Long-term psychotherapy is superior, study finds

Psychotherapy lasting for at least one year is more effective than shorter periods of therapy for people with complex mental disorders, such as personality and chronic disorders, according to a study published today in the Journal of the American Medical Assn. The success of dedicated psychotherapy may matter little, however, because fewer doctors are offering the service and fewer insurers are covering it.

In long-term psychodynamic psychotherapy, the therapist provides continued, close support for the patient while the pair work through problems and interventions. The JAMA study, from researchers in Germany, was an examination of 23 studies on the success of psychotherapy. It found that longer-term therapy (one year or longer) was superior to shorter-term methods in regard to overall outcome and personality functioning. On average, patients with complex mental conditions who were treated long-term were better off than 96% of the patients in the comparison groups.

READ MORE @ LOS ANGELES TIMES

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.

READ MORE @ EUREKALERT

AHRQ Study: Conventional Antipsychotics May Pose Risk To Elderly

Elderly patients who are prescribed a conventional, or first-generation, antipsychotic medication are at an increased risk of death from cardiovascular or respiratory diseases, as compared to those who take an atypical, or second-generation, antipsychotic medication, according to a study funded by the Agency for Healthcare Research and Quality.

The new study, "Potential Causes of Higher Mortality in Elderly Users of Conventional and Atypical Antipsychotic Medications," which was recently posted online in the Journal of the American Geriatrics Society, adds to growing evidence that conventional antipsychotics may not be safer than atypical anitpsychotics for the elderly. Researchers had previously identified that such second-generation medications may pose increased mortality. The new study compares specific causes of death among elderly patients newly started on conventional versus atypical antipsychotics.

READ MORE @ U.S. MEDICINE

Persons With Serious Mental Illness Face Higher Prevalence of Obesity

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

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U.S. Kids Take More Psychotropic Drugs Than Europeans

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

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

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

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

READ MORE @ FORBES

Antidepressants 'may harm sperm'

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

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

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

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

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

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

READ MORE @ BBC

Understanding preemption, Part II

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

To the Editor:

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

READ MORE @ MARSHALL INDEPENDENT

Understanding preemption

To the Editor:

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

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

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

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

READ MORE @ MARSHALL INDEPENDENT

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

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

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

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

READ MORE @ SCIENCE DAILY

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

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

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

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

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

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

READ MORE @ SACRAMENTO BEE

No longer depressed, or on meds

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

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

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

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

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

READ MORE @ MINNEAPOLIS STAR TRIBUNE

The Tyranny of Diagnosis

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

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

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

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

READ MORE @ NY TIMES

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

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

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

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

READ MORE @ PR URGENT

Psychiatrist And Neuroscientist Says Antipsychotics Cause Brain Shrinkage

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

READ MORE @ FURIOUS SEASONS

Obama & McCain Agree On One Thing: Generics

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

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

READ MORE @ PHARMALOT

Army Use of Psychiatrists in Interrogations Called Unethical

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

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

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

READ MORE @ MEDPAGE TODAY

Study rejects cost-effectiveness of CBT for adolescents

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

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

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

READ MORE @ MANAGEMENT PRACTICE

The Bipolar Puzzle

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

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

READ MORE @ NY TIMES

Study of Newer Antipsychotics Finds Risks for Youths

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

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

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

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

READ MORE @ NY TIMES

Medicare: A Bush Disaster That My Life Depends on

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

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

READ MORE @ ALTERNET