The FDA (Food and Drug Administration) warnings about suicidal thoughts linked to antidepressant use among children/adolescents seems to have had some effect on prescribing, says an article in Archives of General Psychiatry (JAMA/Archives).
The authors wrote "The possibility that antidepressant medications, especially selective serotonin reuptake inhibitors (SSRIs), increase the risk of suicidal behavior was first raised in several case reports of children and adults during the early 1990s. In June 2003, the Food and Drug Administration (FDA) recommended that paroxetine hydrochloride not be used to treat young people because of potential increased risk of suicidal behavior, and in October 2004, the FDA issued a black box warning concerning all antidepressants for youth."
The warning(s) got lots of media attention. It is the strongest action the FDA can take before withdrawing a drug from the market.
Mark Olfson, M.D., M.P.H., the Columbia University Medical Center, New York, and team looked at the trends in antidepressant prescribing from the Medco database. Medco is a company that manages prescription drug benefits.
The researchers focused on antidepressant prescribing over three time periods for -
-- Patients aged 6-17
-- Patients 18-64
-- Patients aged 65 or more
The three time periods were
-- prewarning - May 1, 2002, to June 19, 2003
-- paroxetine warning - June 20, 2003, to Oct. 15, 2004
-- black box warning - Oct. 16, 2004, to Dec. 31, 2005
The authors wrote "After the FDA first recommended not treating youth with paroxetine, there was a significant absolute decline in paroxetine use by youth but not significant declines in use of other antidepressants by young people. Similar, though less pronounced, declines occurred in paroxetine treatment of older patients. Following the black box warning, there was a statistically nonsignificant decline in antidepressant treatment of youth, including a significant deceleration in the rate of treatment with SSRIs other than paroxetine."
"From 1985 to 1999, there was a four-fold national increase in per capita antidepressant prescriptions," they write. "The FDA warnings appear to have slowed this longer-term growth of antidepressant treatment of children and adults. Despite fears that these advisories might result in a precipitous decline in antidepressant prescribing, it is reassuring that the pattern of changes in treatment, which were modest in size and greatest for treatment of youth, were broadly consistent with the FDA warnings and the scientific literature."
"Effects of Food and Drug Administration Warnings on Antidepressant Use in a National Sample"
Mark Olfson, MD, MPH; Steven C. Marcus, PhD; Benjamin G. Druss, MD, MPH
Arch Gen Psychiatry. 2008;65(1):94-101.
Click here to view abstract online
Written by -
воскресенье, 31 июля 2011 г.
четверг, 28 июля 2011 г.
A Blue Christmas: The Signs Of Elderly Holiday Depression
So you're heading home to see Mom and Dad this holiday season - or maybe Aunt Sue or Grandpa George. If you're like many Americans, it may have been weeks, months or even years since you've seen them last. And as they - and you - grow older, these holiday reunions grow more special each year.
But what if you notice that one of your older relatives isn't quite their old self? That they're more anxious, more irritable, less joyful or quieter than they once were? That they seem focused on talking about people who have died, or have lost interest in things that they used to enjoy - including holiday traditions and festivities?
It's possible that these changes add up to signs of late-life depression, which may affect as many as one in seven older people. It's especially common among those who have suffered a serious physical problem, whether it's a heart attack, cancer, lung disease, or problems with their hips and joints.
Helen C. Kales, M.D., hears this tale many times each year, from patients who come to see her after their family members notice a serious change in their behavior at the holidays and encourage them to seek help. As a geriatric psychiatrist who specializes in helping older people cope with depression and other mental illness, Kales knows that it often takes the prompting of a family member to help an older person recognize their symptoms.
"One of the big things that happens at the holidays is that families who are coming in from out of town spot these symptoms and changes for the first time. For instance, their parent or relative isn't taking as good care of themselves or their home as they used to," says Kales, a member of the University of Michigan Depression Center. "It's a myth that depression is a normal part of aging, and that you just get old and tired and sad naturally. Normal aging is not associated with depression, and late-life depression is just as treatable as any other form."
Kales, who treats older patients with depression at the U-M Geriatrics Center and the VA Ann Arbor Healthcare System, notes that older people who have experienced mental health problems in the past, and those who have significant physical health problems that limit their lives, face the highest risk of developing late-life depression.
But even otherwise healthy elders can find themselves feeling depressed after a serious blow like the death of a spouse, sibling or close friend, or the loss of their social network when they move to an assisted living facility or to live with relatives.
All of these "triggers", as they are called, can combine with the special pressures and interrupted routines of the holiday season to create an even greater risk of depression during the holidays. Such feelings may pass as Christmas, Hanukkah and New Year's Day fade into memory. Or, they can lead the person to develop more serious and prolonged depression lasting weeks or months. That's when it's important to get help.
People in their seventies, eighties and nineties may also be less likely to recognize their increased tiredness, loss of appetite, and mood swings as signs of depression, Kales says, both because of other physical problems they have, or simply because of the era in which they grew up.
"They were taught to pick themselves up by their bootstraps and not to cry when things went wrong," she explains. "So it may be really hard for them to talk about having emotional problems or experiencing depression. They may feel like they need to be stoic and power through it."
In other words, the generations that witnessed the Great Depression may be less likely to recognize their own depression.
Fortunately, younger people have grown up in an era when research has shown that depression is a physical illness rooted in brain chemistry and genetics, and not in personal failings or weakness. That's why it's so important for them to speak up to their relatives if they notice something wrong, says Kales, who is an assistant professor of psychiatry at the U-M Medical School and Director of the Geriatric Psychiatry Clinic at the VA. Sometimes, it may even be worthwhile to mention those observations to the loved one's main doctor, who can check on things further at the next office visit.
So what can be done for an older person who develops temporary or more lasting depression? The easiest prescription, Kales says, is simply to get out of the house and connect with other people.
"That's actually a hard thing to do, because in depression people feel unmotivated, and feel like being isolated - but it can become a vicious cycle because the more they stay in and don't connect with others, the worse they feel," she explains. "They need to try to get over that hump, and get out there. And what I find is that they often feel much better once they've done it."
Another easy way for older people to confront those blues is to treat themselves to something they haven't done or had in a while, like a nice dinner or a little present - especially at the holidays. And don't forget exercise, no matter what form it takes, Kales adds. "We know that exercise causes all kinds of good hormones to be released, and for older people that can make depression lessen."
One thing to avoid, or at least to cut back on, is alcohol. "It's very important that older people who are feeling low should minimize their use of alcohol," Kales cautions. "Sometimes they might use it to help them go to sleep or improve their mood, but the bottom line is that alcohol is a depressant and helps mess up their sleep."
For those whose depression symptoms continue for weeks or months despite these measures, Kales emphasizes two things: counseling, also known as talk therapy, and medication.
Talk therapy, which can be done with the help of a psychologist, mental health social worker or psychiatrist, involves developing new ways of thinking about one's situation - and confronting negative thoughts and moods.
Older people may conjure up a stereotype of going to a "shrink" as something that will make them recite their childhood feelings while lying on a couch -- but that's not the way it's done these days at all, Kales says. Counseling, whether alone or in groups, has been proven to help people get better and stave off future bouts of depression. "Even though people are getting older, you can teach an old dog new tricks," as the saying goes, Kales explains.
When other approaches don't do enough, older people may want to consider some of the modern antidepressants that have been introduced in the last two decades, Kales says - much better than the mental health treatments of old that they may be familiar with.
Interestingly, older people usually need to start with much lower doses of antidepressants than younger people, because of changes in their drug metabolism and use of other medications as they age. But importantly, many older people need the same final dose as younger people, so it's important to "start low, go slow" but "don't stop" when increasing the antidepressant medication.
Ultimately, the choice of drug, and of dose, varies from person to person, and it may take patience to find something that works. It's best if this trial-and-error process is guided by someone experienced in treating depression, or even someone who specializes in treating older people's depression.
The bottom line is that families need to keep their eyes and ears open for signs of depression in older relatives, especially at the holidays when they have a chance to get together and spend some time. And if someone seems to need help, don't be afraid to speak up and reach out.
Facts about late-life depression:
-- About 15 percent of older people may be experiencing depression at any given time.
-- Depression is different from temporary "blues" or mourning for a lost loved one, in that it lasts longer, and doesn't let up from day to day.
-- Symptoms can include anxiety, irritability, loss of pleasure in activities, feelings of hopelessness and worthlessness, and worsened physical pain.
-- Some of the symptoms of depression that are most common in younger people, such as prolonged sadness, may not be as common in older people.
