Stigma of mental illness pervasive: CMA head: 10% of Canadians think those who are ill could 'just snap out of it' if they wanted to, new survey finds

Almost half of Canadians believe that a diagnosis of mental illness is merely an "excuse for poor behaviour and personal failings" and one in 10 thinks that people with mental illness could "just snap out of it if they wanted," according to the startling findings of a new opinion poll.

The survey, commissioned by the Canadian Medical Association, shows that the stigma of mental illness remains pervasive, making it the "final frontier of socially acceptable discrimination," Canada's top doctor says.

Brian Day, a Vancouver orthopedic surgeon and president of the CMA, said the survey "shines a harsh, and frankly unflattering, light on the attitudes we Canadians have concerning mental health."

But he added that it is best to expose such views and tackle them head-on rather than allow stigma to fester. "It's important that these data be out there and we discuss them," Dr. Day said.

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Antidepressant Use Tied to Poorer Driving - But experts aren't sure if the pills, or underlying depression, are to blame

Taking prescription antidepressants while still highly depressed could impair driving ability, a new study suggests.

"We already know that depression causes concentration problems," said study author Holly J. Dannewitz. "And now it appears that people taking antidepressants who also have relatively higher depression scores fare significantly worse when attempting to perform a computerized simulation of driving."

Dannewitz conducted her research while a graduate student at the University of North Dakota in Grand Forks, where she is currently a psychology resident in a private practice.

She and her colleagues were scheduled to present their findings Sunday the American Psychological Association annual meeting, in Boston.

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FDA approves first drug for Huntington's disease

The U.S. Food and Drug Administration today approved tetrabenazine, the first drug approved for use in the United States to treat Huntington's disease, a fatal, inherited neurodegenerative disorder for which there is no cure. The action comes about eight months after an advisory panel unanimously voted to advise FDA to make the medication available to treat the disease.

The drug is already widely used in Europe, Canada and Australia to treat one of the most disabling symptoms of Huntington's disease, involuntary writhing movements known as chorea. Chorea is one of the trademark symptoms of the disease, which directly affects about 30,000 people in the United States today; another 70,000 people who are alive today will be diagnosed with the disease. FDA has classified tetrabenazine as an "orphan drug," since it's targeted to a disease that directly affects fewer than 200,000 people in the nation.

The pivotal study leading to the drug's approval was done by the Huntington Study Group, based at the University of Rochester Medical Center, and was led by Rochester neurologist Frederick J. Marshall, M.D. That study, published in the journal Neurology in 2006, found that the medication cut down involuntary movements on average by about 25 percent, with many patients experiencing a greater improvement. Overall, patients who received the medication were six times as likely to be considered by their doctors to have improved considerably, compared to participants who received a placebo.

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Dissociative disorder often persists to adulthood

Dissociative disorder that begins in childhood or adolescence frequently persists into adulthood and is often followed by other psychiatric disorders, according to a report published online in the journal Child and Adolescent Psychiatry and Mental Health.

Dr. Thomas Jan from the University of Wuerzburg, Germany and colleagues analyzed the long-term clinical outcomes of 27 former patients with juvenile dissociative disorder (two of whom had committed suicide). The average age at onset of dissociative disorder was 12 years old.

According to the researchers, 89 percent of these patients had "recovered or had markedly reduced symptoms" after treatment during childhood. However, at follow-up an average of 12.4 years after the initial diagnosis, 83 percent of the patients "met the criteria for some form of psychiatric disorder."

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FDA Psychiatry Chief Refuses To Address Questions About Pediatric Bipolar Disorder

Two weeks ago, the FDA announced that pediatric bipolar disorder--aka, child bipolar disorder, juvenile bipolar disorder, etc.--was a valid diagnosis, despite the fact that it doesn't exist in the DSM and child psychiatrists cannot even agree amongst themselves whether the disorder exists, whether it's a proxy term for something else, and what its exact symptomology might be much less its supposed pathology. The announcement occurred in an odd way--one of the inventors of child bipolar disorder, Harvard's Janet Wozniak, asserted in a letter to the editor of the Boston Globe that the FDA considered "pediatric bipolar disorder"--her term--a valid diagnosis. That was news to me, so I queried the FDA and was told that, why yes indeedy, the agency considered the diagnosis real. Despite approving two drugs (Risperdal and Abilify, both atypical antipsychotics) for the treatment of pediatric bipolar disorder in kids aged 10 to 17 in the last year, the agency had not taken any sort of public stance on the existence of the disorder in kids and teens. Now it has.

