Scientists have created what appears to be a schizophrenic mouse by reducing the inhibition of brain cells involved in complex reasoning and decisions about appropriate social behavior.
Findings by Medical College of Georgia scientists, published Dec. 28 in the Proceedings of the National Academy of Sciences, elucidate the critical balance between excitation and inhibition of these cells that appears to go awry in schizophrenia. They also provide the first animal model for studying the disabling psychiatric disorder that affects about 1 percent of the population.
"We believe the mouse, which exhibits some of the same aberrant behavior as patients with this disorder, will help identify better therapies," said Dr. Lin Mei, a developmental neurobiologist who directs MCG's Institute of Molecular Medicine and Genetics. "We are doing testing to see if antipsychotic drugs already on the market are effective in treating the mouse."
MCG scientists made the mouse by deleting a candidate gene for schizophrenia, ErbB4, from interneurons, which are brain cells that help shower larger decision-making neurons, called pyramidal cells, with inhibition.
READ MORE @ SCIENCE DAILY
Monday, December 28, 2009
Friday, December 25, 2009
A happy Christmas – alone Before we universally condemn loneliness we should ensure we understand its roots, and that sometimes solitude can be sweet
The meaning of Christmas, and its supposed power to bring friends and family together, is again in evidence this year. Jonathan Freedland admirably called for an end to loneliness, and urged social policy to address it – a sentiment echoed by a Guardian leader.
I do not wish to detract from the importance of addressing chronic loneliness, particularly in the elderly. Many people end up alone, not just over the festive season, but for significantly longer periods, for want of company, and not of their own volition. It is easy to pity them (which is just offensive) and say that we must do more as a society to help them. What is significantly harder is to understand the nature of, and the causes behind, loneliness in various sections of society, and ask whether and where society should act.
Recently, we have begun to regard loneliness, and not just in the elderly, as a purely social problem. In fact, there can be plenty of individual factors that underlie feelings of loneliness – from bereavement to serious medical illnesses. Therefore, trying to address it through political policy without adequate consultation is a cause for concern. After all, do we know that loneliness is largely a social problem? If so, is it just in the elderly or even among younger generations? What engenders it? Apart from a few intuitive ideas invoking the alienation triggered by online worlds, our obsession with communicating via screens, and the intrusiveness of corporate chains, we frankly do not know.
READ MORE @ THE GUARDIAN
I do not wish to detract from the importance of addressing chronic loneliness, particularly in the elderly. Many people end up alone, not just over the festive season, but for significantly longer periods, for want of company, and not of their own volition. It is easy to pity them (which is just offensive) and say that we must do more as a society to help them. What is significantly harder is to understand the nature of, and the causes behind, loneliness in various sections of society, and ask whether and where society should act.
Recently, we have begun to regard loneliness, and not just in the elderly, as a purely social problem. In fact, there can be plenty of individual factors that underlie feelings of loneliness – from bereavement to serious medical illnesses. Therefore, trying to address it through political policy without adequate consultation is a cause for concern. After all, do we know that loneliness is largely a social problem? If so, is it just in the elderly or even among younger generations? What engenders it? Apart from a few intuitive ideas invoking the alienation triggered by online worlds, our obsession with communicating via screens, and the intrusiveness of corporate chains, we frankly do not know.
READ MORE @ THE GUARDIAN
Thursday, December 24, 2009
Stress speeds mental decline in impaired elders
Chronic stress can speed up memory decline in older people who already have some impairment in their mental function, a new study in the American Journal of Psychiatry shows.
But being stressed doesn't appear to affect memory in older people without such impairment, Dr. Guerry M. Peavy of the University of California San Diego and colleagues found.
Research suggests a "strong relationship" between increased stress and memory loss, the researchers note, but few investigators have looked at stress and memory over time. Chronic stress may affect memory by causing prolonged release of so-called "stress hormones," such as cortisol, resulting in damage to the brain.
To investigate, the researchers followed 52 people 65 to 97 years old for up to three years. Twenty-five had no loss of mental function at the beginning of the study, while the remaining 27 showed evidence of mild mental impairment.
To measure stress, the researchers asked study participants about whether they had experienced stressful life events in the previous year or six months, such as being hospitalized or having a death in the family. A person was considered to have "high stress" if they reported at least one such event in a given period.
READ MORE @ REUTERS
But being stressed doesn't appear to affect memory in older people without such impairment, Dr. Guerry M. Peavy of the University of California San Diego and colleagues found.
Research suggests a "strong relationship" between increased stress and memory loss, the researchers note, but few investigators have looked at stress and memory over time. Chronic stress may affect memory by causing prolonged release of so-called "stress hormones," such as cortisol, resulting in damage to the brain.