-- As older people develop age-related health problems like heart disease, complications of diabetes, lung disease, joint problems and vision or hearing loss, they may start to experience symptoms of depression. In other words, their physical illness can 'trigger' a bout of depression.
-- Other triggers for depression include the loss of a loved one, the loss of social networks of friends and acquaintances because of a move, and even the hubbub of the holidays.
Find more on the Web at:
U-M Depression Center: Depression in older adults
med.umich/depression/geriatric.htm
Free online self-test for depression from the U-M Depression Center
med.umich/depression/screen.htm
Geriatric Mental Health Foundation: Mental Wellness in Older Age depression toolkit
gmhfonline/gmhf/consumer/depression_toolkit.html
To find a mental health professional who specializes in diagnosing and treating older people, visit gmhfonline/gmhf/find.asp, or eldercare.
Or call the national Eldercare Locator service toll-free at 1-800-677-1116 weekdays between 9 a.m. and 8 p.m. ET.
University of Michigan Health System
2901 Hubbard St., Ste. 2400
Ann Arbor, MI 48109-2435
United States
med.umich/
But what if you notice that one of your older relatives isn't quite their old self? That they're more anxious, more irritable, less joyful or quieter than they once were? That they seem focused on talking about people who have died, or have lost interest in things that they used to enjoy - including holiday traditions and festivities?
It's possible that these changes add up to signs of late-life depression, which may affect as many as one in seven older people. It's especially common among those who have suffered a serious physical problem, whether it's a heart attack, cancer, lung disease, or problems with their hips and joints.
Helen C. Kales, M.D., hears this tale many times each year, from patients who come to see her after their family members notice a serious change in their behavior at the holidays and encourage them to seek help. As a geriatric psychiatrist who specializes in helping older people cope with depression and other mental illness, Kales knows that it often takes the prompting of a family member to help an older person recognize their symptoms.
"One of the big things that happens at the holidays is that families who are coming in from out of town spot these symptoms and changes for the first time. For instance, their parent or relative isn't taking as good care of themselves or their home as they used to," says Kales, a member of the University of Michigan Depression Center. "It's a myth that depression is a normal part of aging, and that you just get old and tired and sad naturally. Normal aging is not associated with depression, and late-life depression is just as treatable as any other form."
Kales, who treats older patients with depression at the U-M Geriatrics Center and the VA Ann Arbor Healthcare System, notes that older people who have experienced mental health problems in the past, and those who have significant physical health problems that limit their lives, face the highest risk of developing late-life depression.
But even otherwise healthy elders can find themselves feeling depressed after a serious blow like the death of a spouse, sibling or close friend, or the loss of their social network when they move to an assisted living facility or to live with relatives.
All of these "triggers", as they are called, can combine with the special pressures and interrupted routines of the holiday season to create an even greater risk of depression during the holidays. Such feelings may pass as Christmas, Hanukkah and New Year's Day fade into memory. Or, they can lead the person to develop more serious and prolonged depression lasting weeks or months. That's when it's important to get help.
People in their seventies, eighties and nineties may also be less likely to recognize their increased tiredness, loss of appetite, and mood swings as signs of depression, Kales says, both because of other physical problems they have, or simply because of the era in which they grew up.
"They were taught to pick themselves up by their bootstraps and not to cry when things went wrong," she explains. "So it may be really hard for them to talk about having emotional problems or experiencing depression. They may feel like they need to be stoic and power through it."
In other words, the generations that witnessed the Great Depression may be less likely to recognize their own depression.
Fortunately, younger people have grown up in an era when research has shown that depression is a physical illness rooted in brain chemistry and genetics, and not in personal failings or weakness. That's why it's so important for them to speak up to their relatives if they notice something wrong, says Kales, who is an assistant professor of psychiatry at the U-M Medical School and Director of the Geriatric Psychiatry Clinic at the VA. Sometimes, it may even be worthwhile to mention those observations to the loved one's main doctor, who can check on things further at the next office visit.
So what can be done for an older person who develops temporary or more lasting depression? The easiest prescription, Kales says, is simply to get out of the house and connect with other people.
"That's actually a hard thing to do, because in depression people feel unmotivated, and feel like being isolated - but it can become a vicious cycle because the more they stay in and don't connect with others, the worse they feel," she explains. "They need to try to get over that hump, and get out there. And what I find is that they often feel much better once they've done it."
Another easy way for older people to confront those blues is to treat themselves to something they haven't done or had in a while, like a nice dinner or a little present - especially at the holidays. And don't forget exercise, no matter what form it takes, Kales adds. "We know that exercise causes all kinds of good hormones to be released, and for older people that can make depression lessen."
One thing to avoid, or at least to cut back on, is alcohol. "It's very important that older people who are feeling low should minimize their use of alcohol," Kales cautions. "Sometimes they might use it to help them go to sleep or improve their mood, but the bottom line is that alcohol is a depressant and helps mess up their sleep."
For those whose depression symptoms continue for weeks or months despite these measures, Kales emphasizes two things: counseling, also known as talk therapy, and medication.
Talk therapy, which can be done with the help of a psychologist, mental health social worker or psychiatrist, involves developing new ways of thinking about one's situation - and confronting negative thoughts and moods.
Older people may conjure up a stereotype of going to a "shrink" as something that will make them recite their childhood feelings while lying on a couch -- but that's not the way it's done these days at all, Kales says. Counseling, whether alone or in groups, has been proven to help people get better and stave off future bouts of depression. "Even though people are getting older, you can teach an old dog new tricks," as the saying goes, Kales explains.
When other approaches don't do enough, older people may want to consider some of the modern antidepressants that have been introduced in the last two decades, Kales says - much better than the mental health treatments of old that they may be familiar with.
Interestingly, older people usually need to start with much lower doses of antidepressants than younger people, because of changes in their drug metabolism and use of other medications as they age. But importantly, many older people need the same final dose as younger people, so it's important to "start low, go slow" but "don't stop" when increasing the antidepressant medication.
Ultimately, the choice of drug, and of dose, varies from person to person, and it may take patience to find something that works. It's best if this trial-and-error process is guided by someone experienced in treating depression, or even someone who specializes in treating older people's depression.
The bottom line is that families need to keep their eyes and ears open for signs of depression in older relatives, especially at the holidays when they have a chance to get together and spend some time. And if someone seems to need help, don't be afraid to speak up and reach out.
Facts about late-life depression:
-- About 15 percent of older people may be experiencing depression at any given time.
-- Depression is different from temporary "blues" or mourning for a lost loved one, in that it lasts longer, and doesn't let up from day to day.
-- Symptoms can include anxiety, irritability, loss of pleasure in activities, feelings of hopelessness and worthlessness, and worsened physical pain.
-- Some of the symptoms of depression that are most common in younger people, such as prolonged sadness, may not be as common in older people.
-- As older people develop age-related health problems like heart disease, complications of diabetes, lung disease, joint problems and vision or hearing loss, they may start to experience symptoms of depression. In other words, their physical illness can 'trigger' a bout of depression.
-- Other triggers for depression include the loss of a loved one, the loss of social networks of friends and acquaintances because of a move, and even the hubbub of the holidays.
Find more on the Web at:
U-M Depression Center: Depression in older adults
med.umich/depression/geriatric.htm
Free online self-test for depression from the U-M Depression Center
med.umich/depression/screen.htm
Geriatric Mental Health Foundation: Mental Wellness in Older Age depression toolkit
gmhfonline/gmhf/consumer/depression_toolkit.html
To find a mental health professional who specializes in diagnosing and treating older people, visit gmhfonline/gmhf/find.asp, or eldercare.
Or call the national Eldercare Locator service toll-free at 1-800-677-1116 weekdays between 9 a.m. and 8 p.m. ET.
University of Michigan Health System
2901 Hubbard St., Ste. 2400
Ann Arbor, MI 48109-2435
United States
med.umich/
понедельник, 25 июля 2011 г.
Family Rejection Of Lesbian, Gay And Bisexual Children Linked To Poor Health In Early Adulthood
For the first time, researchers have established a clear link between family rejection of lesbian, gay and bisexual (LGB) adolescents and negative health outcomes in early adulthood. The findings will be published in the January issue of Pediatrics, the journal of the American Academy of Pediatrics, in a peer-reviewed article entitled "Family Rejection as a Predictor of Negative Health Outcomes in White and Latino Lesbian, Gay and Bisexual Young Adults."
