Clues to Role of Brain Development as Risk for Mental Disorders May Also Lead to Better Treatments

Increasing evidence points to links between the timing and growth rates of specific brain areas in the young brain and the likelihood of developing a wide range of mental disorders later in life, say researchers convened by the National Institute of Mental Health ( NIMH ), a part of the National Institutes of Health. Included among these mental disorders are autism, anxiety, bipolar disorder, eating disorders, substance abuse, and attention deficit hyperactivity disorder ( ADHD ).

"Most psychiatric disorders, including those with adult onset such as schizophrenia, are increasingly recognized as being neurodevelopmental in origin," says NIMH's Jay Giedd, MD. "A greater understanding of the specifics of brain development, and where the path of development goes awry in illnesses, may be a key factor in devising better therapies."

The scientists spoke today at a press conference during the American Psychiatric Association Annual Meeting being held here.

A twenty-year ongoing longitudinal neuroimaging project of healthy children and adolescents being conducted at NIMH's child psychiatry branch shows the relationship between dynamic brain changes and the emergence of several classes of psychiatric disorders during adolescence.

The data set, which tracks participants aged three to 30 years every two years, consists of more than 6,000 magnetic resonance imaging ( MRI ) scans from 2,000 subjects. About half are from typically developing subjects and half have disorders such as attention deficit hyperactivity disorder, and childhood-onset schizophrenia. "The large number of typically developing subjects serves not only to provide a yardstick from which to assess developmental deviations but also because understanding the timing, mechanisms, and influences of healthy brain development may illuminate paths to intervention in illness," says Giedd, who oversees the study.

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Unraveling the Link Between Genes and Environment

New studies in the field of epigenetics -- which looks at how environmental factors can change gene function without altering DNA sequence -- are identifying new molecular targets that may lead to improved drug treatment of depression, scientists report.

Epigenetics plays a major role in depression and the actions of antidepressants.

"The mechanisms that precipitate depression, such as stress, are incompletely understood," Dr. Eric Nestler, of the University of Texas Southwestern Medical School in Dallas, said in a prepared statement. "One mystery of the disease is its long-lasting nature and delayed response to antidepressant treatment. This persistence is thought to be influenced by slowly developing but stable adaptations, which might include epigenetic regulation."

Nestler held a symposium Monday on epigenetics at the American Psychiatric Association annual meeting, in Washington, D.C. A number of scientists outlined their research on epigenetics and depression. The symposium was sponsored by the U.S. National Institute of Mental Health.

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Antipsychotic Prescribing For Children Has Risen Sharply

A research team set out to investigate the epidemiologic features of antibiotic prescribing to patients under the age of 18 by GPs (general practitioners, primary care doctors) in Great Britain. They gathered data from the UK General Practice Research Database, involving 384 participating general practices, to identify how many child/adolescent patients were prescribed at least one antipsychotic drug between the beginning of 1992 to the end of 2005. They calculated age-specific prevalences and incidences of antipsychotic prescribing.

You can read about this in the journal Pediatrics.

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Common Medications Could Cause Physical Impairment in the Elderly

Two new studies show that anticholinergics, a commonly prescribed group of drugs, may cause elderly people to "slow down" in their daily physical activities.

The two reports from researchers at Wake Forest University School of Medicine support findings released a few weeks ago that anticholinergic drugs -- which treat a variety of diseases and conditions, including acid reflux, Parkinson's disease and urinary incontinence -- may cause older people to lose their thinking skills more quickly than those who don't take the medicines.

Anticholinergic drugs work by stopping acetylcholine, a chemical that enhances communication between nerve cells in the brain, from binding to its receptors in nerve cells.

In the first Wake Forest study, older adults taking anticholinergics became more likely to walk more slowly and to need help in other daily activities.

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Nursing homes undertreat dementia patients' pain

Nursing home residents with dementia appear to be less likely to receive pain medication than other residents, even though they have just as many painful health conditions, a new study suggests.