READ MORE @ FURIOUS SEASONS

Sensitivity to antidepressants linked with TrkB-mediated neural proliferation

Scientists have unveiled a functional link between production of new neurons and the effectiveness of antidepressants (ADs) in an animal model. The study, published by Cell Press in the August 14 issue of the journal Neuron, provides exciting insight into a mechanism that might underlie a poor response to antidepressive medications for anxiety or depression.

Depression is a significant public health problem due to both its high prevalence and its devastating impact on individuals and society," says senior author Dr. Luis F. Parada from the University of Texas Southwestern Medical Center. "Despite much excitement generated by recent advances in the knowledge of brain development and function, the mechanisms underlying the pathogenesis of depression, as well as its amelioration by AD treatment, remain poorly understood."

Animal studies have indicated that chronic treatment with ADs leads to production of new neurons in a part of the brain called the hippocampus. Exercise, such as running, which has a documented positive impact on mental health, also stimulates hippocampal neurogenesis. In both cases, new neurons arise from neural progenitor cells (NPCs) that seem to be required for the behavioral response to ADs.

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Mental Health: Exercise Is Found Not to Affect Depression

Many people are sure that exercise improves their mood, and studies have suggested that exercise is almost as effective as antidepressants in relieving symptoms of depression. But a new study has found that even though people who exercise are less likely to be depressed or anxious, it is probably not because they exercise.

Dutch researchers studied 5,952 twins from the Netherlands Twins Registry, as well as 1,357 additional siblings and 1,249 parents, all 18 to 50 years old. They recorded survey data about the frequency and duration of exercise and used well-validated scales to uncover symptoms of depression and anxiety. The study was published Monday in The Archives of General Psychiatry.

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Astonishing 52 Percent of Newly Diagnosed Bipolar Disorder Patients Receive Antidepressant Drugs in First-Line Treatment

Lamictal is the Leading Single-Agent in First-, Second- and Third-Line Therapy, According to a New Report from Decision Resources

Decision Resources, one of the world's leading research and advisory firms focusing on pharmaceutical and healthcare issues, finds that an astonishing 52.3 percent of newly diagnosed bipolar disorder patients are prescribed antidepressant drugs first line. The new report entitled Treatment Algorithms in Bipolar Disorder finds that this high preponderance of early-line antidepressant use stems from primary care physician prescribing. Surveyed primary care physicians specify selective serotonin reuptake inhibitors (including Forest Laboratories' Lexapro) as a favored first-line treatment choice for patients with bipolar disorder I with acute depression (51 percent of surveyed physicians), bipolar disorder II with acute depression without hypomania (52 percent of surveyed physicians) and bipolar disorder II with acute depression with hypomania (46 percent of surveyed physicians).
"The number of primary care physicians who are diagnosing and treating bipolar patients has been on the rise in the past few years, but surveyed primary care physicians follow a very different treatment pattern than surveyed psychiatrists," said Madhuri Borde, Ph.D., analyst at Decision Resources. "Nearly half of the patients taking selective serotonin reuptake inhibitors first line receive these drugs as a monotherapy, despite guideline recommendations to give bipolar patients presenting with depression an antimanic first line."

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Houston scientists develop test for personality disorder - Malfunction is identified by brain imaging devices during game play

Using brain imaging devices and a computer game, Houston researchers have developed an objective test for borderline personality disorder, a serious mental illness whose sufferers are unable to form and maintain stable relationships.

The brain malfunction found by Baylor College of Medicine neuroscientists is thought to be the first identified for any personality disorder.

"I'm hopeful this will mark a new approach for mental illness," said Read Montague, director of Baylor's Human Neuroimaging Lab and the project's leader. "It should provide a tool to diagnose the condition and test therapy's effectiveness."

The research, published in Friday's edition of the journal Science, is part of an ongoing effort to understand the neurobiology behind mental illnesses and to develop objective diagnostic tests for them, similar to the bloodwork, biopsies and x-rays used to diagnose other ailments. Baylor has been a leader in the effort.

As many as one in five psychiatric inpatients have borderline personality disorder, a formidable toll on not just those afflicted but on their social network and the health-care system.

READ MORE @ HOUSTON CHRONICLE

Psychiatrists Prescribing More Drugs, But Not Psychotherapy

A declining number of office-based psychiatrists appear to be providing psychotherapy to their patients, according to a report in the August issue of Archives of General Psychiatry.

Psychotherapy has been part of the practice of psychiatry for generations. "Yet, despite the traditional prominence of psychotherapy in psychiatric practice and training, there are indications of a recent decline in the provision of psychotherapy by US psychiatrists -- a trend attributed to reimbursement policies favouring brief medication management visits rather than psychotherapy and the introduction of newer psychotropic medications with fewer adverse effects," the authors wrote.