The paper, authored by Caitlin Ryan, PhD, Director of the Family Acceptance Project and her team at the C?©sar E. Ch??vez Institute at San Francisco State University, shows that negative parental behaviors toward LGB children dramatically compromises their health. The discovery has far reaching implications for changing how families relate to their LGB children and how a wide range of providers serve LGB youth across systems of care. The California Endowment, a health foundation dedicated to expanding access to affordable, quality health care for underserved individuals and communities, funded the study and development of resource materials.
"For the first time, research has established a predictive link between specific, negative family reactions to their child's sexual orientation and serious health problems for these adolescents in young adulthood such as depression, illegal drug use, risk for HIV infection, and suicide attempts," said Ryan, who is the lead author of the paper. "The new body of research we are generating will help develop resources, tools and interventions to strengthen families, prevent homelessness, reduce the proportion of youth in foster care and significantly improve the lives of LGBT young people and their families." (The Family Acceptance Project focuses on lesbian, gay, bisexual and transgender youth.)
Major Research Findings:
-- Higher rates of family rejection during adolescence were significantly associated with poorer health outcomes for LGB young adults.
-- LGB young adults who reported higher levels of family rejection during adolescence were 8.4 times more likely to report having attempted suicide, 5.9 times more likely to report high levels of depression, 3.4 times more likely to use illegal drugs, and 3.4 times more likely to report having engaged in unprotected sexual intercourse, compared with peers from families that reported no or low levels of family rejection.
-- Latino males reported the highest number of negative family reactions to their sexual orientation in adolescence.
"This study clearly shows the tremendous harm of family rejection, even if parents think they are well-intentioned, following deeply held beliefs or even protecting their children," said Sten Vermund, MD, a pediatrician and Amos Christie Chair of Global Health at Vanderbilt University.
"In today's often hostile climate for LGBT youth, it is especially important to note that both mental health issues like depression and suicide and HIV risk behaviors were greatly increased by rejection," Dr. Vermund said. "Given the ongoing HIV epidemic in America, in which half of all new cases of HIV are found in men who have sex with men and there is growing concern about prevention messages reaching young people, it is vital that we share these findings with parents and service providers who work with youth in every way.
"When put to practical, day-to-day use and shared with families and those who serve LGBT youth, these findings will lead to healthier, more supportive family dynamics and better lives for LGBT young people."
The prevailing approach by pediatricians, nurses, social workers, school counselors, peer advocates and community providers has focused almost exclusively on directly serving LGBT youth, and does not consider the impact of family reactions on the adolescent's health and well-being.
Subsequent work with ethnically diverse families by the Family Acceptance Project indicates that parents and caregivers can modify rejecting behavior once they understand the serious impact of their words and actions on their LGBT children's health. In addition, even a little change in parental behavior appears to have a clear impact on decreasing LGBT young people's risk. This new family-related approach to working with LGBT youth being developed by the Family Acceptance Project engages families as allies in decreasing the adolescent's risk and increasing their well-being while respecting the family's deeply held values.
"The new family-related behavioral approach to care being developed by the Family Acceptance Project offers great promise to change the future for LGBT youth and their families by helping parents and caregivers learn how to support their LGBT children and to prevent these extremely high levels of risk related to family rejection," said Erica Monasterio, MN, FNP, in the Division of Adolescent Medicine and Family Health Care Nursing at UCSF. "Rather than seeing families as part of the problem, this approach engages them as an essential resource in promoting healthy outcomes for their LGBT children."
"We are using our research to develop a new model of family-related care to decrease the high levels of risk for LGBT young people that restrict life chances and full participation in society," said Ryan. "Our easy-to-use behavioral approach will help families increase supportive behaviors and modify behaviors their LGBT children experience as rejecting that significantly increase their children's risk. However, redirecting practice and professional training ?¬ from not asking about family reactions to a young person's LGBT identity to engaging families in promoting their LGBT children's well-being requires a substantial shift on the part of both mainstream and LGBT providers, health systems and community programs."
The paper is the first of many research papers on outcomes related to family acceptance and rejection of LGBT adolescents, supporting positive LGBT youth development and providing family-related care to be released by the Family Acceptance Project.
The research sample included 224 LGB young non-Latino white and Latino adults, ages 21 to 25, who were open about their sexual orientation to at least one parent or primary caregiver during adolescence. These youth were recruited within California from 249 LGBT-related venues. Family rejection measures in the survey were developed based on a prior in-depth qualitative study of LGBT adolescents and families throughout California from 2002-2004.
The Family Acceptance Project is a community research, intervention and education initiative that studies the impact of family acceptance and rejection on the health, mental health and well being of lesbian, gay, bisexual and transgender (LGBT) youth. Results are being used to help families provide support for LGBT youth; to improve their health and mental health outcomes; to strengthen families and help maintain LGBT youth in their homes; to develop appropriate programs and policies; and train providers to improve the quality of services and care these youth receive in a wide range of settings. For more information, please visit familyproject.sfsu.
Source
Cathy Renna
San Francisco State University
sfsu
The paper, authored by Caitlin Ryan, PhD, Director of the Family Acceptance Project and her team at the C?©sar E. Ch??vez Institute at San Francisco State University, shows that negative parental behaviors toward LGB children dramatically compromises their health. The discovery has far reaching implications for changing how families relate to their LGB children and how a wide range of providers serve LGB youth across systems of care. The California Endowment, a health foundation dedicated to expanding access to affordable, quality health care for underserved individuals and communities, funded the study and development of resource materials.
"For the first time, research has established a predictive link between specific, negative family reactions to their child's sexual orientation and serious health problems for these adolescents in young adulthood such as depression, illegal drug use, risk for HIV infection, and suicide attempts," said Ryan, who is the lead author of the paper. "The new body of research we are generating will help develop resources, tools and interventions to strengthen families, prevent homelessness, reduce the proportion of youth in foster care and significantly improve the lives of LGBT young people and their families." (The Family Acceptance Project focuses on lesbian, gay, bisexual and transgender youth.)
Major Research Findings:
-- Higher rates of family rejection during adolescence were significantly associated with poorer health outcomes for LGB young adults.
-- LGB young adults who reported higher levels of family rejection during adolescence were 8.4 times more likely to report having attempted suicide, 5.9 times more likely to report high levels of depression, 3.4 times more likely to use illegal drugs, and 3.4 times more likely to report having engaged in unprotected sexual intercourse, compared with peers from families that reported no or low levels of family rejection.
-- Latino males reported the highest number of negative family reactions to their sexual orientation in adolescence.
"This study clearly shows the tremendous harm of family rejection, even if parents think they are well-intentioned, following deeply held beliefs or even protecting their children," said Sten Vermund, MD, a pediatrician and Amos Christie Chair of Global Health at Vanderbilt University.
"In today's often hostile climate for LGBT youth, it is especially important to note that both mental health issues like depression and suicide and HIV risk behaviors were greatly increased by rejection," Dr. Vermund said. "Given the ongoing HIV epidemic in America, in which half of all new cases of HIV are found in men who have sex with men and there is growing concern about prevention messages reaching young people, it is vital that we share these findings with parents and service providers who work with youth in every way.
"When put to practical, day-to-day use and shared with families and those who serve LGBT youth, these findings will lead to healthier, more supportive family dynamics and better lives for LGBT young people."
The prevailing approach by pediatricians, nurses, social workers, school counselors, peer advocates and community providers has focused almost exclusively on directly serving LGBT youth, and does not consider the impact of family reactions on the adolescent's health and well-being.
Subsequent work with ethnically diverse families by the Family Acceptance Project indicates that parents and caregivers can modify rejecting behavior once they understand the serious impact of their words and actions on their LGBT children's health. In addition, even a little change in parental behavior appears to have a clear impact on decreasing LGBT young people's risk. This new family-related approach to working with LGBT youth being developed by the Family Acceptance Project engages families as allies in decreasing the adolescent's risk and increasing their well-being while respecting the family's deeply held values.
"The new family-related behavioral approach to care being developed by the Family Acceptance Project offers great promise to change the future for LGBT youth and their families by helping parents and caregivers learn how to support their LGBT children and to prevent these extremely high levels of risk related to family rejection," said Erica Monasterio, MN, FNP, in the Division of Adolescent Medicine and Family Health Care Nursing at UCSF. "Rather than seeing families as part of the problem, this approach engages them as an essential resource in promoting healthy outcomes for their LGBT children."
