Two new studies, presented at the 2012 Annual Meeting of the American Academy of Orthopaedic Surgeons (AAOS), suggest understanding an individual’s mental health status is an important factor for achieving the best outcome after surgery.

The knowledge is meaningful for obtaining improved clinical and generic (patient-satisfaction) outcomes — two measures that will influence future reimbursement schedules for surgeons.

One paper, derived from a study of 97 men and women who received minimally invasive total knee replacement (TKR) surgery, suggested men with anxiety traits — defined as a high level of anxiety unrelated to a stressful event — had higher post-operative pain ratings resulting in longer hospital stays. Women were found to generally report higher post-operative pain levels than men, and women were consistently less satisfied with pain control.

However, researchers found that some old presumptions did not hold up to the new findings. Specifically, postoperative pain or pain medication use in either men or women was not linked to reports of anxiety or even “catastrophizing” (an extreme response to stress).

In the next paper, reporting on a study of 1,657 patients receiving hip replacement surgery, researchers discovered patients taking antidepressants up to three years prior to undergoing a total hip replacement (THR) were more likely to report greater pain before and after surgery and less satisfaction with their procedure.

Approximately 215 patients were using antidepressants three years before the surgery.

In this study, patients were surveyed before and one year after the THR. The investigators found that a patient’s mental health status, assessed by the use of antidepressants before surgery, was a significant factor in predicting outcomes, as well as gender (men are more likely to report lower outcomes), advanced age and co-morbidity (other joint diseases or conditions which affect walking).

In summary, researchers believe a patient’s mental health status should be assessed prior to surgery and taken into consideration during post-operative care.

Source: American Academy of Orthopaedic Surgeons

Knee in brace photo by shutterstock.

Penn State investigators determined people who are more physically active report greater levels of excitement and enthusiasm than people who are less physically active.

Researchers determined people also are more likely to report feelings of excitement and enthusiasm on days when they are more physically active than usual.

This discovery conceptually dates back to ancient times when the Greeks believed physical and mental well-being were inseparable.

“You don’t have to be the fittest person who is exercising every day to receive the feel-good benefits of exercise,” said David Conroy, Ph.D., professor of kinesiology.

“It’s a matter of taking it one day at a time, of trying to get your activity in, and then there’s this feel-good reward afterwards.”

Conroy believes a common fault is the focus on long-term rather than short-term exercise goals.

“When people set New Year’s resolutions, they set them up to include the entire upcoming year, but that can be really overwhelming,” he said.

“Taking it one day at a time and savoring that feel-good effect at the end of the day might be one step to break it down and get those daily rewards for activity. Doing this could help people be a little more encouraged to stay active and keep up the program they started.”

In the study, researchers asked 190 university students to keep daily diaries of their lived experiences, including free-time physical activity and sleep quantity and quality, as well as their mental states, including perceived stress and feeling states.

Participants were instructed to record only those episodes of physical activity that occurred for at least 15 minutes and to note whether the physical activity was mild, moderate or vigorous. Participants returned their diaries to the researchers at the end of each day for a total of eight days.

Investigators then separated the participants’ feeling states into four categories: pleasant-activated feelings exemplified by excitement and enthusiasm, pleasant-deactivated feelings exemplified by satisfaction and relaxation, unpleasant-activated feelings exemplified by anxiety and anger, and unpleasant-deactivated feelings exemplified by depression and sadness.

“We found that people who are more physically active have more pleasant-activated feelings than people who are less active, and we also found that people have more pleasant-activated feelings on days when they are more physically active than usual,” said co-author and doctoral student Amanda Hyde, who noted that the team was able to rule out alternative explanations for the pleasant-activated feelings, such as quality of sleep.

“Our results suggest that not only are there chronic benefits of physical activity, but there are discrete benefits as well. Doing more exercise than you typically do can give you a burst of pleasant-activated feelings. So today, if you want a boost, go do some moderate-to-vigorous intensity exercise.”