To investigate, the researchers followed 52 people 65 to 97 years old for up to three years. Twenty-five had no loss of mental function at the beginning of the study, while the remaining 27 showed evidence of mild mental impairment.
To measure stress, the researchers asked study participants about whether they had experienced stressful life events in the previous year or six months, such as being hospitalized or having a death in the family. A person was considered to have "high stress" if they reported at least one such event in a given period.
READ MORE @ REUTERS
Monday, December 21, 2009
Antidepressants cut risk of hospital readmission for suicidal youth
Suicidal adolescents who were prescribed an antidepressant medication during inpatient psychiatric hospital treatment were 85 percent less likely than others to be readmitted within a month after discharge, a new study found.
The results provide additional evidence that antidepressants may play a key role in helping improve the mental health of suicidal youth, said Cynthia Fontanella, co-author of the study and assistant professor of social work at Ohio State University.
The findings are especially important now, because antidepressant use dropped in 2003 after the Food and Drug Administration issued a black box warning that some antidepressants may increase the risk of suicidal behavior for pediatric patients. A black-box warning is the most serious type of warning in prescription drug labeling.
"We found that antidepressant treatment had a protective effect on readmission," Fontanella said. "Although the findings are preliminary, our results should be reassuring to child psychiatrists who may have been concerned about prescribing antidepressants since the FDA warning."
But another key finding from the study showed that hospitalized youth who were prescribed three or more medications from different drug classes for mental health issues had a 3-fold increased risk of being readmitted within a month of discharge.
READ MORE @ SCIENCE BLOG
The results provide additional evidence that antidepressants may play a key role in helping improve the mental health of suicidal youth, said Cynthia Fontanella, co-author of the study and assistant professor of social work at Ohio State University.
The findings are especially important now, because antidepressant use dropped in 2003 after the Food and Drug Administration issued a black box warning that some antidepressants may increase the risk of suicidal behavior for pediatric patients. A black-box warning is the most serious type of warning in prescription drug labeling.
"We found that antidepressant treatment had a protective effect on readmission," Fontanella said. "Although the findings are preliminary, our results should be reassuring to child psychiatrists who may have been concerned about prescribing antidepressants since the FDA warning."
But another key finding from the study showed that hospitalized youth who were prescribed three or more medications from different drug classes for mental health issues had a 3-fold increased risk of being readmitted within a month of discharge.
READ MORE @ SCIENCE BLOG
Sunday, December 20, 2009
Not All Drugs Are the Same After All
LET me start by saying I’m a fan of generic drugs. They save Americans billions of dollars each year and give us access to wonderful drugs at affordable prices. I’ve recommended generics in this column many times and use them myself when possible.
But there is a gnawing concern among some doctors and researchers that certain prescription generic drugs may not work as well as their brand-name counterparts. The problem is not pervasive, but it’s something consumers should be aware of — especially now that more insurers insist that patients take generic medications when they are available.
Let me also prepare the groundwork for what I hope will be full and frank reader comments, by acknowledging that this issue is controversial.
Joe Graedon, who has been writing about pharmaceuticals for three decades and runs a consumer advocacy Web site, the People’s Pharmacy (peoplespharmacy.com), was 100 percent behind generics for many years.
“We were the country’s leading generic enthusiasts,” he told me recently. But over the last eight or nine years, Mr. Graedon began hearing about “misadventures” from people who read his syndicated newspaper column, also called The People’s Pharmacy.
READ MORE @ NY TIMES
But there is a gnawing concern among some doctors and researchers that certain prescription generic drugs may not work as well as their brand-name counterparts. The problem is not pervasive, but it’s something consumers should be aware of — especially now that more insurers insist that patients take generic medications when they are available.
Let me also prepare the groundwork for what I hope will be full and frank reader comments, by acknowledging that this issue is controversial.
Joe Graedon, who has been writing about pharmaceuticals for three decades and runs a consumer advocacy Web site, the People’s Pharmacy (peoplespharmacy.com), was 100 percent behind generics for many years.
“We were the country’s leading generic enthusiasts,” he told me recently. But over the last eight or nine years, Mr. Graedon began hearing about “misadventures” from people who read his syndicated newspaper column, also called The People’s Pharmacy.
READ MORE @ NY TIMES
Sunday, December 6, 2009
SSRIs May Prolong Seizure Duration but Shorten Post-Seizure Depression in Patients With Epilepsy: Presented at AES
Use of selective serotonin reuptake inhibitors (SSRIs) appears to be associated with longer seizures in patients with epilepsy, confounding basic science results suggesting SSRIs reduce the frequency of epileptic seizures in animal models, according to a study presented here at the American Epilepsy Society (AES) 63rd Annual Meeting.