"We are using our research to develop a new model of family-related care to decrease the high levels of risk for LGBT young people that restrict life chances and full participation in society," said Ryan. "Our easy-to-use behavioral approach will help families increase supportive behaviors and modify behaviors their LGBT children experience as rejecting that significantly increase their children's risk. However, redirecting practice and professional training ?¬ from not asking about family reactions to a young person's LGBT identity to engaging families in promoting their LGBT children's well-being requires a substantial shift on the part of both mainstream and LGBT providers, health systems and community programs."
The paper is the first of many research papers on outcomes related to family acceptance and rejection of LGBT adolescents, supporting positive LGBT youth development and providing family-related care to be released by the Family Acceptance Project.
The research sample included 224 LGB young non-Latino white and Latino adults, ages 21 to 25, who were open about their sexual orientation to at least one parent or primary caregiver during adolescence. These youth were recruited within California from 249 LGBT-related venues. Family rejection measures in the survey were developed based on a prior in-depth qualitative study of LGBT adolescents and families throughout California from 2002-2004.
The Family Acceptance Project is a community research, intervention and education initiative that studies the impact of family acceptance and rejection on the health, mental health and well being of lesbian, gay, bisexual and transgender (LGBT) youth. Results are being used to help families provide support for LGBT youth; to improve their health and mental health outcomes; to strengthen families and help maintain LGBT youth in their homes; to develop appropriate programs and policies; and train providers to improve the quality of services and care these youth receive in a wide range of settings. For more information, please visit familyproject.sfsu.
Source
Cathy Renna
San Francisco State University
sfsu
пятница, 22 июля 2011 г.
New Study Of Regional Brain Activity Using Functional MRI Looks At The Conflict Of Reward In Depression
In Love and Death, Woody Allen wrote: "To love is to suffer??¦To be happy is to love. To be happy, then, is to suffer." The paradoxical merging of happiness and suffering can be a feature of depression. Biological Psychiatry, on April 1st, is publishing a new study of regional brain activity using functional magnetic resonance imaging, which may help further our understanding of how happiness and suffering are related in depression.
Stanford University researchers recruited both depressed and non-depressed volunteers to undergo brain scans, via functional magnetic resonance imaging (fMRI), while they participated in an activity where they won and lost money. Dr. Brian Knutson, first author on this article, explains their findings: "When they anticipated winning money, both depressed and nondepressed individuals showed neural activation in the nucleus accumbens, a region implicated in the anticipation of reward. Only the depressed participants, however, additionally showed increased activation in the anterior cingulate, a region of the brain that has been implicated in conflict."
John H. Krystal, M.D., Editor of Biological Psychiatry and affiliated with both Yale University School of Medicine and the VA Connecticut Healthcare System, notes that this finding indicates that "this complex mixture of findings suggests that depression is not simply the absence of reward, but rather a contamination of neural processing of rewards with features of neural processing of punishments." Dr. Knutson agrees, commenting that "these findings are consistent with formulations that depression involves difficulties in the processing of positive information, and suggest more specifically that depressed people actually experience conflict when they are faced with the likelihood of receiving a reward."
Dr. Krystal concludes that "one intriguing potential implication of this work is that some forms of depression may be experienced, not as the absence of pleasure, but as the ubiquitous presence of emotional pain, disappointment, or frustration." Dr. Knutson and his colleagues are currently examining whether this increased experience of conflict when anticipating reward hinders recovery from depression.
The article is "Neural Responses to Monetary Incentives in Major Depression" by Brian Knutson, Jamil P. Bhanji, Rebecca E. Cooney, Lauren Y. Atlas and Ian H. Gotlib. The authors are affiliated with the Department of Psychology at Stanford University in Stanford, California. The article appears in Biological Psychiatry, Volume 63, Issue 7 (April 1, 2008), published by Elsevier.
About Biological Psychiatry
This international rapid-publication journal is the official journal of the Society of Biological Psychiatry. It covers a broad range of topics in psychiatric neuroscience and therapeutics. Both basic and clinical contributions are encouraged from all disciplines and research areas relevant to the pathophysiology and treatment of major neuropsychiatric disorders. Full-length and Brief Reports of novel results, Commentaries, Case Studies of unusual significance, and Correspondence and Comments judged to be of high impact to the field are published, particularly those addressing genetic and environmental risk factors, neural circuitry and neurochemistry, and important new therapeutic approaches. Concise Reviews and Editorials that focus on topics of current research and interest are also published rapidly.
Biological Psychiatry (sobp/journal) is ranked 4th out of the 95 Psychiatry titles and 16th out of 199 Neurosciences titles on the 2006 ISI Journal Citations Reports® published by Thomson Scientific.
About Elsevier
Elsevier is a world-leading publisher of scientific, technical and medical information products and services. Working in partnership with the global science and health communities, Elsevier's 7,000 employees in over 70 offices worldwide publish more than 2,000 journals and 1,900 new books per year, in addition to offering a suite of innovative electronic products, such as ScienceDirect (sciencedirect/), MD Consult (mdconsult/), Scopus (info.scopus/), bibliographic databases, and online reference works.
Elsevier (elsevier/) is a global business headquartered in Amsterdam, The Netherlands and has offices worldwide. Elsevier is part of Reed Elsevier Group plc (reedelsevier/), a world-leading publisher and information provider. Operating in the science and medical, legal, education and business-to-business sectors, Reed Elsevier provides high-quality and flexible information solutions to users, with increasing emphasis on the Internet as a means of delivery. Reed Elsevier's ticker symbols are REN (Euronext Amsterdam), REL (London Stock Exchange), RUK and ENL (New York Stock Exchange).
Stanford University researchers recruited both depressed and non-depressed volunteers to undergo brain scans, via functional magnetic resonance imaging (fMRI), while they participated in an activity where they won and lost money. Dr. Brian Knutson, first author on this article, explains their findings: "When they anticipated winning money, both depressed and nondepressed individuals showed neural activation in the nucleus accumbens, a region implicated in the anticipation of reward. Only the depressed participants, however, additionally showed increased activation in the anterior cingulate, a region of the brain that has been implicated in conflict."
John H. Krystal, M.D., Editor of Biological Psychiatry and affiliated with both Yale University School of Medicine and the VA Connecticut Healthcare System, notes that this finding indicates that "this complex mixture of findings suggests that depression is not simply the absence of reward, but rather a contamination of neural processing of rewards with features of neural processing of punishments." Dr. Knutson agrees, commenting that "these findings are consistent with formulations that depression involves difficulties in the processing of positive information, and suggest more specifically that depressed people actually experience conflict when they are faced with the likelihood of receiving a reward."
Dr. Krystal concludes that "one intriguing potential implication of this work is that some forms of depression may be experienced, not as the absence of pleasure, but as the ubiquitous presence of emotional pain, disappointment, or frustration." Dr. Knutson and his colleagues are currently examining whether this increased experience of conflict when anticipating reward hinders recovery from depression.
The article is "Neural Responses to Monetary Incentives in Major Depression" by Brian Knutson, Jamil P. Bhanji, Rebecca E. Cooney, Lauren Y. Atlas and Ian H. Gotlib. The authors are affiliated with the Department of Psychology at Stanford University in Stanford, California. The article appears in Biological Psychiatry, Volume 63, Issue 7 (April 1, 2008), published by Elsevier.
About Biological Psychiatry
This international rapid-publication journal is the official journal of the Society of Biological Psychiatry. It covers a broad range of topics in psychiatric neuroscience and therapeutics. Both basic and clinical contributions are encouraged from all disciplines and research areas relevant to the pathophysiology and treatment of major neuropsychiatric disorders. Full-length and Brief Reports of novel results, Commentaries, Case Studies of unusual significance, and Correspondence and Comments judged to be of high impact to the field are published, particularly those addressing genetic and environmental risk factors, neural circuitry and neurochemistry, and important new therapeutic approaches. Concise Reviews and Editorials that focus on topics of current research and interest are also published rapidly.
Biological Psychiatry (sobp/journal) is ranked 4th out of the 95 Psychiatry titles and 16th out of 199 Neurosciences titles on the 2006 ISI Journal Citations Reports® published by Thomson Scientific.
About Elsevier
Elsevier is a world-leading publisher of scientific, technical and medical information products and services. Working in partnership with the global science and health communities, Elsevier's 7,000 employees in over 70 offices worldwide publish more than 2,000 journals and 1,900 new books per year, in addition to offering a suite of innovative electronic products, such as ScienceDirect (sciencedirect/), MD Consult (mdconsult/), Scopus (info.scopus/), bibliographic databases, and online reference works.
