Focus on Faith and Healing: The Renewal Christian Treatment and Recovery Blog

Impaired Vision Plus Poor Health Possible Suicide Risk

2008-07-18T12:30:00.001-05:00

According to a study published in the July issue of the Archives of Ophthalmology poor vision along with related indirect effects of poor health may be linked to an increase in risk of suicide. The study, conducted by Byron L. Lam, M.D., of the Bascom Palmer Eye Institute at the University of Miami, revealed that those with poor vision and indirect effects such as poor health had a risk of suicide that was 18% greater than those that do not suffer from these conditions. In addition to increased risk of suicide, researchers relayed that the psychosocial and health consequences of having impaired vision are many; social seclusion, increased risk of motor accidents, depression, falls, factures, cognitive impairment, and difficulty with activities of daily living are just a few mentioned in the study. Additionally, those with impaired vision have been associated with an overall increase in mortality risk, researchers said. The following is an excerpt of an article from Medpage Today that reviews findings from the study:

Dr. Lam's team reviewed data from National Health Interview Surveys (1986-1996) including data on 137,479 noninstitutionalized adults.

Participants reported demographic information along with details of visual impairment and other health conditions. Verified deaths of participants up to 2002 were reported through the National Death Index. Structural equation modeling was used to determine the relationship between reported visual impairment and suicide.

During a mean 11 years of follow-up, there were 200 suicides.

After controlling for survey design, age, sex, race, marital status,
number of non-ocular health conditions, and self-rated health, the direct effect of visual impairment on death from suicide was elevated but not significant (hazard ratio 1.50, 95% confidence interval 0.90 to 2.49).

However, the approximate indirect effect of visual impairment on suicide via poorer self-rated health was a significant 5% (HR 1.05, 95% CI 1.02 to 1.08).

For the number of non-ocular health conditions, the rate was a significant 12% (HR 1.12, 95% CI 1.01 to 1.24).

Click here to read the rest of this article from Medpage Today

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Neonatal risks posed by mothers taking psychotropic drugs during pregnancy

2008-07-17T16:46:00.001-05:00

Currently, there is very little known about neonatal risks posed by mothers taking psychotropic drugs during pregnancy. However, two studies have provided some new data on neonatal outcomes associated with psychotropic drugs. The following is an excerpt of an article from Journal Watch that discusses the findings:

Using large medical, demographic, and public drug insurance registries in Quebec, researchers focused on women with psychiatric diagnoses (mostly, mood or anxiety disorders) and antidepressant use for at least 1 month in the year before pregnancy. Researchers compared first-trimester antidepressant exposure and duration in 2140 healthy infants and 189 infants with any major congenital malformation in the year after birth. Antidepressants commonly used were paroxetine (42%), sertraline (15%), and venlafaxine (13%). The risk for congenital malformation (8%, vs. the usual population rate of 3%) was unrelated to first-trimester antidepressant use, its duration, or therapeutic class. Controlling for ethnicity and for drug, alcohol, and tobacco use, determined in 806 mothers, did not alter results.

Other researchers linked maternal and neonatal British Columbian health records to identify recipients of a serotonin reuptake inhibitor… <click here to read the rest of this article from Journal Watch>

Severe psychiatric conditions should be treated at the discretion of a psychiatrist and at the consent of an educated patient or guardian during pregnancy. However, due to the relatively little known effects of psychotropic drugs on neonatal outcomes cognitive-behavioral therapy should be considered by physicians as an alternative to addressing anxiety and depression during pregnancy.

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Anxiety: "Let's get to the root of the problem"

2008-07-15T08:32:00.002-05:00

PSTD is among a variety of anxiety problems that clinicians are seeking innovations in treatment for, especially in light of the Iraq War. Generalized anxiety disorder, phobias, panic disorder, and obsessive-compulsive disorder result from both our environments as well as genetics. Anxiety is so familiar to us, so integral to our survival; separating environmental influences from genetics to truly discover the underlying cause of anxiety is a difficult task.

Many of the drugs that are currently used, such as benzodiazepines and antidepressants, work to deal with the symptoms of anxiety rather than the origin. However, now scientists are looking for drugs that affect the mechanisms that cause anxiety. Currently researchers are experimenting with propranolol, which is a heart disease drug that disrupts the action of stress hormones like epinephrine, for example. The following is an excerpt of an interesting article from The New York Times that further discusses developments in anxiety research and treatment:

Researchers have been experimenting with a heart disease drug called propranolol, for instance, which interferes with the action of stress hormones like epinephrine. Stress hormones are central to the human response to threat; they prime the body to fight or run, and appear to deepen the neural roots of a terrifying memory in the brain. When the memory returns, these hormones flood again into the bloodstream.
But in one series of studies, people with P.T.S.D. who took propranolol reacted more calmly — on measures of heart rate and sweat gland activity — upon revisiting a painful memory than did similar subjects who took a dummy pill. By blocking receptors on brain cells that are sensitive to stress hormones, experts theorize, the drug may have taken the sting out of the frightening recollections.
Propranolol has not been proved to reliably ease the effects of trauma, but the investigation of such drugs is only beginning. Another candidate, an antibiotic called D-cycloserine, may help severely anxious patients alter the way they think about and react to current everyday concerns.