"What we found was not necessarily a causal relationship, but an association, between SSRI use and longer seizures," study presenter Eugen Trinka, MD, MSc, Innsbruck Medical University, Innsbruck, Austria. "Based on our study, we cannot conclude that SSRIs prolong seizures." However, "doctors should use caution in using SSRIs in patients with epilepsy," Dr. Trinka added during his poster presentation held on December 5.
The study found that epilepsy seizures in those on SSRIs lasted a median 132 seconds, compared with 85 seconds in those not using SSRIs.
READ MORE @ DOCTOR;S GUIDEssris,
"What we found was not necessarily a causal relationship, but an association, between SSRI use and longer seizures," study presenter Eugen Trinka, MD, MSc, Innsbruck Medical University, Innsbruck, Austria. "Based on our study, we cannot conclude that SSRIs prolong seizures." However, "doctors should use caution in using SSRIs in patients with epilepsy," Dr. Trinka added during his poster presentation held on December 5.
The study found that epilepsy seizures in those on SSRIs lasted a median 132 seconds, compared with 85 seconds in those not using SSRIs.
READ MORE @ DOCTOR;S GUIDEssris,
Saturday, December 5, 2009
US FDA Approves SEROQUEL XR(R) For Add-On Treatment Of Major Depressive Disorder
AstraZeneca (NYSE: AZN) announced that the US Food and Drug Administration (FDA) has approved once-daily SEROQUEL XR® (quetiapine fumarate) Extended Release Tablets as adjunctive (add-on) treatment to antidepressants in adults with Major Depressive Disorder (MDD). SEROQUEL XR is the only medication in its class approved by the FDA to treat both major depressive disorder as adjunctive therapy and acute depressive episodes associated with bipolar disorder as monotherapy.(1)(2)
MDD affects approximately 14.2 million American adults in a given year, and today it is often treated with antidepressants(3). Selective serotonin reuptake inhibitors, or SSRIs, are among the most commonly prescribed class of antidepressant medications for depression; however, in many cases patients fail to respond adequately to treatment(4). Results from a National Institute of Mental Health study, STAR*D, showed that approximately 63% of patients did not achieve remission with the SSRI citalopram when used as a first-line treatment(4). Additionally, this study reported that overall approximately one-third of patients with MDD failed to achieve study defined remission(4). This approval for SEROQUEL XR provides physicians with a new adjunctive treatment option for patients with MDD who have an inadequate response to their current antidepressant.
READ MORE @ MEDICAL NEWS TODAY
MDD affects approximately 14.2 million American adults in a given year, and today it is often treated with antidepressants(3). Selective serotonin reuptake inhibitors, or SSRIs, are among the most commonly prescribed class of antidepressant medications for depression; however, in many cases patients fail to respond adequately to treatment(4). Results from a National Institute of Mental Health study, STAR*D, showed that approximately 63% of patients did not achieve remission with the SSRI citalopram when used as a first-line treatment(4). Additionally, this study reported that overall approximately one-third of patients with MDD failed to achieve study defined remission(4). This approval for SEROQUEL XR provides physicians with a new adjunctive treatment option for patients with MDD who have an inadequate response to their current antidepressant.
READ MORE @ MEDICAL NEWS TODAY
Friday, December 4, 2009
Why Psychiatry May Sometimes Need “Fuzzy” Diagnoses
“Well, while I’m here, I’ll do the work—and what’s the work? To ease the pain of living . . .”
—Allen Ginsberg
"Many words . . . don't have a strict meaning. But this is not a defect. To think it is would be like saying that the light of my reading lamp is no real light at all, because it has no sharp boundary."
—Ludwig Wittgenstein, The Blue and Brown Books
As a general proposition, most scientists and physicians prefer sharpness to fuzziness, at least when it comes to defining terms. I generally share this view, as regards psychiatric diagnosis, but only up to a point. That point is defined by the well-being of my patient—and sometimes this may call for a “fuzzy” diagnosis.
To understand why this is so, consider the following thought experiment. Imagine that we have a set of psychiatric signs and symptoms, designated as A through F. Suppose that if we select “A,B,C,D,E” as constituting our identified “Syndrome X,” we can correlate it with a specific pathophysiology and even with a specific genetic anomaly. Sounds terrific, right? And all so very “scientific”! But suppose that the syndrome, so defined, corresponds poorly to our patients’ subjective experience of distress; and furthermore, that the “ABCDE” syndrome does not lend itself well to any effective treatment.