Elsevier (elsevier/) is a global business headquartered in Amsterdam, The Netherlands and has offices worldwide. Elsevier is part of Reed Elsevier Group plc (reedelsevier/), a world-leading publisher and information provider. Operating in the science and medical, legal, education and business-to-business sectors, Reed Elsevier provides high-quality and flexible information solutions to users, with increasing emphasis on the Internet as a means of delivery. Reed Elsevier's ticker symbols are REN (Euronext Amsterdam), REL (London Stock Exchange), RUK and ENL (New York Stock Exchange).
вторник, 19 июля 2011 г.
Psychotherapeutic Drug Spending Surges, USA
Spending on prescription drugs to treat depression, anxiety, pain, schizophrenia and other conditions climbed from $7.9 billion in 1997 to $20 billion in 2004 - over a 150 percent increase, according to the latest News and Numbers from the Agency for Healthcare Research and Quality.
-- The sharpest increase was for antipsychotic agents, medications used to manage schizophrenia, bipolar disorder and other psychoses. They saw an increase from $1.3 billion to $4.1 billion from 1997 to 2004.
-- Spending for central nervous system stimulants to treat pain and control seizures, nearly tripled over the same time period, increasing from $0.6 billion to $1.7 billion.
-- Spending on antidepressants more than doubled from 1997 to 2004, increasing from $5.1 billion to $12.1 billion, as did expenditures for anxiolytics, sedatives, and hypnotics for anxiety and sleep disorders. Spending for these drugs rose from $.9 billion to $2.1 billion.
-- During the same time period, overall prescriptions for psychotherapeutic drugs increased from 141.9 million to 244.3 million; the number of people prescribed at least one such drug rose from 21 million to 32.6 million; and the average price per purchase increased from $55.80 to $82.00.
AHRQ, a part of the U.S. Department of Health and Human Services, works to improve the quality, safety, efficiency and effectiveness of health care in the United States. The data in this AHRQ News and Numbers comes from the Agency's Medical Expenditure Panel Survey, a highly detailed source of information on the health services that Americans use, how frequently they use them, the cost of these services, and how they are paid.
For more information on this AHRQ News and Numbers see Trends in the Use and Expenditures for the Therapeutic Class Prescribed Psychotherapeutic Agents and All Subclasses, 1997 and 2004 (PDF).
ahrq
-- The sharpest increase was for antipsychotic agents, medications used to manage schizophrenia, bipolar disorder and other psychoses. They saw an increase from $1.3 billion to $4.1 billion from 1997 to 2004.
-- Spending for central nervous system stimulants to treat pain and control seizures, nearly tripled over the same time period, increasing from $0.6 billion to $1.7 billion.
-- Spending on antidepressants more than doubled from 1997 to 2004, increasing from $5.1 billion to $12.1 billion, as did expenditures for anxiolytics, sedatives, and hypnotics for anxiety and sleep disorders. Spending for these drugs rose from $.9 billion to $2.1 billion.
-- During the same time period, overall prescriptions for psychotherapeutic drugs increased from 141.9 million to 244.3 million; the number of people prescribed at least one such drug rose from 21 million to 32.6 million; and the average price per purchase increased from $55.80 to $82.00.
AHRQ, a part of the U.S. Department of Health and Human Services, works to improve the quality, safety, efficiency and effectiveness of health care in the United States. The data in this AHRQ News and Numbers comes from the Agency's Medical Expenditure Panel Survey, a highly detailed source of information on the health services that Americans use, how frequently they use them, the cost of these services, and how they are paid.
For more information on this AHRQ News and Numbers see Trends in the Use and Expenditures for the Therapeutic Class Prescribed Psychotherapeutic Agents and All Subclasses, 1997 and 2004 (PDF).
ahrq
суббота, 16 июля 2011 г.
Screening For Childhood Depressive Symptoms Could Start In Second Grade
New research indicates that screening children for symptoms of depression, the most common mental health disorder in the United States, can begin a lot earlier than previously thought, as early as the second grade.
A University of Washington study that followed nearly 1,000 children from the second to the eighth grades also found five distinct patterns for the way symptoms of depression develop among adolescents.
"Some children are reporting that they don't have as many friends, feel lonelier and are more anxious than their peers," said James Mazza, a UW professor of educational psychology and lead author of the study. "They are telling us that they feel different from the typical happy- go-lucky second grader.
"We can start to build a profile of children's mental health in the second grade. This is important because children who are experiencing depression symptoms early on may be at great risk for mental health concerns during adolescence, based on other research studies. We want to reassure parents that everyone, including children, may feel sad or depressed once in a while, but that doesn't mean they will go on to develop depression. We are trying to understand how depression starts and evolves in childhood so that we can develop interventions to help children," Mazza said.
The new study relied on annual self reports from the children as well as parental and teacher evaluations collected as part of the Raising Healthy Children study, a larger, long-term investigation looking at the development of healthy and problem behaviors among children at 10 suburban schools in the Pacific Northwest. The depression study used data from 511 boys and 440 girls, and 81 percent of the participants were white.
The study identified five patterns of depression symptoms, but 56 percent of the children showed no or very few symptoms of depression in the second grade.
The five patterns of depression symptoms the researchers found and the percentage of students in each group are:
Low stables - 26 percent. These children showed none or very few signs of depression in the second grade and their rates didn't change over time through the eighth grade.
Low risers - 30 percent. Children in this group also had no or few symptoms in the second grade, but the number went up by a small amount in subsequent years.
Mild stables - 24 percent. This group had few symptoms and then went up by a small amount in subsequent years.
Moderate changers - 11 percent. These children started out with a few more symptoms than the previous group and their number of symptoms rose through elementary school and then dropped in middle school.
Moderate risers - 9 percent. This group started off with a similar number of symptoms as the moderate changers, however their symptoms did not decrease in middle school.
The study identified different early depression risk factors for boys and girls. For boys, behavior and attention problems predicted membership in the different depression groups. For girls anxiety was an early risk factor. The research also reaffirmed previous findings showing gender differences in underlying depressive symptoms, with girls experiencing more symptoms than boys in the eighth grade
"Our children are our best resource in knowing what they are feeling inside. But it is also important to have multiple perspectives. Collecting assessments from parents, teachers and the child to identify children at early risk for depression is a good method for spotting those who may go on to have later mental health risks," Mazza said.
The National Institute on Drug Abuse funded the study, which was published in the Journal of Youth and Adolescence. Co-authors are Charles Fleming, Kevin Haggerty and Richard Catalano of the UW's Social Development Research Group, a part of the School of Social Work, and Robert Abbott, of educational psychology.
A University of Washington study that followed nearly 1,000 children from the second to the eighth grades also found five distinct patterns for the way symptoms of depression develop among adolescents.
"Some children are reporting that they don't have as many friends, feel lonelier and are more anxious than their peers," said James Mazza, a UW professor of educational psychology and lead author of the study. "They are telling us that they feel different from the typical happy- go-lucky second grader.
"We can start to build a profile of children's mental health in the second grade. This is important because children who are experiencing depression symptoms early on may be at great risk for mental health concerns during adolescence, based on other research studies. We want to reassure parents that everyone, including children, may feel sad or depressed once in a while, but that doesn't mean they will go on to develop depression. We are trying to understand how depression starts and evolves in childhood so that we can develop interventions to help children," Mazza said.
The new study relied on annual self reports from the children as well as parental and teacher evaluations collected as part of the Raising Healthy Children study, a larger, long-term investigation looking at the development of healthy and problem behaviors among children at 10 suburban schools in the Pacific Northwest. The depression study used data from 511 boys and 440 girls, and 81 percent of the participants were white.
The study identified five patterns of depression symptoms, but 56 percent of the children showed no or very few symptoms of depression in the second grade.
The five patterns of depression symptoms the researchers found and the percentage of students in each group are:
Low stables - 26 percent. These children showed none or very few signs of depression in the second grade and their rates didn't change over time through the eighth grade.
Low risers - 30 percent. Children in this group also had no or few symptoms in the second grade, but the number went up by a small amount in subsequent years.
Mild stables - 24 percent. This group had few symptoms and then went up by a small amount in subsequent years.
Moderate changers - 11 percent. These children started out with a few more symptoms than the previous group and their number of symptoms rose through elementary school and then dropped in middle school.
Moderate risers - 9 percent. This group started off with a similar number of symptoms as the moderate changers, however their symptoms did not decrease in middle school.