Researchers at the University of North Carolina Chapel Hill evaluated data for 551 residents of six nursing homes across the state and found that residents who were cognitively impaired were less likely to receive regular doses of pain medication or to receive pain drugs at all.

This was despite the fact that dementia patients and cognitively healthy patients had similar rates of often-painful conditions like cancer, osteoarthritis and degeneration in the spinal disks.

Pain medications are often prescribed to be taken "as needed," the researchers note. The findings suggest that more nursing home residents with dementia should be on regularly scheduled doses of pain medication, they report in the Journal of Pain and Symptom Management.

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Do antidepressants help patients with back pain?

That depends on which study you read and what kind of back pain you have.
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In a review of 10 studies on back pain and antidepressants published recently by the Cochrane Collaboration, an international organization that reviews medical studies, Australian researchers found no clear evidence that antidepressants are more effective than sugar pills in helping patients with low-back pain. The finding is somewhat perplexing because, as the Australian researchers themselves noted, there is evidence that antidepressants can help with other types of chronic pain.

The researchers' findings also conflict with recent guidelines issued by the American Pain Society, which does recommend antidepressants for back pain, said Dr. Roger Chou, director of the guideline program. But he cautioned in an e-mail that antidepressants are not recommended as the "first line" treatment for low back pain partly because they can have side effects and partly because the benefit of antidepressants for back pain is "small to moderate."

READ MORE @ BOSTON GLOBE

Antidepressant Found To Alleviate Symptoms Of Irritable Bowel Syndrome In Adolescents

Researchers at Mattel Children's Hospital UCLA have found that low-dose antidepressant therapy can significantly improve the overall quality of life for adolescents suffering from irritable bowel syndrome, or IBS. The syndrome affects 6 percent of middle school students and 14 percent of high school kids in the United States.

he study, published in the May issue of the peer-reviewed Journal of Pediatrics, is the first of its kind to look at the effects of amitriptyline, a tricyclic antidepressant, in the pediatric IBS population, researchers said.

The research was conducted between 2002 and 2005 and involved 33 newly diagnosed IBS patients, including 24 girls, between the ages of 12 and 18.

Irritable bowel syndrome causes discomfort in the abdomen, along with diarrhea, constipation or both. Currently, there is no cure, and treatments only lessen the symptoms.

READ MORE @ SCIENCE DAILY

Prozac may slow MS - Dutch study

The popular antidepressant Prozac may help slow multiple sclerosis, according to a Dutch study showing that people who took the drug had fewer of the brain lesions that are a hallmark of the incurable disease.
The findings were from a small study but justified further examination in those afflicted with MS, the researchers reported in one of the British Medical Journal's specialist journals on Thursday.
"This proof-of-concept study shows that (the drug) tends to reduce the formation of new enhancing lesions in patients with MS," Jop Mostert, a neurologist at the University Medical Center Groeningen in the Netherlands, and colleagues wrote.
There is no cure for MS, which affects more than 1 million people worldwide. It is twice as common in women than men with symptoms often first appearing between the ages of 20 and 40.
The disease can be a mild illness in some people while causing permanent disability in others. Symptoms may include numbness or weakness in one or more limbs, partial or complete loss of vision, tingling or pain, electric-shock sensations with certain head movements, tremors and an unsteady gait.

READ MORE @ THE GUARDIAN

Antipsychotic Drugs Linked to Pneumonia in Elderly

Nursing home patients who take antipsychotic drugs are 60 percent more likely to develop pneumonia in the short term than those who don't take the drugs, a new study shows.

The risk is greatest during the first week after patients start taking the medications and gradually decreases, say Dutch researchers.

"The risk of developing pneumonia is not associated with long-term use, but is the highest shortly after starting the drug," said study authors Dr. Rob van Marum and Dr. Wilma Knol. They warned that "all antipsychotic drugs may be associated with pneumonia in elderly patients."

