpectedly long deployments of 15 months (rather than the standard 12), employment concerns, financial stresses, and overall difficulty in reintegrating into civilian life. The absence of a strong military identity and cohesion, geographical separation from comrades, greater stigma, and misunderstanding from communities without exposure to the military or combat trauma serve as formidable barriers to care for these citizen-soldiers.

READ MORE @ PSYCHIATRIC TIMES

Tuesday, October 6, 2009

Depression Is a Dilemma for Women in Pregnancy

When Sherean Malekzadeh Allen of Marietta, Ga., learned she was pregnant, she was 43, had been married for two years, had gone through two miscarriages and had all but given up hope of having a baby.

But instead of being overjoyed, Ms. Allen was immobilized: panic-ridden, nauseated, listless and thoroughly depressed. She could not rouse herself to go to work in the marketing business she founded and ran, or even get through the newspaper.

And she faced the pregnant woman’s quintessential dilemma: take drugs that might pose a risk to the developing baby, or struggle through an anguishing pregnancy that could harm the baby in other ways?

“Every single thing you put in your body when you’re pregnant, you wonder, ‘Oh, my God, am I growing my baby an extra finger?’ ” Ms. Allen said. “I was worried that I would hurt the baby if I took the pills, and I was worried I would hurt the baby if I didn’t.”

READ MORE @ NY TIMES

Monday, October 5, 2009

Statement emphasizes link between severe mental illness, CVD, diabetes

European organizations are calling for improved care and screening for CVD, diabetes in those with mental illnesses.

People with severe mental illnesses, such as schizophrenia, depression and bipolar disorder, die about 10 to 20 years prematurely compared with the general population, and the most common cause of death is cardiovascular disease, experts said at a press conference on Wednesday.

A joint statement issued by the European Association for the Study of Diabetes, European Society of Cardiology and European Psychiatric Association emphasizes the link between mental illness and CVD, with the goal of increasing awareness, improving care and initiating cooperation and screening.

“In addition to having the devastating effects of severe mental illness, people with schizophrenia and bipolar disorder die prematurely,” Richard Holt, MD, PhD, from the University of Southampton, United Kingdom, said during a press conference.

People with mental illness find it much harder to access physical health services, Holt noted. “Rates of screening for both diabetes and CVD are significantly less than in the general population,” he said. “While maybe 20% of cases of diabetes are unknown in the general population, among people with mental illness, as many as 70% are undiagnosed.”

READ MORE @ ENDOCRINE TODAY

Sunday, October 4, 2009

Antidepressant and placebo are equally effective in child pain relief

When used "off-label," the antidepressant amitriptyline works just as well as placebo in treating pain-predominant gastrointestinal disorders in children, according to a new study in Gastroenterology, the official journal of the American Gastroenterological Association (AGA) Institute. To view this article's video abstract, go to the AGA's YouTube Channel at www.youtube.com/AmerGastroAssn.

"Many pharmaceutical products are prescribed for off-label use in children due to the lack of clinical trials testing the efficacy of the drugs in children and adolescents. Therefore, the pediatric gastroenterologist frequently has to make treatment decisions without the evidence of how drugs work in children," said Miguel Saps, MD, of Children's Memorial Hospital and lead author of the study. "The high placebo effect we identified in this study suggests that further studies of the use of certain antidepressants in children with functional bowel disorders are needed. While several trials have demonstrated a beneficial effect of antidepressants, including amitriptyline, for the treatment of irritable bowel syndrome (IBS) in adults, more research is needed to determine how effective this drug is, if at all, in children."

READ MORE @ EUREKALERT

Saturday, October 3, 2009

Oops, They Did It Again - What Integrity Means to Pfizer

The satire was biting:

"Thanks for making time to see me today," posted a rep on cafepharma about a fictitious sales meeting with a psychiatrist. "Now, I know that you used Neurontin in the past for every condition under the sun. Pfizer knows very well that you guys were and still continue to be the largest writers of off-label Lyrica and so, in the spirit of Bextra [withdrawn in 2004] will you please write Lyrica as much as possible? Remember Dr, this is Pfizer. The company that never met an off-label sale that it wouldn't cover-up."

