New Insights Into Causes Of Anorexia

New imaging technology provides insight into abnormalities in the brain circuitry of patients with anorexia nervosa (commonly known as anorexia) that may contribute to the puzzling symptoms found in people with the eating disorder. In a review paper published online in Nature Reviews Neuroscience, Walter Kaye, MD, professor of psychiatry and director of the Eating Disorders Program at the University of California, San Diego, and colleagues describe dysfunction in certain neural circuits of the brain which may help explain why people develop anorexia in the first place, and behaviors such as the relentless pursuit of dieting and weight loss.

"Currently, we don't have very effective means of treating people with anorexia," said Kaye. "Consequently, many patients with the disorder remain ill for years or eventually die from the disease, which has the highest death rate of any psychiatric disorder."

A better understanding of the underlying neurobiology – how behavior is coded in the brain and contributes to anorexia —is likely to result in more effective treatments, according to the researchers.

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Depression linked to higher death rates from all causes among elderly with diabetes

2-year study looked at more than 10,000 Medicare beneficiaries with diabetes

In a large group of Medicare beneficiaries with diabetes, depression was associated with a higher death rate from all causes during a two-year study period. The findings are published in the October 2008 Journal of General Internal Medicine.

Lead author Dr. Wayne Katon, professor of psychiatry and behavioral sciences at the University of Washington (UW), noted that previous research indicates that depression and diabetes is a potentially lethal mix among young to middle-aged patients. Depression also puts patients at greater risk of complications from their diabetes. This more recent study suggests that depression is also a risk factor for mortality in older patients with diabetes. Most Medicare beneficiaries, like the ones in this study, are over age 65. The mean age of the participants was 75.6 years.

The study tracked 10,704 Medicare beneficiaries with diabetes who were enrolled in a disease management program in Florida. They were surveyed at the start of the study with a health assessment questionnaire. Evidence of depression among members of the group came from physician diagnosis, patient reports of having a prescription for an antidepressant in the year before the survey, or patient answers to a brief screening test. For the next two years, the research team recorded the death and cause of death of participants through bi-monthly checks of Medicare claims and eligibility files, or from phone calls with the participants' families.

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DEA seeks new restrictions on Internet pharmacies

Illicit Internet pharmacies are helping abusers obtain controlled drugs such as the anti-anxiety medication Xanax, the painkiller Vicodin and anabolic steroids, the Drug Enforcement Administration told a House subcommittee on Tuesday.

The DEA wants Congress to require that drugs be sold over the Internet only on the basis of "valid prescriptions" that are written after face-to-face medical evaluations or, under special circumstances, through telemedicine.

Patrick Egan, a Philadelphia lawyer who specializes in Internet pharmacy regulations, countered that the DEA's proposed requirements would impose a hardship on rural and poor patients who use Internet pharmacies to reduce prescription drug costs. Telemedicine might solve part of the problem, he said, but not for patients who can't afford a consultation.

Other witnesses before the House Subcommittee on Crime, Terrorism and Homeland Security said that federal regulation of Internet drug sites is needed. State regulations vary widely, said William Winsley, the executive director of the Ohio State Board of Pharmacy, and illicit Internet drug site operators seek out the least regulated ones.

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Depression After a Heart Attack Dangerous for Years

The increased risk of death associated with depression after a heart attack persists for at least five years, a study finds.

"We've known for a number of years that depression increases the risk of mortality as well as morbidity [illness] after a heart attack for at least three to six months," said study author Robert M. Carney, a professor of psychiatry at Washington University School of Medicine in St. Louis. "We assumed that we would find a decline in risk, but that was not what we found. The risk remained worse after five years."

Carney and his colleagues followed more than 750 people after their heart attacks, according to their report in the current online issue of theJournal of Affective Disorders. Using diagnostic interviews rather than the self-reporting common in most such studies, the researchers determined that 163 had major depression, and 195 had minor depression. Over the five-year study, the death rate was 87 percent higher for those with major depression and 76 percent higher for those with any form of depression.

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