This is the first study to show an association between pneumonia risk and the use of antipsychotic drugs, which are frequently used to treat psychosis and behavioral problems in elderly patients with dementia and delirium.

The study was published in the current issue of theJournal of the American Geriatrics Society.

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Stop drugging dementia patients, urges report

Ministers should step in to stop inappropriate prescriptions of powerful antipsychotic drugs for Alzheimer's patients, an influential group of MPs has said.

Up to 105,000 people with dementia in Britain are wrongly being treated with the drugs, which are used to control behavioural symptoms such as aggression, they claim. Research has shown that the medications have side effects that can accelerate mental decline, triple the risk of stroke, and double the chances of premature death.

They are intended for psychotic patients suffering from delusions, paranoia and hallucinations. Yet the drugs continue to be used as a first resort to address the challenging behaviour of people suffering from Alzheimer's disease and other types of dementia, according to the MPs.

A report from the all-party parliamentary group on dementia demanded Government action on the problem and urged the National Institute for Health and Clinical Excellence, the health watchdog, to carry out a review.

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Stimulating Immune Function With Lithium and Antidepressants

Stimulating immune function would transform the prevention, treatment, research and economics of infectious disorders, among them the acquired immunodeficiency syndrome (AIDS), hospital-acquired infections, antibiotic-resistant bacterial infections, resistant tuberculosis, a possible avian influenza pandemic and acts of bioterrorism. Immune stimulation is widely held to be beyond our reach, an unfortunate misconception, for as early as nineteen eighty-one published evidence showed that lithium (1) and antidepressants (2) have immune stimulating and antimicrobial properties (3).

In the early 1950’s physicians observed that patients treated for tuberculosis with the monoamine oxidase inhibitors isoniazid and iproniazid became animated and energized, the observation the first that drugs are capable of acting as antidepressants. That monoamine oxidase inhibitors have dual antimicrobial and antidepressant properties curiously failed to impact the pharmacology of infectious disorders. Remission of such manifestations of viral infections as sinusitis, bronchitis, frequent colds, sore throats, cold sores and genital herpes in patients taking lithium carbonate has been reported. In various studies chronic lithium therapy reduced the rate of recurrent labial herpes infections, while lithium and antidepressants reduced the rates of common, “flu-like” colds, and lithium reduced the frequency and duration of recurrences of genital herpes.

READ MORE @ MEDHEADLINES

Antipsychotic drugs up pneumonia risk in elderly

Older patients given antipsychotic drugs are at increased risk of pneumonia, particularly during the first week after starting treatment, Dutch researchers report. Thirty days after treatment begins, however, the risk is no longer apparent.

Elderly people are often prescribed antipsychotic drugs, Dr. Rob J. van Marum, at University Medical Center in Utrecht, and colleagues point out in a report in the Journal of the American Geriatrics Society. Usually treatment is related to controlling the effects of dementia, but not always.

In fact, studies have shown that up to 40 percent of nursing home residents are treated with the drugs, and in half of those cases the treatment is "inappropriate."

To look at the risk of pneumonia with antipsychotic drugs, the researchers studied information from community pharmacies and the hospital records of 22,944 patients aged 65 or older who received a prescription for an antipsychotic at some point between 1985 and 2003.

After taking into account factors such as age, other medications, and other illnesses, the investigators found that the likelihood of being hospitalized for pneumonia was 60 percent higher for subjects who were currently on an antipsychotic medication than for those who were weren't.

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More children are suffering from mental health problems, says report

Rising numbers of children are suffering mental health problems caused by family breakdown and peer pressure, a report suggests.

It says that more than a quarter of under-16s regularly feel depressed because of the stresses of family life, friendships and school. The report by the Good Childhood Inquiry, which heard evidence from mental health experts, says that 13 per cent of girls between 13 and 15 years old and 10 per cent of boys in the same age group suffer from mental health problems, yet there is little treatment on offer.

The report is part of a two-year inquiry into the state of modern childhood commissioned by the Children’s Society. It comes after Unicef concluded that Britain was one of the worst places in the industrialised world to be a child.