Click here to read the rest of this article from the New York Times

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Heavy drinking associated with different risks for men and women

2008-07-14T08:42:00.002-05:00

According to a recent study published in the Journal of the American Heart Association, heavy drinking (approximately four drinks a day) is associated with increased mortality in both men and women. The study, authored by Hiroyasu Iso, M.D., Ph.D., of Osaka University, and colleagues, found more specifically that men who drank four drinks a day were at elevated risk for stroke (HR 1.48, 95% CI 1.22 to 1.80), while women were not. Conversely, women who drank at least four drinks a day had a four-fold increase in risk for coronary heart disease; men that drank four drinks a day, however, had a nonsignificant 19% reduction in risk of dying from coronary heart disease. The following is an excerpt of an article from Medpage Today that reviews the study's findings:

Previous cohort studies have explored the connection between drinking alcohol and cardiovascular risk, but none have involved Asian women, "probably because of the low prevalence of drinkers and coronary heart disease," according to the researchers.

To explore the issue, they turned to the Japan Collaborative Cohort Study, in which 34,776 men and 48,906 women living in 45 communities completed a baseline questionnaire that included information about alcohol consumption. The participants (ages 40 to 79 at baseline) were then followed for a median of 14.2 years.

Compared with nondrinkers, both male and female moderate-to-heavy drinkers -- those who consume two or more drinks a day -- tended to be younger, more hypertensive, and more likely to smoke (P<0.001 for all).

During the study, 1,628 participants (864 men and 764 women) died from stroke and 736 (431 men and 305 women) died from coronary heart disease.

Among men, consuming at least four drinks a day was associated with increased mortality from total stroke (HR 1.48, 95% CI 1.22 to 1.80), and hemorrhagic (HR 1.67, 95% CI 1.17 to 2.38), intraparenchymal (HR 1.62, 95% CI 1.07 to 2.45), and ischemic (HR 1.35, 95% CI 1.04 to 1.75) subtypes.

This level of alcohol consumption appeared to be associated with protection against coronary heart disease, but the risk reduction was not statistically significant (HR 0.81, 95% CI 0.61 to 1.08).

Men who drank 69 grams of alcohol -- about six drinks -- a day or more were at an elevated risk of total stroke (HR 1.71, 95% CI 1.31 to 2.24) and total cardiovascular disease (HR 1.28, 95% CI 1.07 to 1.55).

Click here to read the rest of this article from Medpage Today

Click here for information on the treatment of alcoholism

Risks of Suicidal Ideation and Behavior with Epilepsy Drugs Reaffirmed

2008-07-11T08:31:00.001-05:00

The FDA released the results of an analysis of 11 anticonvulsant drugs used primarily for seizures and certain psychiatric conditions in January, which found double the risk of suicidality associated with the drugs. Accordingly, the FDA voted that risks be described in a medication guide that patients taking the drugs would be provided. The FDA has yet to issue a black box warning due to concerns that such a warning would prevent physicians from prescribing such drugs to those that need them. However, Russell Katz, M.D., director of neurology products for the FDA's Center for Drug Evaluation and Research, said that the FDA may still issue a black box warning. The following is an excerpt of an article from Medpage Today that discusses the FDA's findings:

The drugs evaluated were carbamazepine (Carbatrol, Equetro, Tegretol, Tegretol XR), felbamate (Felbatol), gabapentin (Neurontin), lamotrigine (Lamictal), levetiracetam (Keppra), oxcarbazepine (Trileptal), pregabalin (Lyrica), tiagabine (Gabitril), topiramate (Topamax), divalproex sodium (Depakote), and zonisamide (Zonegran).

A meta-analysis of 199 placebo-controlled trials consisting of 27,863 patients on active treatment and 16,029 on placebo found that 0.37% of those receiving one of the 11 drugs and 0.22% of those taking placebo had suicidal ideation or behavior (OR 1.80, 95% CI 1.24 to 2.66).

For three of the drugs, there was no increased risk for suicidality -- carbamazepine (OR 0.66), felbamate (OR not defined), divalproex (OR 0.91). The elevated risk only reached nominal significance for two of the other eight.

Dr. Katz explained why the agency and the committees concluded that the warnings should be applied to all epilepsy drugs.

The committee members "felt that the signal occurred across a whole range of drugs with different mechanisms of action," he said, "so it's perfectly reasonable to conclude that the other drugs that weren't studied were likely to show the same signal."

Click here to read the rest of this article from Medpage Today

Pregnancy is not associated with increased risk for many mental health disorders

2008-07-09T08:50:00.003-05:00

According to a recent study published in the July issue of the Archives of General Psychiatry, although pregnancy does increase the risk for depression it is not associated with increased risk for most mental health disorders. The authors explained, "Pregnancy per se is not associated with increased risk of the most prevalent mental disorders, although the risk of major depressive disorder may be increased during the postpartum period." According to Bridget F. Grant, Ph.D., of the National Institute on Alcohol Abuse and Alcoholism, women who had been pregnant or postpartum showed no increased risk of alcohol or substance abuse either. Of concern, however, was the fact that statistics reflecting treatment for psychiatric disorders among pregnant women were markedly lower in the previous year (10.5%) compared to those that were not pregnant (16.5%). Commenting about this finding the researchers said, "Low rates of maternal mental healthcare underscore the need to improve recognition and delivery of treatment for mental disorders occurring during pregnancy and the postpartum period." The following is an excerpt of an article from Medpage Today that discusses the study:

Pregnancy and the postpartum period have been considered times of heightened risk for mental disorders. However, knowledge about psychiatric problems during pregnancy has come primarily from clinical series with no nonpregnant control group, the authors noted.