Don't forget, writes the next poster on the pharma site, the psychiatrist answers, "Great! and I also heard that it is about to be approved on state Medicaid and I can write it for anything. Is this true?" to which the rep assents in defiance of, "that nice little 2004 CIA agreement."

Pfizer's nice little 2004 "CIA" or Corporate Integrity Agreement in which a company promises to sin no more to which the poster refers was for fraudulent marketing of seizure drug Neurontin. It was preceded by a CIA for fraud related to Pfizer's cholesterol drug, Lipitor, in 2002.

And this month it's followed by a CIA for mis-marketing pain drug Bextra, antipsychotic Geodon, seizure drug Lyrica and antibiotic Zyvox.

Pfizer's $2.3 billion health care fraud settlement with the government announced this month by the US Department of Justice adds some firsts to the world's biggest pharmaceutical company.

It is the largest health care fraud settlement in the history of the Department of Justice "to resolve criminal and civil liability arising from the illegal promotion of certain pharmaceutical products,"--and the largest criminal fine ever imposed in the United States. It covers Pfizer's kickbacks to health care providers and false claims submitted to government health care programs, also known as our tax dollars, in violation of the Food, Drug and Cosmetic Act. Forty-three states will share in the "give backs."

But it is not exhaustive.

READ MORE @ COUNTERPUNCH

Friday, October 2, 2009

Rx America: Drug companies want patent protection in health care overhaul

As Congress debates a health-care insurance overhaul, the pharmaceutical industry is lobbying heavily for expanded patent protections that its lobbyists say are necessary to protect the industry’s investments and encourage future developments.

The question is how long a period a drug developer will have exclusive rights to a certain kind of drug – called biologics – before competitors can be allowed into the market with generic versions.

Biologics are costly drugs produced from living organisms, not from chemicals as the more common small molecule drugs are composed. Americans spend an estimated $40 billion per year on the drugs, which comprise almost a third of Medicare Part B spending.

PhRMA – the lobbying arm of the industry headed by former Louisiana Congressman Billy Tauzin – wants at least 12 years of protection from competition, saying that’s about what it would take, on average, to recoup the initial research and development investment of getting a drug to the marketplace.

READ MORE @ NEW ORLEANS PICAYUNE

Antidepressant improves recovery from spine injury

A common antidepressant combined with an intensive treadmill training program helped people with partial spinal cord injuries walk better and faster, U.S. researchers said on Sunday.

They said Forest Laboratories' antidepressant Lexapro or escitalopram, which affects a message-carrying brain chemical called serotonin, helps strengthen remaining nerve connections along the spine, giving patients with spinal cord injuries more ability to control their muscles during training.

"The drug is enhancing the effects of the therapy," said George Hornby, a research scientist at the Rehabilitation Institute of Chicago, who is presenting his findings at the Society for Neuroscience's meeting in Chicago.

"The drug on its own isn't a miracle drug. What you need is the drug plus the training," Hornby said in a telephone interview.

The findings are the first in humans and builds on studies in animals that found giving serotonin-like drugs after spinal cord injuries can promote recovery of walking when paired with an intensive training program.

READ MORE @ REUTERS

Thursday, October 1, 2009

CORRECTED - US family doctors prescribe most mental health drugs

(Corrects final paragraph to show the FDA did not approve Seoquel's use in children, but an FDA advisory panel)

* Most mental health drugs prescribed by family doctors

* Doctors' role raises concerns about quality of care

Fifty-nine percent of U.S. mental health drug prescriptions are written by family doctors, not psychiatrists, raising concerns about the quality of some treatments, according to a study released on Wednesday.

Researchers from Thomson Reuters (TRI.TO) and the U.S. Substance Abuse and Mental Health Services Administration examined 472 million prescriptions written for psychotropic drugs from August 2006 and July 2007.

They found that general practitioners prescribed the bulk of prescriptions in two main categories -- 62 percent of antidepressants and 52 percent of stimulants.

The stimulants were mainly drugs for treating attention deficit hyperactivity disorder, or ADHD. About 25 percent of all stimulant prescriptions examined were written by pediatricians, they reported in the journal Psychiatric Services.

READ MORE @ REUTERS