Thousands of children took part in the study. Twenty-seven per cent of those aged 14 to 16 said that they often felt depressed, and 22 worried about the state of their physical health. Anxiety about appearance was mentioned by seven out of ten under16s, who said that they dieted some or all of the time. Family breakdown was a common problem.

READ MORE @ TIMESONLINE

Mood lifting - Growing evidence suggests that exercise is as good for your mental health as it is for your physical well-being

Monday mornings, Theo Baars's exhausting depression often tries to seduce him into just staying in bed. But then, he says, a staffer at Appleton House, a residence for people with psychotic disorders at McLean Hospital, comes into his room and says, insistently, "You want to go work out."

So Baars, a 22-year-old surfer and musician, drags himself to McLean's new gym and sweats through a half hour of presses and curls. And then, he finds, he doesn't want to go back to bed. And more: His confidence is pumped up. His thinking tends to be less delusional, more reality-based.

"Working out helps me get my self back," he said.

Baars's personal experience reflects longstanding wisdom that is now gaining the added heft that comes from carefully conducted research. Exercise, the studies increasingly suggest, may be as good for your brain as it is for your body, whether you are mentally ill or not.

As Cambridge psychiatrist and author Dr. John Ratey puts it, if exercise could be bottled, it would be the greatest blockbuster drug ever. "Exercise is medicine for the brain," he said.

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NIH study reveals incidence, precursors and psychiatric sequelae of major psychiatric disorders

A new study by the National Institute on Alcohol Abuse and Alcoholism (NIAAA) presents results on the first onset of substance use disorders (i.e., alcohol and drug abuse and dependence) and major mood and anxiety disorders, based on Wave 2 of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC).

This landmark survey is the first conducted in the U.S. to identify rates of first episodes (i.e., incidence) of these disorders in the U.S. population. In addition, it provides information on sociodemographic and psychopathologic risk factors for those disorders—information critical for developing evidence-based preventive interventions—and estimates risk for subsequent comorbid disorders.

Bridget Grant, Ph.D., Chief of NIAAA’s Laboratory of Biometry and Epidemiology, and her colleagues found that 1-year incidence rates were highest for DSM-IV alcohol dependence (1.70%), alcohol abuse (1.02%), major depressive disorder (1.51%) and generalized anxiety disorder (1.12%), followed by panic disorder (0.62%), bipolar I disorder (0.53%) and specific phobia (0.44%). One-year incidence rates of DSM-IV social phobia (0.32%), bipolar II (0.21%) and drug abuse (0.28%) and drug dependence (0.32%) were lower but not insignificant. These rates are comparable to or exceed corresponding incidence rates for other common medical diseases such as lung cancer (0.06%), stroke (0.45%) and cardiovascular disease (1.5%).

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NO CLEAR RX FOR DISPOSING OF DRUGS - Local groups start take-back programs for unwanted medicines

Pittsburg resident Maggie Dee Dowling used to flush her expired medications down the toilet, but decided to take them back to her local Walgreens after hearing that traces of prescription drugs have been found in drinking water. She was stunned when the pharmacy refused to accept them.

"The pharmacy tech opened the brown paper bag and said, 'What do you want us to do with it?' " said Dowling, 68, adding that the drugs she tried to drop off about a week ago included an inhaler and some anti-diarrheal pills.

The experience left Dowling frustrated and unsure of what to do with her unwanted medications. "It just seems to me that with all the things we're doing to pollute the Earth, if I can in some small way do my part in not flushing pollutants down the drain, then I was all for it," she said.

Consumers are rightly confused about what to do with their unwanted medications because they've received conflicting messages from government and environmental sources. Federal guidelines direct consumers which medications to flush and how to properly put others in the trash. But landfills can leak, potentially causing drugs to leach into the soil, and flushing has contaminated waterways.