Now imagine we start with the same A through F signs and symptoms, but we decide to group them as either “A,B,C,D,E” or as “B,C,D,E, F.” We are, in other words, making our definition of Syndrome X “fuzzier.” We now find that Syndrome X no longer corresponds as well to a particular pathophysiology or genetic defect, but that it better captures our patients’ subjective experience, and also lends itself to an effective treatment. In short, the fuzzier syndrome allows us to reduce our patients’ degree of suffering and incapacity to a greater extent than did the “sharp” ABCDE category. Which syndrome is more “real”—the “sharp” or the “fuzzy” one? Which is more pragmatically useful? And which syndrome leads us to more humane medical care, consistent with our ethical responsibilities as physicians?
READ MORE @ PSYCHIATRIC TIMES
—Allen Ginsberg
"Many words . . . don't have a strict meaning. But this is not a defect. To think it is would be like saying that the light of my reading lamp is no real light at all, because it has no sharp boundary."
—Ludwig Wittgenstein, The Blue and Brown Books
As a general proposition, most scientists and physicians prefer sharpness to fuzziness, at least when it comes to defining terms. I generally share this view, as regards psychiatric diagnosis, but only up to a point. That point is defined by the well-being of my patient—and sometimes this may call for a “fuzzy” diagnosis.
To understand why this is so, consider the following thought experiment. Imagine that we have a set of psychiatric signs and symptoms, designated as A through F. Suppose that if we select “A,B,C,D,E” as constituting our identified “Syndrome X,” we can correlate it with a specific pathophysiology and even with a specific genetic anomaly. Sounds terrific, right? And all so very “scientific”! But suppose that the syndrome, so defined, corresponds poorly to our patients’ subjective experience of distress; and furthermore, that the “ABCDE” syndrome does not lend itself well to any effective treatment.
Now imagine we start with the same A through F signs and symptoms, but we decide to group them as either “A,B,C,D,E” or as “B,C,D,E, F.” We are, in other words, making our definition of Syndrome X “fuzzier.” We now find that Syndrome X no longer corresponds as well to a particular pathophysiology or genetic defect, but that it better captures our patients’ subjective experience, and also lends itself to an effective treatment. In short, the fuzzier syndrome allows us to reduce our patients’ degree of suffering and incapacity to a greater extent than did the “sharp” ABCDE category. Which syndrome is more “real”—the “sharp” or the “fuzzy” one? Which is more pragmatically useful? And which syndrome leads us to more humane medical care, consistent with our ethical responsibilities as physicians?
READ MORE @ PSYCHIATRIC TIMES
Thursday, December 3, 2009
New Safety Concern Related to Antipsychotic Treatment
Overall, antipsychotic medications are reasonably effective, and fairly well tolerated treatments for mood and psychotic disorders. However, treatment with a number of antipsychotic medications is associated with weight gain, and for some, hyperglycemia and hyperlipidemia. In the current issue of Biological Psychiatry, published by Elsevier, researchers discuss this cluster of metabolic side effects and how it may contribute to the risk for diabetes, hypertension, and other medical disorders associated with heart disease. This is of particular concern because there is a higher cardiovascular mortality among the severely mentally ill compared to the general population.
Researchers already know that differences exist between antipsychotics in their effect on clinical measures associated with cardiovascular risk, namely weight, lipids and glucose. Systemic inflammation has recently emerged as an important marker of cardiovascular risk, but the effects of antipsychotics on inflammatory markers in the blood have not been extensively studied until now.
READ MORE @ SCIENCE DAILY
Researchers already know that differences exist between antipsychotics in their effect on clinical measures associated with cardiovascular risk, namely weight, lipids and glucose. Systemic inflammation has recently emerged as an important marker of cardiovascular risk, but the effects of antipsychotics on inflammatory markers in the blood have not been extensively studied until now.
READ MORE @ SCIENCE DAILY
Wednesday, December 2, 2009
The Doctors Were Real, the Patients Undercover
It had all the markings of a television detective show. Posing as patients, three undercover observers got themselves admitted as patients to a locked psychiatric ward to investigate conditions on the inside.
Each undercover patient had rehearsed an extensive back story, and the supposed family members who visited them were professional actors. A remote team monitored the project via hidden cameras and microphones from a command center in a nearby hotel.
The project, which took place this spring in De Gelderse Roos, a psychiatric complex about 40 miles from Amsterdam, was not a sting operation. The staff was told there would be mystery shoppers, of a sort, in the facility over a couple of months.