The study identified different early depression risk factors for boys and girls. For boys, behavior and attention problems predicted membership in the different depression groups. For girls anxiety was an early risk factor. The research also reaffirmed previous findings showing gender differences in underlying depressive symptoms, with girls experiencing more symptoms than boys in the eighth grade
"Our children are our best resource in knowing what they are feeling inside. But it is also important to have multiple perspectives. Collecting assessments from parents, teachers and the child to identify children at early risk for depression is a good method for spotting those who may go on to have later mental health risks," Mazza said.
The National Institute on Drug Abuse funded the study, which was published in the Journal of Youth and Adolescence. Co-authors are Charles Fleming, Kevin Haggerty and Richard Catalano of the UW's Social Development Research Group, a part of the School of Social Work, and Robert Abbott, of educational psychology.
среда, 13 июля 2011 г.
Mind: Public Must Be Able To Have Trust In Medicines, Says Mental Health Charity 'Mind', UK
Mental health charity Mind responds to the MHRA's ruling on GlaxoSmithKline.
Paul Farmer, chief executive of Mind, said:
"Mind welcomes news that the Government is to increase drug companies' responsibility to pass on clinical trials information. We look forward to discussions with ministers to ensure that patients' interests are best served. We hope that the legislation will pass quickly through Parliament; this is far too important to be delayed any longer.
"There can be no excuses from the pharmaceutical industry. The public must be able to have trust and confidence in the medicines they are taking. We need to be sure that the tragedies associated with Seroxat can never happen again. The best way to achieve this is for drug companies to publish all clinical trials data, making it available for scrutiny and review, and to inform prescribing decisions.
"The Health Committee's 2005 report on the influence of the pharmaceutical industry made powerful recommendations. We hope that both the Health Committee and the Government will be able to revisit those recommendations soon."
Mind first drew attention to the problems of Seroxat in the 1990s. View our Seroxat timeline.
Further Seroxat background.
Mind is the leading mental health charity in England and Wales. We work to create a better life for everyone with experience of mental distress.
Mind values its independence, and accepts no funding or donations from pharmaceutical companies.
mind.uk
Paul Farmer, chief executive of Mind, said:
"Mind welcomes news that the Government is to increase drug companies' responsibility to pass on clinical trials information. We look forward to discussions with ministers to ensure that patients' interests are best served. We hope that the legislation will pass quickly through Parliament; this is far too important to be delayed any longer.
"There can be no excuses from the pharmaceutical industry. The public must be able to have trust and confidence in the medicines they are taking. We need to be sure that the tragedies associated with Seroxat can never happen again. The best way to achieve this is for drug companies to publish all clinical trials data, making it available for scrutiny and review, and to inform prescribing decisions.
"The Health Committee's 2005 report on the influence of the pharmaceutical industry made powerful recommendations. We hope that both the Health Committee and the Government will be able to revisit those recommendations soon."
Mind first drew attention to the problems of Seroxat in the 1990s. View our Seroxat timeline.
Further Seroxat background.
Mind is the leading mental health charity in England and Wales. We work to create a better life for everyone with experience of mental distress.
Mind values its independence, and accepts no funding or donations from pharmaceutical companies.
mind.uk
воскресенье, 10 июля 2011 г.
Study: Premenstrual Mood Changes Predictive Of Greater Bipolar Disorder Severity
A study of nearly 300 women with bipolar disorder showed that those reporting flare-ups of mood symptoms before menstruation had more depressive episodes and more severe symptoms during the following year, compared with bipolar women without premenstrual mood changes.
The study was part of the Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD) and was conducted by Rodrigo Dias, M.D., and colleagues at Massachusetts General Hospital in Boston. The report will be published online at AJP in Advance, the online advance edition of The American Journal of Psychiatry, the official journal of the American Psychiatric Association.
The study results provide evidence that premenstrual mood exacerbation may be a clinical marker predicting a worse presentation and course of bipolar disorder in reproductive-age women. The authors note that estrogen and other reproductive hormones influence mood symptoms through their action in the central nervous system. In women with bipolar disorder, the time following childbirth and the menopause transition are also periods of increased vulnerability to illness relapse. The susceptibility of mood to fluctuating hormone levels may result in greater mood instability in general.
The number of diagnosed illness episodes differed only for depressive episodes, not those characterized by mania or hypomania. Also, the women with premenstrual exacerbations were no more likely to have the extreme form of bipolar disorder known as rapid cycling (defined as four or more episodes per year). They did, however, have shorter gaps between symptomatic intervals.
Dr. Dias pointed out the implications for clinical practice: "The results reinforce the importance of identifying mood fluctuations across the menstrual cycle in women with bipolar disorder. The women with premenstrual mood changes may benefit from more intensive monitoring. The value of antidepressants isn't clear, since on the one hand, these women were less likely to be taking antidepressants and might have benefited from them, but on the other hand, antidepressants can trigger manic symptoms in bipolar patients."
The article will appear on Feb. 15 at AJP in Advance. STEP-BD is funded by the National Institute of Mental Health; this study was funded in part by a donation from the Thompson Motta Family to the Bipolar Research Program, Institute of Psychiatry of the Hospital das Clinicas,
University S??o Paulo Medical School. Financial support received by the individual authors is reported in the article.
The study was part of the Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD) and was conducted by Rodrigo Dias, M.D., and colleagues at Massachusetts General Hospital in Boston. The report will be published online at AJP in Advance, the online advance edition of The American Journal of Psychiatry, the official journal of the American Psychiatric Association.
The study results provide evidence that premenstrual mood exacerbation may be a clinical marker predicting a worse presentation and course of bipolar disorder in reproductive-age women. The authors note that estrogen and other reproductive hormones influence mood symptoms through their action in the central nervous system. In women with bipolar disorder, the time following childbirth and the menopause transition are also periods of increased vulnerability to illness relapse. The susceptibility of mood to fluctuating hormone levels may result in greater mood instability in general.
The number of diagnosed illness episodes differed only for depressive episodes, not those characterized by mania or hypomania. Also, the women with premenstrual exacerbations were no more likely to have the extreme form of bipolar disorder known as rapid cycling (defined as four or more episodes per year). They did, however, have shorter gaps between symptomatic intervals.
Dr. Dias pointed out the implications for clinical practice: "The results reinforce the importance of identifying mood fluctuations across the menstrual cycle in women with bipolar disorder. The women with premenstrual mood changes may benefit from more intensive monitoring. The value of antidepressants isn't clear, since on the one hand, these women were less likely to be taking antidepressants and might have benefited from them, but on the other hand, antidepressants can trigger manic symptoms in bipolar patients."
The article will appear on Feb. 15 at AJP in Advance. STEP-BD is funded by the National Institute of Mental Health; this study was funded in part by a donation from the Thompson Motta Family to the Bipolar Research Program, Institute of Psychiatry of the Hospital das Clinicas,
University S??o Paulo Medical School. Financial support received by the individual authors is reported in the article.
четверг, 7 июля 2011 г.
Using The Web To Treat Panic Disorder
An online treatment system for patients suffering with panic disorder and anxiety problems combine biofeedback therapy with web technologies and allows patients and medical professionals to communicate effectively, according to research published in the International Journal of Business Intelligence and Data Mining.
Vincent Tseng and Bai-En Shie of the National Cheng Kung University are working with psychiatrist Fong-Lin Jang of the Chi-Mei Medical Center, in Tainan, Taiwan, to develop a system they say will have a "pivotal impact" on the healthcare industry.
The increasing pace of life, the industrialisation of society, and the advent of digital technology are all thought to underlie the growing prevalence of mental illness. Disorders, such as anxiety, obsessive-compulsive disorder, and depression are now diagnosed more frequently than ever before.
Panic disorders are not easily diagnosed but do represent chronic illness for countless patients and lead to hospitalisation with increasing frequency. Patients can become acutely fearful and uncomfortable and suffer dizziness, chest pain, difficulty breathing, a racing pulse, and even palpitations, all of which increase the sense of panic and mimic the symptoms of a heart attack or asthma episode, hence the emergency room admissions.
Sufferers often restrict their day to day activities to avoid inducing anxiety and the problem persists can lead to substance abuse and depression. Victims of panic disorder often have a poor quality of life overall.
The team has coupled a wireless-enabled finger-ring device that measures skin temperature with a web-enabled system. The system provides a convenient channel for communication between patients and healthcare worker as well as allowing hospital staff to allow patients to ask questions and download pertinent information.
The key to the system is that patients can also upload physiological data and their self-assessment to the database. The "emotion ring" continuously monitors and records the patient's finger skin temperature, which the researchers explain is a useful indicator of the patient's emotional state. It may simply provide a focus. Patients are then taught muscle and mental relaxation exercises and how to observe the effects of these on their skin temperature, thus providing a biofeedback mechanism that can also be monitored by their healthcare worker.