Ramin Mojtabai, MD, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, and Mark Olfson, MD, Columbia University Medical Center and New York State Psychiatric Institute, New York, New York, analysed trends in psychotherapy provision using data from national surveys of office-based psychiatrist visits from 1996 through 2005.

READ MORE @ DOCTOR'S GUIDE

Shock therapy makes a quiet comeback - Despite the stigma, 100,000 desperate patients a year now seek treatment

When Bill Russell tells people that his severe depression was relieved by shock therapy, the most common response he gets is: "They're still doing that?"

Most people might be quicker to associate electroshock therapy with torture rather than healing. But since the 1980s, the practice has been quietly making a comeback. The number of patients undergoing electroconvulsive therapy, as it's formally called, has tripled to 100,000 a year, according to the National Mental Health Association.

During an ECT treatment, doctors jolt the unconscious patient's brain with an electrical charge, which triggers a grand mal seizure. It's considered by many psychiatrists to be the most effective way to treat depression especially in patients who haven't responded to antidepressants. One 2006 study at Wake Forest University School of Medicine in North Carolina found that ECT improved the quality of life for nearly 80 percent of patients.

READ MORE @ MSNBC

Estrogen Patch Boosts Schizophrenia Treatment Success

Schizophrenia symptoms in women were significantly alleviated by the addition of estradiol patches to conventional antipsychotic therapy, researchers here said.

In a randomized, placebo-controlled trial over four weeks, women given 100 mcg/day by patch plus standard drug therapy showed reductions in positive schizophrenia symptoms, general psychopathological symptoms, and overall scores on the Positive and Negative Syndrome Scales, reported Jayashri Kulkarni, M.B.B.S., M.P.M., Ph.D., of Monash University, and colleagues in the August issue of Archives of General Psychiatry.

The reductions were significant compared with baseline and with patients given placebo plus standard treatment, the researchers said. However, estradiol treatment had no significant effect on negative symptoms.

READ MORE @ MEDPAGE TODAY

Medication increasingly replaces psychotherapy, study finds

Fewer patients are undergoing in-depth treatment as antidepressants and other drugs are more widely used. The shift is attributed partly to insurance reimbursement policies.


Wider use of antidepressants and other prescription medications has reduced the role of psychotherapy, once the defining characteristic of psychiatric care, according to an analysis published today.

The percentage of patients who received psychotherapy fell to 28.9% in 2004-05 from 44.4% in 1996-97, the report in Archives of General Psychiatry said.

Researchers attributed the shift to insurance reimbursement policies that favor short medication visits compared with longer psychotherapy sessions, and to the introduction of a new generation of psychotropic medications with fewer side effects.

Although not a surprise to many psychiatrists, the findings were expected to intensify a debate over the increased medicalization of psychiatric care, which in part reflects an emphasis on the biology of mental illness, as opposed to the processes of the mind.

Psychotherapy is an interpersonal intervention that may involve such things as behavior modification and group discussion. It is recommended -- with or without medication -- for major depression, post-traumatic stress disorder, bipolar disorder and other psychiatric illnesses.

READ MORE @ LOS ANGELES TIMES

Generic Med for Bipolar

Generic versions of Risperdal (risperidone) tablets have been approved by the U.S. Food and Drug Administration for treatment of schizophrenia, bipolar disorder, and other psychiatric conditions.

“This generic drug approval is another example of the FDA’s efforts to increase access to safe and effective generic drugs as soon as the law permits,” said Gary Buehler, director of the FDA’s Office of Generic Drugs in the Center for Drug Evaluation and Research.

Varying strengths of risperidone tablets, manufactured by TEVA Pharmaceuticals USA, have been approved.

The labeling of the generic risperidone may differ from that of Risperdal because some uses of the drug are protected by patents and exclusivity.