To address the data limitations, investigators examined responses to the 2001-2002 National Epidemiologic Survey on Alcohol and Related Conditions. Of the 43,000 participants in the survey, 14,549 were women ages 18 to 50 with known pregnancy status for the previous year (including 1,524 pregnant and 994 postpartum).

Women reporting past-year pregnancy had a 12-month prevalence of any psychiatric disorder of 25.3% versus 30.1% in nonpregnant women (OR 0.75, 95% CI 0.62 to 0.90). Past-year pregnancy also was associated with a significantly lower prevalence of any substance-use disorder, including alcohol and nicotine dependence (14.6% versus 19.9% for nonpregnant women, OR 0.56, 95% CI 0.44 to 0.71).

Younger age, not being married, exposure to traumatic or stressful life events in the past 12months, pregnancy complications, and overall poor health increase the risk of mental disorders in past-year pregnant women.

Psychiatric treatment rates among pregnant women with psychiatric disorders are low.

Click here to read the rest of this article from Medpage Today

Click here for information on the treatment of depression

Pastoral Action Point: When individuals do not understand the heightened risk for depression during or after pregnancy they may blame themselves or feel that their faith is failing in the event that they experience postpartum depression. Pastors and other church professionals are in a unique position to reach out to forming families. As such, providing information about the physiological changes during pregnancy may be appropriate for your church or for a family ministry within your church.

Electromagnetic treatments to replace electroconvulsive therapy?

2008-07-08T08:37:00.001-05:00

Most individuals are responsive to traditional treatments for clinical depression, which include talk therapy and medications. However, there are still an estimated 15 to 20 percent of individuals suffering depression that do not experience successful outcomes with traditional measures. Previously, many of these patients have turned to electroconvulsive therapy (ECT), which has a 60 to 70 percent response rate; however, due to the adverse side effects of ECT and the emergence of research targeting a variety of electromagnetic treatments, ECT may soon be a relic of the past.

There are many different forms of electromagnetic treatment that are currently being researched. One of these treatments is FDA approved; it is referred to as vagus nerve stimulation. Originally used to treat epilepsy, clinicians noticed that vagus nerve stimulation improved mood. According to A. John Rush, M.D., of the University of Texas Southwestern Medical Center in Dallas, pulses that are sent to the vagus nerve "…go to specific areas in the central nervous system that control mood, motivation, sleep, appetite, and other symptoms that are relevant to depression." This is one of many developing electromagnetic treatments for depression which show promise. The following is an excerpt of an article from Medpage Today that discusses these varying treatments:

There's a new wave of research into targeted electromagnetic treatments for resistant depression, all aiming to relegate traditional electroconvulsive therapy (ECT) to obsolescence.

An estimated 15% to 20% of depressed patients don't respond to drug or talk therapies, sending many into the realm of ECT. Although 60% to 70% of patients respond to ECT, its baggage includes frequent adverse side effects and a bad PR problem.

Now, a variety of alternative approaches that apply electrical currents to the brain are in the research pipeline, and one is FDA approved. They include:

* Vagus nerve stimulation
* Magnetic seizure therapy
* Repetitive transcranial magnetic stimulation
* Deep brain stimulation
* Transcranial direct current stimulation
* Implantable cortical stimulation

Click here to read the rest of this article from Medpage Today

Click here for information on the treatment of depression

Obedience studies revisited

2008-07-07T08:44:00.000-05:00

The obedience studies of Stanley Milgram have long been the topic of discussion among psychologists, perhaps even more today in light of the events at Abu Ghraib prison. For those of you that need reminding the obedience studies, which were conducted in the early 1960's, tested the behavior of hundred's of average individuals when being asked to deliver a shock that they believed to be real and increasingly painful to test subjects as a part of what they thought was a “learning experiment.” A couple of new studies, one which will be published in the July issue of the journal Perspectives of Psychological Science and the other which is scheduled to be released soon, bring out more detail on the concepts underlying the obedience studies. The following is an excerpt of an article from the New York Times that discusses these studies:

In one, a statistical analysis to appear in the July issue of the journal Perspectives on Psychological Science, a postdoctoral student at Ohio State University verifies a crucial turning point in Milgram’s experiments, the voltage level at which participants were most likely to disobey the experimenter and quit delivering shocks.

The participants usually began with what they thought were 15-volt shocks, and worked upward in 15-volt increments, as the experimenter instructed. At 75 volts, the “learner” in the next room began grunting in apparent pain. At 150 volts he cried out: “Stop, let me out! I don’t want to do this anymore.”

At that point about a third of the participants refused to continue, found Dominic Packer, author of the new paper. “The previous expressions of pain were insufficient,” Dr. Packer said. But at 150 volts, he continued, those who disobeyed decided that the learner’s right to stop trumped the experimenter’s right to continue. Before the end of the experiments, at 450 volts, an additional 10 to 15 percent had dropped out.

Click here to read the rest of this article from the New York Times

More than half of firearm deaths are suicides

2008-07-03T08:32:00.003-05:00

Statistics generated in 2005 (the most recent year for which statistics are available surrounding firearms deaths) reveal that deaths accounted for by firearms are largely suicides. Specifically, out of the nation's 31,000 firearm deaths in 2005, 55 percent were accounted for by suicide. Homicide accounted for 40 percent of gun deaths in 2005, accidents 3 percent, and legal killings (police shootings) 2 percent.