The researchers say that this is one of the first studies to acknowledge a benefit of physical activity is activation of positive feelings and energy.

“Knowing that moderate and vigorous physical activity generates a pleasant-activated feeling, rather than just a pleasant feeling, might help to explain why physical activity is so much more effective for treating depression rather than anxiety,” Conroy said.

“People dealing with anxious symptoms don’t need an increase in activation. If anything, they might want to bring it down some. In the future, we plan to look more closely at the effects of physical activity on mental health symptoms.”

The results of the study may be found in the current issue of the Journal of Sport & Exercise Psychology.

Source: Penn State

Young man running photo by shutterstock.

Investigators discovered short-term stimulant treatment did not substantially increase the risk of cardiovascular events or symptoms in healthy youth.

ADHD affects 5-9 percent of youth and is frequently treated with stimulant medications, such as methylphenidate and amphetamine products. A recent safety communication from the US Food and Drug Administration advised that all patients undergoing ADHD treatment be monitored for changes in heart rate or blood pressure.

In the study, Dr. Mark Olfson and his colleagues assessed the risk of adverse cardiovascular events in children and adolescents without known heart conditions treated with stimulants for attention deficit hyperactivity disorder.

The investigation is one of the largest studies to date that focused primarily on youth while controlling for pre-existing cardiovascular risk factors.

As reported in the study, Olfson and colleagues examined claims records from a large privately insured population for associations between cardiovascular events in youth with ADHD and stimulant treatment.

In total 171,126 privately insured youth aged 6-21 years without known pre-existing heart-related risk factors were followed throughout the study.

Researchers included patients who have previously received stimulant treatment, patients currently receiving stimulant treatment, and patients who began or ceased stimulant treatments during the study period.

Olfson and colleagues assessed the various groups for incidents of severe cardiovascular events such as acute myocardial infarction, less severe cardiovascular events such as cardiac dysrhythmias, and cardiovascular symptoms such as tachycardia and palpitations.

Analysis showed that cardiovascular events and symptoms were rare in this cohort and not associated with stimulant use.

This finding helps to allay concerns of adverse events in otherwise healthy young people receiving treatment for ADHD. Olfson and colleagues said of the results, “It is reassuring that in these young people, short-term stimulant treatment did not substantially increase the risk of cardiovascular events or symptoms.”

The research is published in the Journal of the American Academy of Child and Adolescent Psychiatry.

Source: Elsevier

Child with pencil photo by shutterstock.

Researchers at the school’s Feinberg School of Medicine are working on a variety of web-based, mobile and virtual technologies to treat depression and other mood disorders.

Other projects include a virtual human therapist who will work with teens to prevent depression; a medicine bottle that reminds you to take antidepressant medication and tells your doctor if the dosage needs adjusting; and a web-based social network to help cancer survivors relieve sadness and stress.

“We’re inventing new ways technology can help people with mental health problems,” said psychologist Dr. David Mohr, director of the new Center for Behavioral Intervention Technologies and a professor of preventive medicine at Northwestern’s Feinberg School.

“The potential to reduce or even prevent depression is enormous.”

The new approaches could offer new treatment options to people who are unable to access traditional services or are uncomfortable with standard therapy, he added. “They also can be offered at significantly lower costs, which makes them more viable in an era of limited resources.”

Topping the list of projects is a smartphone that spots symptoms of depression by harnessing all the sensor data within the phone to interpret a person’s location, activity level (via an accelerometer), social context and mood. If the phone — which learns your usual patterns — senses you are isolated, it will send a suggestion to call or see friends. The technology, which still is being tweaked, is called Mobilyze! and has been tested in a small pilot study, researchers said, noting it helped reduce symptoms of depression.

“By prompting people to increase behaviors that are pleasurable or rewarding, we believe that Mobilyze! will improve mood,” Mohr said.

“It creates a positive feedback loop. Someone is encouraged to see friends, then enjoys himself and wants to do it again. Ruminating alone at home has the opposite effect and causes a downward spiral.”