“We didn’t go in there like cowboys,” said Menko Soeters, a partner at Clearfields, a consulting firm that developed the project with De Gelderse Roos. “But we did use an unorthodox instrument for psychiatric care.”
Surrounded by manicured greenery, the closed-off ward of the complex, known as De Riethorst, recalls a suburban dental clinic, and its sunny gymnasium and carpeted hallways do little to suggest that it houses up to a dozen acute psychiatric patients, many of whom are there involuntarily.
And that is why the undercover participants were all experienced psychiatric nurses. “You couldn’t have done it otherwise,” said Edo De Vries, the director of De Gelderse Roos, which released the results of the project last summer.
READ MORE @ NY TIMES
Each undercover patient had rehearsed an extensive back story, and the supposed family members who visited them were professional actors. A remote team monitored the project via hidden cameras and microphones from a command center in a nearby hotel.
The project, which took place this spring in De Gelderse Roos, a psychiatric complex about 40 miles from Amsterdam, was not a sting operation. The staff was told there would be mystery shoppers, of a sort, in the facility over a couple of months.
“We didn’t go in there like cowboys,” said Menko Soeters, a partner at Clearfields, a consulting firm that developed the project with De Gelderse Roos. “But we did use an unorthodox instrument for psychiatric care.”
Surrounded by manicured greenery, the closed-off ward of the complex, known as De Riethorst, recalls a suburban dental clinic, and its sunny gymnasium and carpeted hallways do little to suggest that it houses up to a dozen acute psychiatric patients, many of whom are there involuntarily.
And that is why the undercover participants were all experienced psychiatric nurses. “You couldn’t have done it otherwise,” said Edo De Vries, the director of De Gelderse Roos, which released the results of the project last summer.
READ MORE @ NY TIMES
Tuesday, December 1, 2009
Antidepressants can be helpful but risky
Feelings of unhappiness, decreased energy, insomnia and irritability are all symptoms of depression. And antidepressants can help relieve depression.
But for some people, these drugs may also have dangerous or troubling side effects -- drowsiness, feelings of panic, nervousness, sexual problems, thoughts of suicide or weight gain -- and should be taken only by people who really need them. So it's alarming that a new study shows antidepressant use has nearly doubled in the United States since the mid-1990s.
In the study, published in the August issue of Archives of General Psychiatry, researchers analyzed data from a national survey of antidepressant use conducted in 1996 and again in 2005. The survey included people age 6 and older.
Between 1996 and 2005, the rate of those reporting that they had used antidepressants in the past year jumped from 5.8 percent to 10.1 percent. This translates to an increase from about 13.3 million people to 27 million. The change was more dramatic among whites than African Americans or Hispanics.
READ MORE @ WASHINGTON POST
But for some people, these drugs may also have dangerous or troubling side effects -- drowsiness, feelings of panic, nervousness, sexual problems, thoughts of suicide or weight gain -- and should be taken only by people who really need them. So it's alarming that a new study shows antidepressant use has nearly doubled in the United States since the mid-1990s.
In the study, published in the August issue of Archives of General Psychiatry, researchers analyzed data from a national survey of antidepressant use conducted in 1996 and again in 2005. The survey included people age 6 and older.
Between 1996 and 2005, the rate of those reporting that they had used antidepressants in the past year jumped from 5.8 percent to 10.1 percent. This translates to an increase from about 13.3 million people to 27 million. The change was more dramatic among whites than African Americans or Hispanics.
READ MORE @ WASHINGTON POST
Monday, November 30, 2009
Should Drug Companies Carry Out Their Own Clinical Trials?
Two experts question on bmj.com today whether the conflict of interest is unethical when drug companies perform clinical trials on their own medicines.
Their opinions come as new guidance on the obligatory standards for communicating company sponsored medical research.
Vincent Lawton is a healthcare consultant and non-executive director at the Medicines and Healthcare products Regulatory Agency in London. He argues that after having invested billions of pounds in medicine development, it is unrealistic to expect the drug industry to "surrender its intellectual property." He comments that withdrawing research from pharmaceutical companies will lead to delays, ineffectiveness and a deficiency in innovation.
MEDICAL NEWS TODAY
Their opinions come as new guidance on the obligatory standards for communicating company sponsored medical research.
Vincent Lawton is a healthcare consultant and non-executive director at the Medicines and Healthcare products Regulatory Agency in London. He argues that after having invested billions of pounds in medicine development, it is unrealistic to expect the drug industry to "surrender its intellectual property." He comments that withdrawing research from pharmaceutical companies will lead to delays, ineffectiveness and a deficiency in innovation.