A great deal of controversy surrounds these numbers. One study found that families which experience suicide are three to five times more likely to have a gun in the house. Justice Stephen Breyer commenting said, "If a resident has a handgun in the home that he can use for self-defense, then he has a handgun in the home that he can use to commit suicide or engage in acts of domestic violence." However, many still contend that individuals who wish to commit suicide will find other means. The Supreme Court had its say about this issue this past week in a 5 to 4 ruling that overthrew a handgun ban enacted in the District of Columbia in 1976, focusing on the citizen's ability to defend from home intruders. The following is an excerpt of an article from CNN.com that discusses the issue:

Studies have also shown that homes in which a suicide occurred were three to five times more likely to have a gun present than households that did not experience a suicide, even after accounting for other risk factors.

In a 5-4 decision, the high court on Thursday struck down a handgun ban enacted in the District of Columbia in 1976 and rejected requirements that firearms have trigger locks or be kept disassembled. The ruling left intact the district's licensing restrictions for gun owners.

One public-health study found that suicide and homicide rates in the district dropped after the ban was adopted. The district has allowed shotguns and rifles to be kept in homes if they are registered, kept unloaded and taken apart or equipped with trigger locks.

The American Public Health Association, the American Association of Suicidology and two other groups filed a legal brief supporting the district's ban. The brief challenged arguments that if a gun is not available, suicidal people will just kill themselves using other means.

Click here to read the rest of this article from CNN.com

Click here for information on the treatment of clinical depression

Psychological distress during treatment and anxiety over possible recurrence in cancer patients

2008-07-01T08:36:00.000-05:00

In the online version of the journal Urologic Oncology, findings from a longitudinal study focusing on depression and anxiety in patients with cancer were reported late this June. The study measured psychological distress during treatment and anxiety over possible recurrence in cancer patients. The study collected data on individuals treated at a University Hospital in Germany from 2002 to 2004, which were treated for prostate and other urogenital cancers. Findings revealed that patient anxiety was highest in all patients during the beginning of the patient’s stay in the hospital; however, results measured six months and one year after the stay revealed no significant anxiety related to possible recurrence. Patient anxiety was the highest in cancer patients who received chemotherapy or radiotherapy. Additionally, patient anxiety was comparatively high among young patients. The following is an excerpt of an article from Medical News Today that discusses the particulars of the study:

Sample size was not large enough for separate analyses for each cancer diagnosis. Values were highest at T1, with only minor changes between T2 and T4. Two significant results were identified; depression at T3 and depression at T4 with lower scores for prostate cancer patients. Anxiety at T1 was significantly higher than the mean value of the general population. Compared with cardiac patients, there were significantly higher values for cardiac patients at T2 to T4. Prostate cancer patients had significantly lower depression scores than the control groups for T2-T4. HADS scores >15 occurred in 28% of prostate cancer patients, 39% of other urogenital cancer patients, 24% of the general public and 35% of cardiac patients. Anxiety was more pronounced among young patients, and patients treated with radiotherapy or chemotherapy suffered from higher levels of depression at T1 compared to surgical patients.

Click here to read the rest of this article from Medical News Today

Click here for information on the treatment of clinical depression and anxiety

Substance Abuse Treatment in Pregnancy Reduces Complications

2008-06-30T08:42:00.001-05:00

A recent study has revealed that mother's who were treated successfully for substance abuse problems during routine obstetric visits almost entirely removed related risks posed to their child. According to the study the risks for preterm labor, stillbirth, and placental abruption were the same for both women who were successfully treated for substance abuse and for those that did not have substance abuse problems. Their children were still at risk for low birth weight; however, all other risks were drastically reduced after receiving treatment. Screening for substance abuse problems at routine obstetric appointments should be the gold standard, researchers explained. The following is an excerpt of an article from Medpage Today that reviews the findings:

These findings from a large observational study of women insured through Kaiser Permanente Northern California suggest that integration of substance abuse treatment into obstetric care should be the gold standard, the researchers said.

Before Kaiser Permanente started this program, women with substance abuse problems were counseled to stop and referred to outside programs but generally didn't keep those appointments, the researchers noted.

Having someone in the clinic who specializes in both pregnancy and substance abuse treatment "affords women easy access to the program by removing both the physical and emotional barriers that can be overwhelming during pregnancy," they wrote.

The American College of Obstetricians and Gynecologists recommends universal screening for substance abuse in pregnancy with a brief intervention and referral to treatment within the department for those who test positive.

At the 21 Kaiser Permanente obstetric clinics included in the study, all women were screened for drugs and alcohol with a questionnaire at the first prenatal visit along with urine toxicology testing for those who consented.

Click here to read the rest of this article from Medpage Today

Click here for information on the treatment of chemical dependency

The Pipeline: One Soldier’s Trip Through the Military’s Medical Megaride

2008-06-27T08:38:00.000-05:00

This past Thursday area ministers, chaplains and other church professionals gathered to hear area author and former Brookhaven case manager Michael Mason present about systems of care for those who suffer traumatic brain injury through engagement in the Iraq war. The presentation, which Michael entitled “The Pipeline: One Soldier’s Trip Through the Military’s Medical Megaride,” gave participates a heart wrenching look into the lives of individuals injured in the Iraq war, which was intended to bring attention to issues surrounding the quality of systems of care for brain injured individuals both stateside and in Iraq’s national health care system. The seminar proved to be a success as Michael received numerous requests to bring his talk to venues at area churches.