The new medicine bottle now in development will track if you forgot your daily dose of antidepressant medication and remind you to take it.

“People whose depression is being treated by primary care doctors often don’t do very well, partly because patients don’t take their medications and partly because the doctors don’t follow up as frequently as they should to optimize the medication and dosage when necessary,” Mohr said. “This pill dispenser addresses both issues.”

The bottle is part of a MedLink system, which will include a mobile app that monitors the patient’s depressive symptoms and any medication side effects and will provide tailored advice to manage problems, he explained. The information is then sent to the physician or health care provider with a recommendation, such as a change in the dose or drug, if necessary. The MedLink system also will be used to improve medication adherence in patients with schizophrenia and HIV.

Also in the works is a virtual programmable human who will role-play with adolescents and adults to teach social and assertiveness skills to prevent and treat depression. A prototype is being developed with researchers from the University of Southern California.

“We think this will be especially helpful for kids, who often are reluctant to see a therapist,” Mohr said.

The program will allow them to practice these behaviors in the safety of virtual space, he said, noting that existing online interventions for teens “look like homework,” while the virtual human feels like a game.

The Northwestern lab will be evaluating a number of social interactions that are hard for teens and adults.

“Having trouble with those situations makes people more vulnerable to depression,” Mohr said. “When people have the confidence and skills to better manage difficult interpersonal interactions, they are less likely to become depressed.”

Previous research also has shown that intervening early in adolescents who have difficulty with social skills can help prevent the first onset of depression, researchers said.

Lastly, the researchers are working on web-based content to help cancer survivors manage stress and depression. They note this is more effective when a human coach checks in on their progress via a phone call or e-mail.

“People are more likely to stick with an online program if they know that someone they like or respect can see what they’re doing,” Mohr said.

His group is creating a social network and collaborative learning environment where peers can serve that function for each other.

“People can get feedback from the group, share goals and check in with members if someone has stayed offline for too long,” he said.

Source: Northwestern University

Teenager on phone photo by shutterstock.

Since the mid-1950s, millions of children and adults have been prescribed stimulant medications to control attention deficit hyperactivity disorder (ADHD). But since the first experiment that gave an amphetamine drug to children diagnosed with behavioral problems, scientists have not known how stimulants work to control hyperactivity.

New research has identified a possible mechanism by which certain stimulants accomplish this paradoxical reduction of motor activity.

David Erlij, M.D., Ph.D., professor of physiology and pharmacology at SUNY Downstate, and fellow researchers have identified a network of nerve terminals in the rat brain where stimulation of dopamine D4 receptors depresses motor activity.

“This network is localized deep in the brain, in the basal ganglia and the thalamus,” said Erlij, “and its responses explain the reduction in motor activity caused by psychostimulants.”

The findings were published in a recent edition of the journal Neuropharmacology.

“When, in 1937, Dr. Charles Bradley administered Benzedrine to a group of children with hyperactivity and learning disorders and discovered that ’14 children responded in a spectacular fashion,’ a new era of psychopharmacology was inaugurated,” Erlij said.

“Bradley showed, for the first time, that taking a pill could successfully treat a behavioral abnormality. Eventually, this discovery led to the widespread use of psychostimulant drugs in the treatment of ADHD.”

“Despite their well established beneficial effects, it was not understood why psychostimulant drugs, which normally amplify the stimulatory responses of dopamine signals, reduce hyperactivity.

“Our results suggest that enhancing dopamine D4 transmission in the basal ganglia and the thalamus is likely part of the mechanism of the therapeutic effects of psychostimulants on ADHD.”

Erlij believes the therapeutic action of psychostimulants in ADHD occurs because the condition is caused by abnormalities of dopamine signaling in the brain. That is, when an individual has ADHD, the dopamine D4 receptor gene is abnormal.