MEDICAL NEWS TODAY
Sunday, November 29, 2009
Patient advocates ill at ease with Rx data mining Patient advocates see sales tactic as medical meddling
When your doctor writes you a prescription, that's just between you, your doctor and maybe your health insurance company, right?
Wrong. The pharmaceutical companies that make those prescription drugs are also looking over the doctor's shoulder, keeping track of how many prescriptions for which drugs the physician is writing.
And that data on the prescribing habits of thousands of doctors has become a powerful sales and marketing tool for the pharmaceutical industry, but also a source of growing concern among some elected officials, health care advocates and legal authorities.
The identity of patients is not disclosed, but knowing in detail what doctors are prescribing enables drugmakers to fine-tune their messages when sales reps call on doctors. They can lobby for use of an alternative drug made by their own company, for instance, bolstering the pitch with specially selected research data or free samples.
What worries some government officials and patient advocates is that sales tactics keyed to a doctor's prescribing preferences may distort decision-making. That's especially likely, the critics say, when many doctors have trouble finding time to examine a plethora of studies and weigh the results carefully. And, given the concern over costs, they say, free samples or other inducements could influence decisions for nonmedical reasons.
The practice is known as "prescription data mining." Medical data firms annually blend several billion prescription records -- purchased from pharmacies and health insurers -- with physician data from the American Medical Association and other sources and sell the results to drug companies.
READ MORE @ CHICAGO TRIBUNE
Wrong. The pharmaceutical companies that make those prescription drugs are also looking over the doctor's shoulder, keeping track of how many prescriptions for which drugs the physician is writing.
And that data on the prescribing habits of thousands of doctors has become a powerful sales and marketing tool for the pharmaceutical industry, but also a source of growing concern among some elected officials, health care advocates and legal authorities.
The identity of patients is not disclosed, but knowing in detail what doctors are prescribing enables drugmakers to fine-tune their messages when sales reps call on doctors. They can lobby for use of an alternative drug made by their own company, for instance, bolstering the pitch with specially selected research data or free samples.
What worries some government officials and patient advocates is that sales tactics keyed to a doctor's prescribing preferences may distort decision-making. That's especially likely, the critics say, when many doctors have trouble finding time to examine a plethora of studies and weigh the results carefully. And, given the concern over costs, they say, free samples or other inducements could influence decisions for nonmedical reasons.
The practice is known as "prescription data mining." Medical data firms annually blend several billion prescription records -- purchased from pharmacies and health insurers -- with physician data from the American Medical Association and other sources and sell the results to drug companies.
READ MORE @ CHICAGO TRIBUNE
Friday, November 27, 2009
Focus on Pharmacotherapy Studies in Elderly
The NIMH-sponsored New Clinical Drugs Evaluation Unit (NCDEU) meeting is a favored venue for reports and reviews of NIH-funded psychopharmacological studies, and this was true of the recent annual meeting in Hollywood, Fla. The meeting included a workshop on new investigations of antidepressant use in Alzheimer disease and a panel session on the safety of pharmacotherapy in older adults.
Two studies were developed, in part, in response to growing concern about both safety and lack of efficacy of antipsychotics for behavior symptoms in patients with dementia. These were the Depression in Alzheimer’s Disease Study–2 (DIADS-2) sertraline (Zoloft) trial, the citalopram (Celexa) versus antipsychotics nested study in the Clinical Antipsychotic Trials of Intervention Effectiveness–Alzheimer’s Disease (CATIE-AD), and the recently initiated Citalopram for Agitation in Alzheimer’s Disease (CITAD).
In describing the rationale and design of the CITAD study, Bruce Pollock, MD, Center for Addiction and Mental Health, questioned the premise for using antipsychotics in this population. “The neuropharmacologic rationale for using dopamine antagonists in elders with dopaminergic deficits is questionable,” Pollock indicated. “Agitation in Alzheimer disease is commonly derived from anxious, impulsive, and compulsive symptoms, which may be responsive to serotonergic agents.”
READ MORE @ PSYCHIATRIC TIMES
Two studies were developed, in part, in response to growing concern about both safety and lack of efficacy of antipsychotics for behavior symptoms in patients with dementia. These were the Depression in Alzheimer’s Disease Study–2 (DIADS-2) sertraline (Zoloft) trial, the citalopram (Celexa) versus antipsychotics nested study in the Clinical Antipsychotic Trials of Intervention Effectiveness–Alzheimer’s Disease (CATIE-AD), and the recently initiated Citalopram for Agitation in Alzheimer’s Disease (CITAD).