Click here to view our sister site’s podcast archive wherein I interview Mike about his new book “Headcases: Stories of Brain Injury and Its Aftermath”

Discrimination: Mental health and chemical dependency overlooked in health care reforms

2008-06-25T12:40:00.000-05:00

New data suggests that approximately one in four adult Americans that do not have health insurance have a mental illness, chemical dependency problem, or both. Although there are a variety of state funded health care initiatives that intend to aid individuals without private insurance many states are neglecting to cover mental health and chemical dependency problems. “Many states are trying to cover the uninsured but need to do more in these critical areas that affect one in four Americans,” said National Alliance on Mental Illness executive director Michael J. Fitzpatrick.

Mental illness and chemical dependency should not take the back seat to other health conditions; the fact is that mental illness is the leading cause of disability among adults and substance use the second. Commenting about the situation, Linda Rosenberg, President and CEO of the National Council for Community Behavioral Healthcare, said, "It is distressing that there are insurance plans and health care reform initiatives that continue to discriminate.” The following are some major findings of the report from http://healthcareforuninsured.org:

1. People with mental illness, substance use disorders, or both are prevalent among the uninsured. More than one in four adult Americans who lack insurance coverage have a mental illness, substance use disorder, or co-occurring disorder.
2. The scope of the benefit package for mental illness and substance use treatment varies greatly. Some state programs provide a variety of services designed to promote recovery from these disorders. Two state programs provide no coverage for either mental illness or substance use disorders.
3. Approximately 60 percent of the states evaluated had at least equal coverage for serious mental illness or mental illness compared with other health conditions in at least one of their programs for the uninsured.
4. Substance use disorders fare worse than mental illness in many state programs. Roughly 28 percent of the states evaluated have an equal benefit for substance use and other health conditions in at least one of their programs.

Click here to read the rest of the report's major findings from http://healthcareforuninsured.org/

Schizophrenia: Findings from recent studies

2008-06-24T21:17:00.000-05:00

In some ways diagnosis and treatment of schizophrenia has traditionally been approached categorically and without much creativity. However, findings from recent studies have created new resolve in psychiatric researchers to look for answers about schizophrenia that are "out side of the box." Several recent studies have indicated that schizophrenia is not just a singular problem with a standardized solution but rather a disease that encompasses a variety of mental health disorders that should be treated individualistically. One such study indicated that genetic mutations, which some have assumed would have been similar in nature among those with schizophrenia, are in fact unique, varying greatly from patient to patient. Findings from studies such as this one are causing a shift in thinking about schizophrenia and are already changing treatment plans to address the disorder. The following is an interesting article from the New York Times which discusses some new thinking about schizophrenia:

Yet there’s a restless energy among psychiatric researchers now, and it’s in part because of several recent studies that, paradoxically, reveal how insufficient current theories about schizophrenia are. Schizophrenia is not a single problem with a uniform solution, these results suggest. Rather, the disease most likely comprises a variety of related mental disorders, with an underlying biology and symptoms that can differ from person to person.

That shift in thinking has already led to expanded treatment options for some patients, and it is likely to guide research on the disorder for years to come.

Perhaps the most striking demonstration of how biologically diverse schizophrenia may be came in a gene study published in March. An analysis of blood samples revealed that rare and previously undetectable genetic mutations were strongly associated with the development of the disorder.

Click here to read the rest of this article from the New York Times

Connection between type 2 diabetes and depression

2008-06-18T08:08:00.002-05:00

A recent study published in the Journal of the American Medical Association found a connection between type 2 diabetes and depression. The connection, according to Sherita Hill Golden, M.D., of John's Hopkins, was found to be a “bidirectional association;” those that had diabetes were likely to develop depression and those that had depression were at risk of developing diabetes. The researchers believe that "... psychological stress associated with diabetes management may lead to elevated depressive symptoms." Conversely, lifestyle choices associated with depression may account for increased risk of the development of diabetes. The following is an excerpt of an article from Medpage Today that reviews findings from the study:

At the same time, the investigators found a nonsignificant trend for depressed patients to develop type 2 diabetes, primarily because of lifestyle changes engendered by depression.

They concluded that the studies support a "bidirectional association" between depression and type 2 diabetes, in which each contributes to or exacerbates the other.

Patients with type 2 diabetes had an odds ratio of 1.54 (95% CI 1.13 to 2.09) of developing depressive symptoms during three to four years of follow-up, compared with participants with normal glucose, the researchers found.

Click here to read the rest of this article from Medpage Today

Click here for information on the treatment of depression

Severe sleep disturbance in returning vets

2008-06-17T08:45:00.001-05:00

Preliminary findings from a study focusing on the sleep disturbances of vets returning from the middle east conflict have yielded some intriguing results. According to Anne Germain, Ph.D., of the University of Pittsburg, returning vets can have sleep disturbance just as severe as persons with insomnia. Vets who served in combat and are having difficulty with adjustment upon returning home “do not get good sleep like good sleepers,” said Dr. Germain. During her talk at the Professional Sleep Societies meeting Dr. Germain presented both subjective patient reports of sleep disturbance and objective findings from measures used in the study. The current findings are a part of a study that intends to gather data from 90 participants by the time of its close. The following is an excerpt of an article from Medpage today that discusses the findings:

In the sleep lab, Dr. Germain said, she tested 11 medication-free veterans, of whom nine met full criteria for current moderate-to-severe posttraumatic stress disorder (PTSD).