Source: SUNY Downstate Medical Center

The study comes after the FDA issued a rare “black box warning” in 2004 after concerns were raised about antidepressant drugs increasing suicidal thoughts and behaviors in young patients.

The analysis, based on data from 41 trials and more than 9,000 patients, also found that fluoxetine and venlafaxine (marketed as Effexor), reduced suicidal behavior and depression symptoms in adult and geriatric patients.

The failure to replicate the link between these antidepressants and suicide should reassure doctors about prescribing these drugs to depressed patients, said Robert Gibbons, Ph.D., professor of medicine, health studies, and psychiatry at University of Chicago Medicine.

“The key finding here, when we re-analyze all the patient-level longitudinal records in these studies, is that antidepressants neither increase nor decrease suicidal thoughts or behavior in children,” Gibbons said.

The FDA decision on the black box warning was based on data from 25 clinical trials of newer antidepressant medications, including the serotonin reuptake inhibitor drug fluoxetine. An analysis of the data, primarily self-reports of suicidal thoughts, revealed a small, but significant, increase in suicidal thoughts and behavior in children and young adults up to the age of 25.

For the new analysis, Gibbons and colleagues from the University of Illinois at Chicago, the University of Miami, and Columbia University obtained individual-level, longitudinal clinical trial data — some of it unpublished — from pharmaceutical producers and a National Institute of Mental Health collaborative study of fluoxetine and venlafaxine. The data included weekly screenings of each trial subject for depression and suicidal thoughts, allowing researchers to compare the effect of drug or placebo over time.

In the analysis of the adult and geriatric trials testing fluoxetine or venlafaxine, both antidepressants were found effective in reducing suicide risk and depression symptoms, the researchers said, who said the two effects were associated.

“Basically, the results say that the mechanism by which the antidepressants affect suicide rates is by decreasing depression,” Gibbons said. “It follows that if a treatment is not working for an individual, the risk for suicidal behavior and perhaps worse remains high.”

To analyze the effects of antidepressants in children, the researchers used four trials of fluoxetine, which until recently was the only antidepressant approved for pediatric use. Once again, a reduction in depressive symptoms was observed in the drug-treated population compared to placebo. However, no significant change in suicide risk was detected between the two patient groups.

“I think that this paper supports the general idea that the effects of antidepressants in kids and adults are not really the same, since we don’t see anything but beneficial effects of antidepressants in adults and geriatrics,” Gibbons said. “In kids, we don’t see a harmful effect, but we do see a disassociation between the beneficial effects on depression and the potential beneficial effect on suicide.”

“This raises continued questions about what’s going on in children,” he continued. “Maybe children think about suicide in part because of depression, but also maybe due to other reasons not related to depression that are not affected by antidepressants.”

Gibbons, who sat on the Food and Drug Administration panel that considered placing the black box warning on antidepressants, said he hoped the new results would reassure clinicians about the safety of the drugs. Previous research by his group found that the addition of the warning significantly reduced antidepressant prescriptions to both children and adults and correlated with a spike in suicide rates.

“I hope that the warnings will not prevent depressed children and adults from getting treatment for depression,” Gibbons said. “The greatest cause of suicide is untreated or undiagnosed depression. It’s very important that this condition be recognized and appropriately treated and not discarded because doctors are afraid to be sued.”

The paper was published online in Archives of General Psychiatry.

Source: University of Chicago Medical Center

Child taking a pill photo by shutterstock.

Researcher Christopher Coleman, Ph.D., M.P.H., R.N., of the University of Pennsylvania School of Nursing said women tend to let their guard down with new sexual partners and avoid using protection since they are unafraid of getting pregnant. His study looked at newly divorced middle-aged women.

Additionally, as aging occurs, physiological changes due to menopause such as the thinning of vaginal walls make women more susceptible to contracting a virus.

Medications that would be used to treat an STD or HIV become hard for a woman to tolerate because an aging body metabolizes medications differently.

“There is a knowlege gap with women knowing what the physiological changes associated with menopause are,” said Dr. Coleman.