In describing the rationale and design of the CITAD study, Bruce Pollock, MD, Center for Addiction and Mental Health, questioned the premise for using antipsychotics in this population. “The neuropharmacologic rationale for using dopamine antagonists in elders with dopaminergic deficits is questionable,” Pollock indicated. “Agitation in Alzheimer disease is commonly derived from anxious, impulsive, and compulsive symptoms, which may be responsive to serotonergic agents.”
READ MORE @ PSYCHIATRIC TIMES
Thursday, November 26, 2009
'Doctors should stop pushing drugs at depressed people'
Despite a large increase in cognitive behaviour therapy (CBT) doctors are still pushing drugs at patients, according to Dr Jennifer Wild, a senior lecturer at the Institute of Psychiatry.
In this week's Scrubbing Up, she argues that GPs need to understand that psychological therapies like CBT work and should choose to offer them.
People with depression often get better when they change the way they think.
Since therapy is more likely to achieve this with longer-lasting results than drugs, doctors need to stop pushing pills and start pushing treatments that work.
Depressed people feel low, worthless, and often suicidal. They need treatment.
Six million people suffer from depression and anxiety in the UK, and surveys show that most do not want to take drugs.
They want a treatment with long-lasting results.
READ MORE @ BBC NEWS"
'Distorted thinking'
This treatment is cognitive behavioural therapy (CBT).
CBT is based on a well-supported theory of how depression starts and what keeps it going: distorted thinking patterns.
Change people's thoughts and recovery occurs.
In this week's Scrubbing Up, she argues that GPs need to understand that psychological therapies like CBT work and should choose to offer them.
People with depression often get better when they change the way they think.
Since therapy is more likely to achieve this with longer-lasting results than drugs, doctors need to stop pushing pills and start pushing treatments that work.
Depressed people feel low, worthless, and often suicidal. They need treatment.
Six million people suffer from depression and anxiety in the UK, and surveys show that most do not want to take drugs.
They want a treatment with long-lasting results.
READ MORE @ BBC NEWS"
'Distorted thinking'
This treatment is cognitive behavioural therapy (CBT).
CBT is based on a well-supported theory of how depression starts and what keeps it going: distorted thinking patterns.
Change people's thoughts and recovery occurs.
Wednesday, November 25, 2009
Ziprasidone Okayed for Bipolar Disorder
The FDA has cleared ziprasidone (Geodon) for maintenance treatment of bipolar I disorder as an adjunct to lithium or valproate.
It joins several other antipsychotic drugs -- including quetiapine (Seroquel), aripiprazole (Abilify), and olanzapine (Zyprexa) -- approved for this indication.
Ziprasidone is also approved for acute manic and mixed episodes associated with bipolar disorder, with or without psychotic features, and for schizophrenia.
The approval as bipolar maintenance therapy follows a a six-month, double-blind, randomized, placebo-controlled trial in adult patients with bipolar I disorder, according to the drug's manufacturer, Pfizer.
READ MORE @ MEDPAGE TODAY
It joins several other antipsychotic drugs -- including quetiapine (Seroquel), aripiprazole (Abilify), and olanzapine (Zyprexa) -- approved for this indication.
Ziprasidone is also approved for acute manic and mixed episodes associated with bipolar disorder, with or without psychotic features, and for schizophrenia.
The approval as bipolar maintenance therapy follows a a six-month, double-blind, randomized, placebo-controlled trial in adult patients with bipolar I disorder, according to the drug's manufacturer, Pfizer.
READ MORE @ MEDPAGE TODAY
Tuesday, November 24, 2009
Psychiatrist Helped Demonstrate Psychotherapy Is Cost-Effective
Whether psychotherapy is cost-effective was an important question during President Clinton's health care reform effort. Lessons from that era remain relevant during current health reform debates.
If psychotherapy has a place in the American health care system of tomorrow, give some credit to psychiatrist Susan Lazar, M.D., and other clinician-researchers who helped establish the evidence base for the cost-effectiveness of psychotherapy beginning more than 16 years ago.
That was when Hillary Rodham Clinton's Health Care Task Force was at work. Though the exact content of health insurance benefit packages hasn't yet been a focus of today's health care debates, a decade and a half ago task force members were weighing the relative value of any health care service as a criterion for inclusion in mandated benefits.
And “value” meant cost-effectiveness—the cost of providing the service compared with the benefits derived from the service.
READ MORE @ PSYCHIATRIC NEWS
If psychotherapy has a place in the American health care system of tomorrow, give some credit to psychiatrist Susan Lazar, M.D., and other clinician-researchers who helped establish the evidence base for the cost-effectiveness of psychotherapy beginning more than 16 years ago.