She also tested 11 medication-free and healthy volunteers who were good sleepers, using Cohen's d-values to assess group differences with small, medium, and large effect sizes indicated by d-values of 0.20, 0.50, and 0.80, respectively.

* Had lower sleep efficiency (d=0.81), related to moderate increases in sleep latency (d=0.35), duration and number of nocturnal awakenings (d=0.49 and d=0.62, respectively), and reduced total sleep time (d=0.34).
Sleep efficiency was significantly and negatively correlated with PTSD severity, at P<0.001.

Click here to read the rest of this article from Medpage Today

Click here for information on the treatment of PTSD

Pastoral Action Point: Adjustment is a major issue for most combat vets returning from war. One of the things that can help bring normal life back into perspective for returning vets is community. Obviously, church is a wonderful place to find compassionate, supportive community. As such, it is important to embrace returning vets, welcoming them back, letting them know that the church community embraces them. Perhaps a house visit, some home baked goods, or simply a phone call would be appropriate to reestablish connection with these heroes.

Sleepy Cell Phone Users

2008-06-13T16:35:00.001-05:00

Could cell phone usage contribute to poor sleep? Findings from a small pilot study suggest that it does. According to Gaby Badre. M.D., Ph.D., of the University in Gothenberg Sweden, healthy young adults and teens who make more than 15 calls a day are more likely to have poor sleep compared to those who use cell phones less often. In his presentation at the meeting of the Associated Professional Sleep Societies, Dr. Badre said that heavy cell phone users in the study had more difficulty sleeping, waking up, and generally felt more tired during the day. However, Dr. Badre and colleagues found no differences in depression or anxiety among the participants using the Beck Youth Scale. The following is an excerpt of an article from Medpage Today that reviews the study:

Dr. Badre said that as a sleep specialist whose patients include young people working in London's financial district, he has seen many heavy cell phone users who suffered from anxiety and whose sleep was disrupted.

To study the issue, he and colleagues enrolled 21 healthy volunteers, ages 14 through 20 and divided them into two groups according to cell phone use. The 11 in the experimental group used the phone a minimum of 15 times a day, although four reached more than 30 and one young woman continually hit 200 calls or messages a day, he said.

Click here to read the rest of this study from Medpage Today

Too much alcohol is bad for the heart

2008-06-11T08:11:00.003-05:00

There are many studies that relay the heart health benefits of moderate consumption of red wine; however, consuming large amounts of alcohol could actually be bad for your heart. According to findings presented at a recent American Society of Hypertension meeting, too much alcohol is bad for the heart. Azra Mahmud, M.D., Ph.D. of St. James Hospital in Dublin, explained that the effects of too much drinking are different based on gender. Men who have on average more than three stout drinks per day are likely to suffer from stiff ventricles and arteries. Women, on the other hand, who consume more than two stout drinks per day are likely to develop large hearts. The following is an excerpt of an article from Medpage Today that reviews the findings:

Dr. Mahmud and colleagues studied 200 consecutive patients seen at her hypertension clinic for initial assessment of elevated blood pressure. On the basis of self reports, patients were classified as nondrinkers, moderate drinkers (one to 21 units of alcohol per week for men and one to 14 for women), or excessive drinkers (more than 21 units for men and more than 14 for women).

Approximately 10% of the women in the study and 35% of the men were excessive drinkers and about 20% of men and women were nondrinkers, she said.

The patients were assessed with echocardiography with tissue Doppler imaging, and arterial stiffness was measured with pulse-wave velocity and augmentation index.

Blood pressure was measured with a digital oscillometric monitor after a supine rest of 15 minutes and also by 24-hour ambulatory blood pressure monitoring.

Click here to read the rest of this article from Medpage Today

"A little hard work never hurt anyone..."

2008-06-09T16:32:00.002-05:00

Work is sometimes labeled as being stressful or depressing; however, a recent study published in the journal Occupational Medicine found that returning to work can help in the recovery of depressed patients. The study examined the lives of 500 individuals with depression from a variety of industries that were unable to work over a year's time. In this population, returning to work was found to be a significant factor in recovery from depression. One vital dynamic was the flexibility and attentiveness of employers during the recovery process. The following is an excerpt of an article from Medical News Today that reviews the study:

The study echoes the findings of Dame Carol Black's Review 'Working for a healthier tomorrow' which recognized that for most people work is good both for their long-term health and for their family's well-being. The review found that ill health was costing the country £100 billion a year - £40 billion of which was related to mental health.

"Better access to occupational health services and psychological support are essential if employees with depression and anxiety are to get back to work quickly" said Dr Gordon Parker, President of the Society of Occupational Medicine. "'Employers are often frightened of contacting an employee whose sick note says 'depression' for fear of being accused of harassment, but sympathetic contact with the employee and early help through occupational health can identify the most appropriate support. Occupational health services are ideally placed to advise managers and employees on the best return to work plan and should be involved early in the management of the employee's absence."