“There is very little research on this subject and society and the government don’t talk about it, but these high risk sexual behaviors need to be addressed because the rate of HIV-positive middle aged women is increasing.”

Source: University of Pennsylvania School of Nursing

Woman thinking photo by shutterstock.

In both situations, scientists observe brain activity in the dorsolateral prefrontal cortex — the part of the brain that controls high-level cognitive functions like working memory and attention.

Now, however, a new study challenges the theory that the placebo effect is a high-level cognitive function. The results could help clinicians maximize pain relief without drugs.

For the study, researchers reduced pain in two ways — either by giving participants a placebo or a difficult memory task.  

But when they put the two together, “the level of pain reduction that people experienced added up. There was no interference between them,” says  Jason T. Buhle of Columbia University. “That suggests they rely on separate mechanisms.”

For the study, 33 volunteers attended three separate sessions. In the first, researchers applied heat to the skin with a small metal plate and adjusted each person’s pain perception. In the second session, some of the subjects were given an ordinary skin cream but were told it was a powerful but safe analgesic. The others applied the cream and were told it was regular hand cream.

In the placebo-only trials, volunteers stared at a cross on a screen and were asked to rate the pain of numerous heat applications — the same level of pain, although they were told it varied.

During other trials they were given a tough memory task — distraction and placebo simultaneously. For the third session, individuals who had been given the plain cream received the “analgesic” and vice versa. The procedure was the same.

The results show that when either the memory task or the placebo was given alone, volunteers felt less pain than during the trials when they just stared at the cross. Together, the two effects added up and did not interact or interfere with each other. This suggests that the placebo effect does not require executive attention or working memory.

“Neuroimaging is great,” says Buhle, “but because each brain region does many things, when you see activation in a particular area, you don’t know what cognitive process is driving it.”

The findings are promising for pain relief. Clinicians utilize both placebos and distraction—for example, virtual reality in burn units, but it has been unclear if one could diminish the other’s efficacy. “This study shows you can use them together,” says Buhle, “and get the maximum bang for your buck without medications.”

The research is published in Psychological Science.

Source:  Association for Psychological Science

Photo courtesy of Science Photo Library.

Children exposed to two or more anesthetics before age 3 had more than double the incidence of ADHD than children who had no exposure, says David Warner, M.D., a Mayo Clinic pediatric anesthesiologist and investigator on the observational study.

The researchers’ interest was piqued when studies began to suggest anesthesia used in surgery causes changes in the brains of young animals, Warner says.

“We were skeptical that the findings in animals would correlate with kids, but it appears that it does,” he notes.

The new study examined results of an existing epidemiological study that looked at the educational records of children born between 1976 and 1982 in Rochester, Minn., and determined those who developed some form of learning disability or ADHD.

Among 341 cases of ADHD in those younger than 19, researchers traced medical records in the Rochester Epidemiology Project, a decades-long database of all patient care in Olmsted County, Minn., looking for exposure to anesthesia and surgery before age 3.

What they found is that children who had no exposure to anesthesia and surgery had ADHD at a rate of 7.3 percent. The rate after a single exposure to anesthesia and surgery was approximately the same.

But for children who had two or more exposures to anesthesia and surgery, the rate of ADHD was 17.9 percent — even after researchers adjusted for other factors, including gestational age, sex, birth weight, and other health conditions.

The results of the study, however, do not mean that anesthesia causes attention deficit disorder, Warner says.

“This is an observational study,” he says. “A wide range of other factors might be responsible for the higher frequency of ADHD in children with multiple exposures. The findings certainly do suggest that further investigation into this area is warranted, and investigators at Mayo Clinic and elsewhere are actively pursuing these studies.”

Source: Mayo Clinic

Unfortunately, despite their widespread use, most of the medications are known to cause the metabolic side effects of obesity and diabetes.

Naturally this presents a significant dilemma to individuals as they weigh a choice between improving their mental health and damaging their physical health.