That was when Hillary Rodham Clinton's Health Care Task Force was at work. Though the exact content of health insurance benefit packages hasn't yet been a focus of today's health care debates, a decade and a half ago task force members were weighing the relative value of any health care service as a criterion for inclusion in mandated benefits.
And “value” meant cost-effectiveness—the cost of providing the service compared with the benefits derived from the service.
READ MORE @ PSYCHIATRIC NEWS
Monday, November 23, 2009
Psychotropic Drugs Boost Fall Risk in the Elderly
A new analysis of studies including nearly 80,000 people aged 60 and older confirms that certain types of widely prescribed drugs, such as antidepressants and sedatives, can increase their risk of falling.
Falls often have serious consequences for older people, such as injuries leading to disability and admission to a nursing home, or even death.
While prescription drugs are recognized as contributing to fall risk among older people --who are likely to be on lots of medications -- discovering just which drugs are the problem is still a "challenge," Dr. Carlo A. Marra of the University of British Columbia in Vancouver and colleagues note in the Archives of Internal Medicine.
To update a review of studies on this subject published in 1996, Marra and his team identified 22 studies published between 1996 and 2007 including 79,081 people 60 and older, some of whom lived independently, and some of whom were institutionalized. They analyzed the risk of falling associated with nine classes of drugs.
Three classes turned out to significantly boost fall risk: sedatives and hypnotics, typically prescribed as sleeping aids; antidepressants; and benzodiazepines, which include tranquilizers like Xanax and Valium.
READ MORE @ ABC NEWS
Falls often have serious consequences for older people, such as injuries leading to disability and admission to a nursing home, or even death.
While prescription drugs are recognized as contributing to fall risk among older people --who are likely to be on lots of medications -- discovering just which drugs are the problem is still a "challenge," Dr. Carlo A. Marra of the University of British Columbia in Vancouver and colleagues note in the Archives of Internal Medicine.
To update a review of studies on this subject published in 1996, Marra and his team identified 22 studies published between 1996 and 2007 including 79,081 people 60 and older, some of whom lived independently, and some of whom were institutionalized. They analyzed the risk of falling associated with nine classes of drugs.
Three classes turned out to significantly boost fall risk: sedatives and hypnotics, typically prescribed as sleeping aids; antidepressants; and benzodiazepines, which include tranquilizers like Xanax and Valium.
READ MORE @ ABC NEWS
Sunday, November 22, 2009
The stigma of mental illness The suicides of a German footballer and two of my colleagues show how destructive is the stigma of psychiatric ill-health
Last week's suicide of the German goalkeeper Robert Enke revealed more than the terrible news of one man's death, the cruelty of depression and the pressures on sportsmen to protect the public's idealised view of them; it also exposed the ongoing shame and stigma of mental illness. For years he had been struggling with depression, kept secret from the public and his colleagues for fear of a vicious backlash that could, he apparently feared, raise questions about his capacity to care for his adopted baby girl and play for his nation.
Rather than risk this, and perhaps further despairing under the force of these private terrors, he chose the solution of death. That this seemed preferable to risking public awareness of his depression and the imagined consequences of personal shame, family destruction and exclusion from his nation's crucial sporting event, demonstrates something of the huge level of hatred that mental illness still evokes in the public imagination. The stigma only worsens the burden on those with mental health problems, typically reported as one in four of the adult population in the UK.
When people die by their own hand, a response of shocked disbelief, of the sense of an awful secret that has been starkly exposed, occurs all too often. How is it in this advanced age of emotional literacy, psychological self-help and media shrinks that the shame of depression and other mental illness causes people to desperately try to hide their problems rather than challenge society to accept that they, like so many others, are vulnerable?
READ MORE @ THE GUARDIAN
Rather than risk this, and perhaps further despairing under the force of these private terrors, he chose the solution of death. That this seemed preferable to risking public awareness of his depression and the imagined consequences of personal shame, family destruction and exclusion from his nation's crucial sporting event, demonstrates something of the huge level of hatred that mental illness still evokes in the public imagination. The stigma only worsens the burden on those with mental health problems, typically reported as one in four of the adult population in the UK.
When people die by their own hand, a response of shocked disbelief, of the sense of an awful secret that has been starkly exposed, occurs all too often. How is it in this advanced age of emotional literacy, psychological self-help and media shrinks that the shame of depression and other mental illness causes people to desperately try to hide their problems rather than challenge society to accept that they, like so many others, are vulnerable?
READ MORE @ THE GUARDIAN
Subscribe to:
Posts (Atom)