READ MORE @ PSYCHCENTRAL

From Prevention to Preemption: A Paradigm Shift in Psychiatry

Universal prevention has been a focus of psychiatric research for the past 4 decades. Using a public health approach, research has shown that mitigating major risk factors, such as poverty and early life stress, and promoting protective factors can improve behavioral outcomes. In other areas of medicine, we have observed how similar preventive approaches have reduced deaths from cancer and infectious disease. By contrast, while reducing environmental stress and providing better maternal support improve general behavioral outcomes (by preventing the development of antisocial behavior, for example), there are few, if any, examples of preventive approaches in psychiatry that reduce either the morbidity or the mortality of our most disabling illnesses—such as schizophrenia and bipolar disorder.1,2

What can be done to improve the impact of preventive interventions in psychiatry? Do we have effective pre- ventions that are not being implemented? Or do we need new approaches
to reduce morbidity and mortality? While we certainly can do much more to implement what we already know, it may soon be time for us to consider a shift from universal prevention provided in the broad population to “preemptive” approaches. Preemptive interventions target those at greatest risk for mental illness and those with subdiagnostic signs or symptoms, and they provide what previously has been labeled “selective” and “indicated” prevention.3

READ MORE @ PSYCHIATRIC TIMES

How Antidepressants And Cocaine Interact With Brain Cell Targets

In a first, scientists from Weill Cornell Medical College and Columbia University Medical Center have described the specifics of how brain cells process antidepressant drugs, cocaine and amphetamines.

These novel findings could prove useful in the development of more targeted medication therapies for a host of psychiatric diseases, most notably in the area of addiction.

Their breakthrough research, featured as the cover story in a recent issue of Molecular Cell, describes the precise molecular and biochemical structure of drug targets known as neurotransmitter-sodium symporters (NSSs), and how cells use them to enable neural signaling in the brain. A second study, published in the latest issue of Nature Neuroscience, pinpoints where the drug molecules bind in the neurotransmitter transporter — their target in the human nervous system.

READ MORE @ SCIENCE DAILY

Schizophrenia Ties to Random DNA Mutations Bolstered in Study

Spontaneous defects in DNA may trigger schizophrenia, according to research that bolsters results of smaller studies aimed at finding the genetic causes of the disabling mental disorder.

In the largest study of its kind, international research teams found evidence that schizophrenia can be caused when genes are duplicated or deleted in an often random process that isn't inherited from parents, according to reports published today in the journals Nature and Nature Genetics. Scientists found that people with schizophrenia are more than 10 times as likely to have these rare chromosomal alterations as people who don't have the illness.

While the findings fill in parts of the puzzle of the disease, they also suggest it may be caused by a complex set of genetic flaws, which could complicate the search for effective treatments.

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Gene-Hunters Find Hope and Hurdles in Schizophrenia Studies

Two groups of researchers hunting for schizophrenia genes on a larger scale than ever before have found new genetic variants that point toward a different understanding of the disease.

The variants discovered by the two groups, one led by Dr. Kari Stefansson of Decode Genetics in Iceland and the other by Dr. Pamela Sklar of Massachusetts General Hospital, are rare. They substantially increase the risk of schizophrenia but account for a tiny fraction of the total number of cases.

This finding, coupled with the general lack of success so far in finding common variants for schizophrenia, raises the possibility that the genetic component of the disease is due to a large number of variants, each of which is very rare, rather than to a handful of common variants.

“What is beginning to emerge is that a lot of the risk of brain diseases is conferred by rare deletions,” Dr. Stefansson said. The three variants discovered by his group and Dr. Sklar’s involve the deletion of large sections of DNA from specific sites in a patient’s genome.

READ MORE @ NY TIMES

Lilly May Need Stronger U.S. Warning on Zyprexa Label (Update4)

Eli Lilly & Co.'s current label warning on health risks linked to its antipsychotic Zyprexa may not be strong enough, according to court documents.

Lilly added a warning to its packaging in October 2007 saying that more than half of patients in 13 studies gained an average of 12 pounds after taking the drug for less than a year. It also says Zyprexa is more ``associated'' with higher blood- sugar levels -- a risk factor for diabetes -- than similar medications.

The warning, approved by the U.S. Food and Drug Administration, may need to be adjusted to link Zyprexa more directly to higher blood sugar and diabetes, according to a letter to the Indianapolis-based drugmaker from the agency. The document was produced for a lawsuit by the state of Alaska claiming the company withheld information on risks of Zyprexa, Lilly's top-selling drug with sales of $4.76 billion last year.

``We anticipate that additional labeling changes will be necessary when we have reviewed the results of the additional analyses that we have requested,'' FDA administrator Tom Laughren wrote to Lilly in an Aug. 28 letter.

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Could Viagra Be an Antidote for Women's Sexual Dysfunction?

Antidepressants can disrupt a woman's sex life. New research suggests Viagra could counteract that

Viagra might be more than a man's drug after all. Four years after Pfizer abandoned trials seeking FDA approval of its use as a potential treatment for female sexual arousal disorder, new research suggests that the diamond-shaped pill may help some women overcome sexual side effects caused by antidepressants.

READ MORE @ U.S. NEWS & WORLD REPORT