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‘Lethal’ drugs given for dementia

WHEN David Ramsay, a former senior consultant at Guy’s hospital in London, was diagnosed with dementia in 1998, his wife fought for three years to have him taken into full-time care.

But just months after winning her battle, David’s neck twisted by 90 degrees, leaving his chin permanently fixed to his chest and forcing him to spend the rest of his life staring at the ground.

His condition, a rare neurological disorder, was a side-effect of a powerful antipsychotic drug prescribed to control the symptoms of Alzheimer’s. According to a parliamentary report, to be published later this month, his case is far from isolated.

The report, by the all party parliamentary group on dementia, has found that elderly people are routinely being prescribed antipsychotic drugs to make the lives of carers easier, despite evidence that they are of little benefit to the patient and have potentially lethal side effects.

Jeremy Wright MP, the Conservative chairman of the group, said: “It is clear that there are many occasions when these drugs are being used as a method of chemical restraint. This is undoubtedly systematic abuse.”

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Common Medications May Harm Memory in Older People - Those on anticholinergic drugs had sharper declines in thinking skills, study finds

Common medications known as anticholinergic drugs -- used to treat ulcers, stomach cramps, motion sickness, Parkinson's disease and urinary incontinence -- may cause older people to lose their thinking skills more quickly than seniors who don't take the medicines, new research suggests.

"What we found is being on these drugs does worsen your cognitive performance," said Dr. Jack Tsao, an associate professor of neurology at Uniformed Services University in Bethesda, Md., who led the study of the effect of the medications on older adults who were, on average, 75. "In the course of a few years, there is a small slippage. It's a minor effect."

Medications for bladder problems and Parkinson's appear to have the worst effect on memory, he said.

Anticholinergic drugs are a class of medicines that work by blocking the binding of a brain chemical called acetylcholine to its receptor in nerve cells.

"You need acetylcholine for [good] memory," Tsao explained. Drugs used to treat Alzheimer's inhibit the enzyme which breaks down acetylcholine, he said, allowing more of it to be used by the brain.

Tsao was expected to present his research Thursday at the American Academy of Neurology annual meeting, in Chicago.

READ MORE @ US NEWS & WORLD REPORT

1 in 5 veterans found with mental disorder - Depression, stress called undertreated

The latest and most comprehensive study of veterans of the Iraq and Afghanistan wars has concluded that nearly 1 in every 5 veterans is suffering from depression or stress disorders and that many are not getting adequate care.
more stories like this

* Wars, guns and money
* Nearly 1 in 5 troops has mental problems after war service
* Summary: Nearly 1 in 5 troops has mental problems after war
* Nearly 1 in 5 vets reports mental problems
* Study: 300,000 veterans suffer mental problems
*

The study shows that mental disorders are more prevalent and lasting than previously known, surfacing belatedly and lingering after troops have been discharged into civilian and family life.

An estimated 300,000 veterans among the nearly 1.7 million who have served in Iraq and Afghanistan are battling depression or post-traumatic stress disorder. More than half of those people, according to the study conducted by the Rand Corp., are slipping through the cracks in the bureaucratic system, going without necessary treatment.

The Rand study underscores one of the hard lessons of modern counterinsurgency conflicts: Such wars might kill fewer soldiers than traditional fights but can leave deeper psychological scars.

READ MORE @ BOSTON GLOBE

Who Are We? Coming of Age on Antidepressants

“I’ve grown up on medication,” my patient Julie told me recently. “I don’t have a sense of who I really am without it.”

At 31, she had been on one antidepressant or another nearly continuously since she was 14. There was little question that she had very serious depression and had survived several suicide attempts. In fact, she credited the medication with saving her life.

But now she was raising an equally fundamental question: how the drugs might have affected her psychological development and core identity.

It was not an issue I had seriously considered before. Most of my patients, who are adults, developed their psychiatric problems after they had a pretty clear idea of who they were as individuals. During treatment, most of them could tell me whether they were back to their normal baseline.

READ MORE @ NY TIMES