Click here to read the rest of this article from Medical News Today

Exposure Therapy Tops Cognitive Restructuring in Preventing PTSD

2008-06-06T08:41:00.005-05:00

A recent study published in the June issue of the Archives of General Psychiatry found that prolonged-exposure therapy is more successful in treating individuals who have suffered a traumatic event than cognitive restructuring. According to the study, six months after the traumatic event only 37% of patients who received prolonged-exposure therapy developed PTSD. Conversely, 63% of those that were treated with cognitive restructuring developed PTSD. This is the first study that has compared the two types of therapies. Prolonged-exposure therapy helps the individual to confront the traumatic event and as such some feel that it elicits a certain amount of distress. However, Dr. Richard A. Bryant and colleagues conducting the study said, "Despite some concerns that patients may not be able to manage the distress elicited by [prolonged-exposure therapy], there was no difference in dropout rates." The following is an excerpt of a article from Medpage Today that reviews the study:

In prolonged-exposure therapy, patients are encouraged to relive the traumatic event over and over. They may describe it verbally in detail in sessions with a therapist and do daily homework assignments that force patients to go over the event in their minds.

Dr. Bryant and colleagues said many clinicians have resisted using exposure therapy because they worry the distress it creates may drive patients away from therapy altogether.

Cognitive restructuring involves identifying unhealthy thoughts and emotional responses to the trauma and tries to modify them by having patients apply rational analysis. The unhealthy thoughts typically revolve around guilt about behavior during the trauma and excessive worry about future harm and their reactions to the stress.

The researchers recruited 90 patients who had been involved in motor vehicle accidents or non-sexual assaults and who met criteria for acute stress disorder -- 30 patients were assigned to prolonged-exposure therapy, 30 to cognitive restructuring, and 30 were assigned to a wait list. Patients on the wait list were reassessed six weeks later and then offered unspecified active treatment.

Click here to read the rest of this article from Medpage Today

Click here for information on the treatment of PTSD

"Significantly smaller"

2008-06-05T08:20:00.002-05:00

According to a new study some regions of the brain may actually shrink with heavy long-term marijuana use. Mural Yücel, Ph.D., of the University of Melbourne, and colleagues, used magnetic resonance imaging to measure various regions of the brain in the participants. According to the cross-sectional study, the hippocampus and the amygdala were found to be "significantly smaller" in heavy long-term users. These regions of the brain are abundant in cannabiniod receptors, which would likely be affected if heavy long-term use of marijuana were toxic. According to the researchers, "the results… suggest that heavy daily use might indeed be toxic to human brain tissue." The following is an excerpt of an article from Medpage Today that reviews the study:

While other studies have looked at changes in the brain associated with use of marijuana, they have not been found before, perhaps because instruments were not sensitive enough or the use of marijuana wasn't heavy enough, the researchers said.

For this study, the researchers enrolled 15 men who had smoked more than five joints a day for more than 10 years, but who did not have other co-morbid drug use or neurological or psychiatric illness.

On average, the men had used marijuana for nearly 20 years.

They were contrasted with 16 matched controls who did not use the drug.

The volunteers took tests for subthreshold psychiatric symptoms and verbal learning ability, as well as being scanned in a high-resolution, three-Tesla MRI machine.

Click here to read the rest of this article from Medpage Today

Click here for information on drug addiction

Pastoral Action Point: One of the myths among cannabis users is that marijuana is “all natural and therefore can’t hurt you.” Obviously, this information is false. However, the very fact that this kind of thinking exists relays the urgent need for education. The afore mentioned study is the first of its kind in that it found certain regions of the brain were “significantly smaller” after heavy long-term marijuana use. Given the illustrative quality of this study’s findings and the fact that the information it presents is original, incorporating it into anti-drug forums might help to change up the old one-two of cautionary accounts.

Energy drinks linked with risk taking

2008-06-03T08:12:00.002-05:00

A study recently published in The Journal of American College Health reported a link between risky behaviors and energy drinks. According to the study, authored by Kathleen Miller of the University of Buffalo, high levels of energy drink consumption are linked with what Miller calls "toxic jock" behavior, to include unprotected sex, violence, and substance abuse. The author clarified that toxic jock behavior is not a direct result of drinking energy beverages but rather that personalities that consume higher amounts of these types of drinks would also be likely to engage in risky behaviors. According to Dr. Miller, “It appears the kids who are heavily into drinking energy drinks are more likely to be the ones who are inclined toward taking risks." Sadly, approximately one third of 12 to 24 year olds self-report regular consumption of energy drinks. The following is an excerpt of an article from the New York Times that discusses the issue:

The trend has been the source of growing concern among health researchers and school officials. Around the country, the drinks have been linked with reports of nausea, abnormal heart rhythms and emergency room visits.

In Colorado Springs, several high school students last year became ill after drinking Spike Shooter, a high caffeine drink, prompting the principal to ban the beverages. In March, four middle school students in Broward County, Fla., went to the emergency room with heart palpitations and sweating after drinking the energy beverage Redline. In Tigard, Ore., teachers this month sent parents e-mail alerting them that students who brought energy drinks to school were “literally drunk on a caffeine buzz or falling off a caffeine crash.”