A new paper in the journal Molecular Psychiatry, discusses the biochemical changes triggered by the antipsychotic drugs.

The medications interfere with normal metabolism by activating a protein called SMAD3. The SMAD3 protein, in turn, is an important component of a cellular conduit termed the transforming growth factor beta (TGFbeta) pathway.

The TGFbeta pathway regulates many biological processes, including cell growth, inflammation, and insulin signaling.

In the current study, all antipsychotics that cause metabolic side effects activated SMAD3, while antipsychotics free from these side effects did not.

What’s more, SMAD3 activation by antipsychotics was completely independent from their neurological effects, raising the possibility that antipsychotics could be designed that retain beneficial therapeutic effects in the brain, but lack the negative metabolic side effects.

“We now believe that many antipsychotics cause obesity and diabetes because they trigger the TGFbeta pathway. Of all the drugs we tested, the only two that didn’t activate the pathway were the ones that are known not to cause metabolic side effects,” said Fred Levine, M.D., Ph.D., senior author of the study.

The TGFbeta pathway also plays an important role in metabolic disease in people who don’t take antipsychotic medications.

“It’s known that people who have elevated TGFbeta levels are more prone to diabetes. So having a dysregulated TGFbeta pathway — whether caused by antipsychotics or through some other mechanism — is clearly a very bad thing,” said Dr. Levine.

“The fact that antipsychotics activate this pathway should be a big concern to pharmaceutical companies. We hope this new information will lead to the development of improved drugs.”

Source: Sanford-Burnham Medical Research Institute

Investigators discovered the genetic variation can cause a six-fold greater risk for children to develop metabolic syndrome. Metabolic syndrome is a combination of symptoms that increase the risk for cardiovascular disease.

The study showed susceptible children displayed an increased risk to develop high blood pressure and elevated fasting blood sugar levels (a precursor to diabetes).

The research is published in the medical research journal Translational Psychiatry.

“This is the first report of an underlying biological factor predisposing children to complications associated with second-generation antipsychotic medication use,” said Dr. Dina Panagiotopoulos, study co-author.

“It’s concerning because these children take medications to treat a chronic disease – mental illness – and then develop risk factors for a second chronic disease,” said co-author Dr. Angela Devlin.

Second-generation antipsychotics such as quetiapine (Seroquel) and risperidone (Risperdal) are prescribed to approximately 5,500 children and youth in British Columbia for psychotic disorders like schizophrenia, mood and anxiety disorders, attention deficit hyperactivity disorder, autism spectrum disorders, adjustment disorders and substance abuse.

Researchers assessed 209 children who were inpatients between April 2008 and June 2011 at the Child & Adolescent Psychiatry Department at BC Children’s Hospital.
Their average age was 13 years, and 105 of the children were treated with second-generation anti-psychotics while 112 did not use these drugs.

DNA analysis showed that eight per cent of children from both groups had a genetic variation called C677T on the MTHFR gene. Children with the MTHFR C677T variant who used these medications were six times more likely to have metabolic syndrome.

The researchers targeted the MTHFR C677T variant because it is known to be associated with metabolic syndrome in adults who have schizophrenia, and with cardiovascular disease in adults who don’t have psychiatric illness.

Devlin and Panagiotopoulos said their discovery is an important step in preventing and managing metabolic complications associated with second-generation antipsychotic medications.

Researchers believe the knowledge is critically important to reduce these risks in childhood because adults with mental illness have a 19 per cent increased mortality rate that is largely due to cardiovascular disease risk.

Future investigations will incorporate a study of vitamin B status among affected children as the MTHFR gene is involved in metabolizing the B-vitamin folate.

“We now plan to assess B vitamin status and dietary intake in children who take these medications to gain a better understanding of this association,” said Panagiotopoulos.

Source: Child & Family Research Institute

Researchers from The City College of New York followed smokers from different socioeconomic backgrounds after they had completed a statewide smoking cessation program in Arkansas.