Temperature biofeedback has been utilized in medicine for more than three decades and because performance anxiety can occur during biofeedback a professional therapist must help the patient master the sensation of relaxation, especially in the initial stages of training.
The team has tested the system with ten patients in a pilot study. "Once the patients learned the cues for relaxation and the method to obtain rapid relaxation, they were able to apply the methods and cues to relieve the symptoms of panic disorder," they conclude. The next step is to develop a related system that works with mobile devices rather than a personal computer.
"After receiving the muscle relaxation program, patients could feel the difference between relaxation and tension, and learned the skill of relaxation," Tseng says, "The most important is that patients had fewer panic attacks and had improvement in Panic Disorder Severity Scale(PDSS). A large multi-center clinical trial with this system is going on in Taiwan."
"Intelligent panic disorder treatment by using biofeedback analysis and web technologies" in Int. J. Business Intelligence and Data Mining, 2010, 5, 77-93 dx.doi/10.1504/IJBIDM.2010.030300
Vincent Tseng and Bai-En Shie of the National Cheng Kung University are working with psychiatrist Fong-Lin Jang of the Chi-Mei Medical Center, in Tainan, Taiwan, to develop a system they say will have a "pivotal impact" on the healthcare industry.
The increasing pace of life, the industrialisation of society, and the advent of digital technology are all thought to underlie the growing prevalence of mental illness. Disorders, such as anxiety, obsessive-compulsive disorder, and depression are now diagnosed more frequently than ever before.
Panic disorders are not easily diagnosed but do represent chronic illness for countless patients and lead to hospitalisation with increasing frequency. Patients can become acutely fearful and uncomfortable and suffer dizziness, chest pain, difficulty breathing, a racing pulse, and even palpitations, all of which increase the sense of panic and mimic the symptoms of a heart attack or asthma episode, hence the emergency room admissions.
Sufferers often restrict their day to day activities to avoid inducing anxiety and the problem persists can lead to substance abuse and depression. Victims of panic disorder often have a poor quality of life overall.
The team has coupled a wireless-enabled finger-ring device that measures skin temperature with a web-enabled system. The system provides a convenient channel for communication between patients and healthcare worker as well as allowing hospital staff to allow patients to ask questions and download pertinent information.
The key to the system is that patients can also upload physiological data and their self-assessment to the database. The "emotion ring" continuously monitors and records the patient's finger skin temperature, which the researchers explain is a useful indicator of the patient's emotional state. It may simply provide a focus. Patients are then taught muscle and mental relaxation exercises and how to observe the effects of these on their skin temperature, thus providing a biofeedback mechanism that can also be monitored by their healthcare worker.
Temperature biofeedback has been utilized in medicine for more than three decades and because performance anxiety can occur during biofeedback a professional therapist must help the patient master the sensation of relaxation, especially in the initial stages of training.
The team has tested the system with ten patients in a pilot study. "Once the patients learned the cues for relaxation and the method to obtain rapid relaxation, they were able to apply the methods and cues to relieve the symptoms of panic disorder," they conclude. The next step is to develop a related system that works with mobile devices rather than a personal computer.
"After receiving the muscle relaxation program, patients could feel the difference between relaxation and tension, and learned the skill of relaxation," Tseng says, "The most important is that patients had fewer panic attacks and had improvement in Panic Disorder Severity Scale(PDSS). A large multi-center clinical trial with this system is going on in Taiwan."
"Intelligent panic disorder treatment by using biofeedback analysis and web technologies" in Int. J. Business Intelligence and Data Mining, 2010, 5, 77-93 dx.doi/10.1504/IJBIDM.2010.030300
понедельник, 4 июля 2011 г.
Panic Attacks Linked To Higher Risk Of Heart Attacks And Heart Disease, Especially In Younger People
People who have been diagnosed with panic attacks or panic disorder have a greater risk of subsequently developing heart disease or suffering a heart attack than the normal population, with higher rates occurring in younger people, according to research published in Europe's leading cardiology journal, the European Heart Journal [1] today (Thursday 11 December).
The study found that people who were younger than 50 when first diagnosed had a significantly higher risk of subsequent heart attacks (or myocardial infarctions, MI), but this was not the case in older people. It also found there was a significantly higher incidence of subsequent coronary heart disease (CHD) in people diagnosed with panic attacks/disorder at all ages, but this was more marked in the under 50s.
However, the research also showed that the risk of dying from CHD was actually reduced amongst people of all ages who had been diagnosed with panic attacks/disorder.
The study is the first to look at a very large sample of the UK population of all ages (a total of 404,654 people) selected from a primary care population that can be broadly generalised to other countries with a similar socio-demographic structure. It is also the first to identify that the higher risk of heart attacks with panic attacks/disorder is mainly in younger people (aged under 50 years), and that having a panic attacks/disorder diagnosis is associated with a lower risk of dying from heart conditions.
Dr Kate Walters, a senior lecturer in primary care at University College London (UK), who led the research, said: "Not much is known about the relationship between panic disorder and cardiac disease. The symptoms of panic attacks can closely mimic those of a heart attack or acute cardiac disease, and it seems that there may be a complex relationship between them.
"Our findings have significant implications for clinicians. Panic attacks were associated with a significant increased risk of a subsequent diagnosis of CHD and acute MI in those aged younger than 50. This may be due to initial misdiagnosis of CHD as panic attacks, or a true underlying increased risk of CHD with panic attacks. Clinicians should be vigilant for this possibility when diagnosing and treating people presenting with symptoms of panic."
Dr Walters and her colleagues looked at primary care medical records for 57,615 adults diagnosed with panic attacks/disorder and 347,039 adults who did not have the condition. They found that those aged under 50 were more than a third (38%) as likely to have a heart attack and nearly half (44%) as likely to develop heart disease subsequently than people who had not been diagnosed with the condition. For people aged over 50 there was a slightly increased risk of heart disease (11%).
However, when the researchers looked at deaths amongst adults diagnosed with panic attacks/disorder, they found that for all ages the risk of death from heart disease was reduced by about a quarter (24%) compared with the normal population.
Dr Walters speculated about the possible reasons for the reduced risk of death. "This might be because the higher risk of coronary heart disease and heart attacks occurred amongst younger people who have fewer heart-related deaths generally; or it might be because people with panic disorders go to their doctors earlier and more frequently and, therefore, are more likely to have their heart disease identified and treated early, thus reducing the likelihood of dying from it."
The study also found that women younger than 40 with panic attacks/disorder had higher increases in incidence of MI and CHD than men, but Dr Walters said this result needed to be treated with caution as the actual number of events was very low and so it could be due to chance.
The reasons why panic attacks/disorder are linked to higher rates of MI and CHD are not understood completely. Dr Walters said: "These findings could be due to several factors, including initial misdiagnosis of CHD as panic attacks/disorder by GPs or due to a true increase in CHD and acute MI caused by panic disorder, potentially through activation of the sympathetic nervous system [3] in ways that lead to clogging of the arteries and reductions in the normal variation in heart rate. This hypothesis, rather than GP misdiagnosis, is supported by the fact that we observed an increasing risk of CHD with increasing frequency of panic attacks/disorder events.
"In addition, although we made adjustments for identified depression, it is possible that some patients with panic might have had undiagnosed depression, which is also associated with an increased risk of CHD."
She stressed that people who have been diagnosed with panic attacks/disorder should not worry about her findings but should consult their doctors. "While there is a small increased risk among people diagnosed by their GP with panic attacks/disorder, the vast majority of people with panic attacks will not go on to have a heart attack or heart diseases such as angina," she said. "This is particularly the case for younger people, as the overall likelihood of heart attacks at this age is so low. For example, less than three in 10,000 men and less than two in 10,000 women under 40 diagnosed by their GP with panic attacks will go on to have a heart attack. In your 40s the risk of heart attacks is higher, but it is still less than four in 1,000 men with panic attacks and less than one in 1,000 women.
"People should be encouraged to go back to their GPs for further assessment if their symptoms continue or reoccur, and GPs should consider the possibility of CHD or MI.
"I should add that this research was based on a large database of GP records, and we do not know if any of our findings apply to people who do not consult their GPs about panic attacks."
Notes
[1] "Panic disorder and risk of new onset coronary heart disease, acute myocardial infarction, and cardiac mortality: cohort study using the general practice research database". European Heart Journal 2008 29 (24): 2981-2988. doi:10.1093/eurheartj/ehn477.