Click here to read the rest of this article from the New York Times

Click here for information on substance abuse

Pastoral Action Point: It may well be worth the time to address the risks associated with energy drink consumption during youth gatherings. With energy drinks so readily available and consistently marketed many teenagers and young adults may not have any idea of the risky behaviors associated with personalities who consume higher amounts of the product. I for one was intrigued to find that so many reports of emergency room visits, abnormal heart rhythm, and nausea have been associated with energy drink abuse; I imagine that teenagers and young adults would also find this information to be interesting and useful.

Depression in stroke victims

2008-05-30T12:42:00.002-05:00

Depression often occurs after individuals suffer from a stroke. Approximately 37% of stroke victims deal with resulting depression. However, a recent study published in the Journal of the American Medical Association found that problem-solving therapy or escitalopram within one year of stroke reduces the risk of depression. The following is an excerpt of an article from Medpage Today that reviews the study:

To investigate methods of preventing post-stroke depression, they conducted a multi-site randomized controlled trial among 176 nondepressed patients (mean age 62) within three months of an acute stroke (ischemic or hemorrhagic). Patients were enrolled from July 9, 2003, to Oct. 1, 2007.

The 12-month trial included three groups: a double-blind placebo-controlled comparison of escitalopram (n=59) with placebo (n=58) and a nonblinded problem-solving therapy group (n=59).

Escitalopram, a selective serotonin reuptake inhibitor similar to citalopram (Celexa), was chosen, the researchers said, because of empirical evidence that it might be more effective with a faster onset of action than citalopram and would be better tolerated over a 12-month period.

The drug was given at 10 mg/d in the morning for patients younger than 65 and five mg/day for those 65 or older.

,In the problem-solving therapy, patients selected a problem and then went through steps to arrive at a course of action. The intervention consisted of six treatment sessions over the first 12 weeks and six reinforcement sessions beginning at four months.

Click here to read the rest of this article from Medpage Today

Jordan Burnham: On a mission of hope

2008-05-27T08:28:00.003-05:00

A recent congressional briefing found Jordan Burnham co-presenting with Actor Joe Pantoliano, Actress Marcia Gay Harden, and Minnesota Rep. Jim Ramstad. The purpose of the Capital Hill presentation was to promote brain equality, that mental illness would be treated with no more stigma than cancer or diabetes, for example. Jordan relayed an amazing story of survival and hope during the meeting. For those of you that don’t know, after struggling with depression Jordan attempted suicide on Sept. 28, 2007 by jumping from his parent's ninth floor apartment. In the aftermath of this event, Jordan has joined the ranks of those trying to end the stigma associated with mental illness. During his presentation at the congressional gathering, Jordan asserted that young people need to "replace their feelings... of embarrassment, shame and defeat" with feelings of acceptance. He went on to explain that young people need to be able to come out and discuss suicidal feelings without stigma or feelings of societal shame.

Actor Joe Pantoliano, who after struggling with depression for years founded the non-profit "No Kidding, Me Too!,” whose aim is to eliminate stigma surrounding mental illness, spoke of Jordan Burnham saying, "He's got an incredible story… I don't think kids want to hear from old people. He's representative of this message for his generation." After his presentation, Jordan was invited by the heads of various national mental health organizations to speak. The director of the federal Center for Mental Health Services, Kathryn Power, said that Jordan is an articulate speaker and that she would be in touch. "I think this is his calling," Jordan’s mother commented.

Click here to view a video from CBS that discusses Jordan’s efforts

Lack of Motivation in Psychosis

2008-05-23T11:05:00.000-05:00

According to a recent small study published in BMC Psychiatry, deficits in motivation may not be accounted for entirely by institutionalization or long-term treatment in patients with schizophrenia and other forms of psychosis. According to Graham Murray, M.D., Ph.D., these deficits are present at the first episode of psychosis. Dr. Murray's team measured "reinforcement-related speeding," response time in relationship to the chance for reward, in patients with a first episode of psychosis; only four out of eighteen of these patients improved their response time to increase their chances for reward. Conversely, 17 out of 19 from a control group improved their response time to gain reward. The researchers believe that abnormalities in the brain's reward center account for motivation deficits in psychosis. According to Dr. Murray, "Patients with psychosis already have motivational deficits the first time they present to health services… understanding the brain basis of these problems will ultimately help in developing new treatments." The following is an excerpt of an article from Medpage Today that reviews the study:

It has been proposed that there are abnormalities in the brain's reward system and in the processing of incentive motivation in psychosis, and that dopamine dysfunction may be responsible, but this has not been well evaluated clinically, the researchers said.

So the investigators recruited 18 patients (mean age 23, nine males) who had symptoms of psychosis for the first time and 19 healthy controls (mean age 25, nine males) to complete the Cued Reinforcement Reaction Time Task, which measures motivationally driven behavior.

Eleven of the 18 psychosis patients were taking atypical antipsychotics, including olanzapine (Zyprexa) (three), risperidone (Risperdal) (two), quetiapine (Seroquel) (two), clozapine (Clozaril) (one), aripiprazole (Abilify) (two), and amisulpride (one).

A year after the evaluation, nine patients were diagnosed by a psychiatrist with schizophrenia, two with schizoaffective disorder, five with bipolar disorder, one with delusional disorder, and one with a psychosis not otherwise specified.

On the task, all participants were asked to choose which of a simple set of three shapes did not belong in 96 trials, with varying likelihood of reward indicated by three different colors as the test progressed. Previous studies in healthy participants have shown increased reaction times associated with a higher likelihood of reward, the researchers said.

Click here to read the rest of this article from Medpage Today