[2] The prevalence of panic attacks that do not meet the full criteria for panic disorder is 1.9% of the general population. Panic disorder has a prevalence of about 1.8%, and this rises to 5.6-9.2% of patients in primary care, and 10-53% in cardiology outpatients and patients with documented CHD.
[3] The sympathetic nervous system is a part of the nervous system that controls the body's internal, involuntary processes.
A pdf of the full paper is available here.
The European Heart Journal is the flagship journal of the European Society of Cardiology
escardio
The study found that people who were younger than 50 when first diagnosed had a significantly higher risk of subsequent heart attacks (or myocardial infarctions, MI), but this was not the case in older people. It also found there was a significantly higher incidence of subsequent coronary heart disease (CHD) in people diagnosed with panic attacks/disorder at all ages, but this was more marked in the under 50s.
However, the research also showed that the risk of dying from CHD was actually reduced amongst people of all ages who had been diagnosed with panic attacks/disorder.
The study is the first to look at a very large sample of the UK population of all ages (a total of 404,654 people) selected from a primary care population that can be broadly generalised to other countries with a similar socio-demographic structure. It is also the first to identify that the higher risk of heart attacks with panic attacks/disorder is mainly in younger people (aged under 50 years), and that having a panic attacks/disorder diagnosis is associated with a lower risk of dying from heart conditions.
Dr Kate Walters, a senior lecturer in primary care at University College London (UK), who led the research, said: "Not much is known about the relationship between panic disorder and cardiac disease. The symptoms of panic attacks can closely mimic those of a heart attack or acute cardiac disease, and it seems that there may be a complex relationship between them.
"Our findings have significant implications for clinicians. Panic attacks were associated with a significant increased risk of a subsequent diagnosis of CHD and acute MI in those aged younger than 50. This may be due to initial misdiagnosis of CHD as panic attacks, or a true underlying increased risk of CHD with panic attacks. Clinicians should be vigilant for this possibility when diagnosing and treating people presenting with symptoms of panic."
Dr Walters and her colleagues looked at primary care medical records for 57,615 adults diagnosed with panic attacks/disorder and 347,039 adults who did not have the condition. They found that those aged under 50 were more than a third (38%) as likely to have a heart attack and nearly half (44%) as likely to develop heart disease subsequently than people who had not been diagnosed with the condition. For people aged over 50 there was a slightly increased risk of heart disease (11%).
However, when the researchers looked at deaths amongst adults diagnosed with panic attacks/disorder, they found that for all ages the risk of death from heart disease was reduced by about a quarter (24%) compared with the normal population.
Dr Walters speculated about the possible reasons for the reduced risk of death. "This might be because the higher risk of coronary heart disease and heart attacks occurred amongst younger people who have fewer heart-related deaths generally; or it might be because people with panic disorders go to their doctors earlier and more frequently and, therefore, are more likely to have their heart disease identified and treated early, thus reducing the likelihood of dying from it."
The study also found that women younger than 40 with panic attacks/disorder had higher increases in incidence of MI and CHD than men, but Dr Walters said this result needed to be treated with caution as the actual number of events was very low and so it could be due to chance.
The reasons why panic attacks/disorder are linked to higher rates of MI and CHD are not understood completely. Dr Walters said: "These findings could be due to several factors, including initial misdiagnosis of CHD as panic attacks/disorder by GPs or due to a true increase in CHD and acute MI caused by panic disorder, potentially through activation of the sympathetic nervous system [3] in ways that lead to clogging of the arteries and reductions in the normal variation in heart rate. This hypothesis, rather than GP misdiagnosis, is supported by the fact that we observed an increasing risk of CHD with increasing frequency of panic attacks/disorder events.
"In addition, although we made adjustments for identified depression, it is possible that some patients with panic might have had undiagnosed depression, which is also associated with an increased risk of CHD."
She stressed that people who have been diagnosed with panic attacks/disorder should not worry about her findings but should consult their doctors. "While there is a small increased risk among people diagnosed by their GP with panic attacks/disorder, the vast majority of people with panic attacks will not go on to have a heart attack or heart diseases such as angina," she said. "This is particularly the case for younger people, as the overall likelihood of heart attacks at this age is so low. For example, less than three in 10,000 men and less than two in 10,000 women under 40 diagnosed by their GP with panic attacks will go on to have a heart attack. In your 40s the risk of heart attacks is higher, but it is still less than four in 1,000 men with panic attacks and less than one in 1,000 women.
"People should be encouraged to go back to their GPs for further assessment if their symptoms continue or reoccur, and GPs should consider the possibility of CHD or MI.
"I should add that this research was based on a large database of GP records, and we do not know if any of our findings apply to people who do not consult their GPs about panic attacks."
Notes
[1] "Panic disorder and risk of new onset coronary heart disease, acute myocardial infarction, and cardiac mortality: cohort study using the general practice research database". European Heart Journal 2008 29 (24): 2981-2988. doi:10.1093/eurheartj/ehn477.
[2] The prevalence of panic attacks that do not meet the full criteria for panic disorder is 1.9% of the general population. Panic disorder has a prevalence of about 1.8%, and this rises to 5.6-9.2% of patients in primary care, and 10-53% in cardiology outpatients and patients with documented CHD.
[3] The sympathetic nervous system is a part of the nervous system that controls the body's internal, involuntary processes.
A pdf of the full paper is available here.
The European Heart Journal is the flagship journal of the European Society of Cardiology
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пятница, 1 июля 2011 г.
Genome Survey Finds Depression Genes
U.S. researchers using the newly published human gene map said on Wednesday they had identified 19 different genetic regions linked with depression.
The findings could eventually lead to better treatments and screening for depression and related conditions, such as addiction, a leading cause of disability in the United States.
Dr. George Zubenko, a professor of psychiatry at the University of Pittsburgh School of Medicine, and colleagues screened 81 families with members suffering from recurrent, early-onset, major depressive disorder, which runs in families.
They found 19 regions on chromosomes that seem to be involved in the condition, they reported in the American Journal of Medical Genetics. Further work should be able to pinpoint the actual genes involved.
The information could eventually lead to tailored treatments for depression, Zubenko said.
'For example, individuals with particular genetic markers in these regions may respond better to particular current treatments than others,' he said in a statement.
Zubenko's team found some mutations seem to be sex-specific -- some for women and at least one for men.
'Women are twice as likely as men to develop depression, and genetic differences appear to account for some of that disparity,' Zubenko said.
These could help explain why women seem more vulnerable to depression during puberty, pregnancy and childbirth and menopause, Zubenko said.
They also noticed that people in families with these genetic changes tend to live shorter lives.
People who had died in the 81 families were eight years younger when they died than the average for the general population, the researchers found.
They found a five-fold increase in the proportion of babies who died in the first year of life and several-fold increases in deaths by suicide, murder and liver disease, although most of the deaths were from heart disease, cancer and stroke.
The National Institute of Mental Health reported last month that 16 percent of Americans -- more than 30 million people -- will suffer major depression at some point in their lives, costing employers more than $30 billion in lost productivity.
The findings could eventually lead to better treatments and screening for depression and related conditions, such as addiction, a leading cause of disability in the United States.
Dr. George Zubenko, a professor of psychiatry at the University of Pittsburgh School of Medicine, and colleagues screened 81 families with members suffering from recurrent, early-onset, major depressive disorder, which runs in families.
They found 19 regions on chromosomes that seem to be involved in the condition, they reported in the American Journal of Medical Genetics. Further work should be able to pinpoint the actual genes involved.
The information could eventually lead to tailored treatments for depression, Zubenko said.
'For example, individuals with particular genetic markers in these regions may respond better to particular current treatments than others,' he said in a statement.
Zubenko's team found some mutations seem to be sex-specific -- some for women and at least one for men.
'Women are twice as likely as men to develop depression, and genetic differences appear to account for some of that disparity,' Zubenko said.
These could help explain why women seem more vulnerable to depression during puberty, pregnancy and childbirth and menopause, Zubenko said.
They also noticed that people in families with these genetic changes tend to live shorter lives.
People who had died in the 81 families were eight years younger when they died than the average for the general population, the researchers found.
They found a five-fold increase in the proportion of babies who died in the first year of life and several-fold increases in deaths by suicide, murder and liver disease, although most of the deaths were from heart disease, cancer and stroke.
The National Institute of Mental Health reported last month that 16 percent of Americans -- more than 30 million people -- will suffer major depression at some point in their lives, costing employers more than $30 billion in lost productivity.
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