After a program of cognitive-behavioral therapy, either with or without nicotine patches, underprivileged and those from higher social economic backgrounds were able to quit at about the same rate.

However, as time progressed, a significant number of the underprivileged returned to smoking. Those with the fewest social and financial resources had the hardest time staving off cravings over the long run.

“The poorer they are, the worse it gets,” said clinical psychologist Christine Sheffer, Ph.D., who directed the program.

Shaffer discovered smokers on the lowest rungs of the socioeconomic ladder were 55 percent more likely than those at the upper end to start smoking again three months after treatment.

By six months post-quitting, the probability of their going back to cigarettes jumped to 2-1/2 times that of the more affluent smokers.

The research will be published in the March issue of the American Journal of Public Health and will appear online under the journal’s “First Look” section.

As part of the study, Sheffer and her colleagues noted that overall, Americans with household incomes of $15,000 or less smoke at nearly three times the rate of those with incomes of $50,000 or greater.

Smoking is still the greatest cause of preventable death and disease in the U.S. today, noted Sheffer. “And it’s a growing problem in developing countries.”

Sheffer believes there are several reasons why it may be harder for some to give up tobacco permanently. Stress is a common reason for nicotine addiction. Unfortunately, those on the lower end of the socioeconomic scale suffer more hardships than those at the top, in the form of financial difficulties, discrimination, and job insecurity, to name a few.

And for those smokers who started as teenagers, they may have never learned other ways to manage stress, Sheffer said.

For people with lower socioeconomic status (SES), it can be tougher to avoid temptation as well.

“Lower SES groups, with lower paying jobs, aren’t as protected by smoke-free laws,” said Sheffer, so individuals who have quit can find themselves back at work and surrounded by smokers. Also, fewer of them have no-smoking policies in their homes.

Unfortunately these real-world circumstances are rarely addressed in standard treatment programs.

“The evidence-based treatments that are around have been developed for middle-class patients,” Sheffer pointed out. “So (in therapy) we talk about middle-class problems.”

Additional research will help determine how the standard six sessions of therapy may be augmented to address various clients.

“Our next plan is to take the results of this and other studies and apply what we learned to revise the approach, in order to better meet the needs of poor folks,” says Sheffer. “Maybe there is a better arrangement, like giving ‘booster sessions’. Not everybody can predict in six weeks all the stresses they will have later on down the road.

“Some people say [quitting] is the most difficult thing in their life to do,” she said. “If we better prepare people with more limited resources to manage the types of stress they have in their lives, we’d get better results. “

Source: The City College of New York

Researchers discovered younger women with breast cancer experience a decrease in their health-related quality of life. They also may experience increased psychological distress, weight gain, a decline in their physical activity, infertility and early onset menopause.

The study is published in the Journal of the National Cancer Institute.

Breast cancer is the most common non-skin cancer in women, and is the leading cause of death in women under 50 in the U.S.

Researchers note that although the survival rate for younger women with breast cancer has improved over the last two decades, their cancer treatments, despite their effectiveness, can seriously affect quality of life and other health outcomes.

In the study, researchers sought to determine the impact of cancer treatment on the quality of life of younger breast cancer survivors. Patricia A. Ganz, M.D., and colleagues reviewed studies that focused on overall quality of life, psychosocial effects, menopause and fertility-related concerns, and behavioral outcomes related to weight gain and physical activity.

The studies were published between January 1990 and July 2010. Of the 840 titles and abstracts reviewed, they focused on 28 with the most relevant data.

Investigators found that overall quality of life was compromised in younger breast cancer survivors, with the mental issues more severe than the physical problems.

Depression was also a problem as young women were also more depressed compared to the general age-matched population of women without cancer or women over 50 with breast cancer.

Premature menopause, infertility and menopause-related symptoms were more common and contributing factors to the level of distress in women 50 or younger after treatment.

Weight gain and physical inactivity were common health outcomes in younger women, although exercise rates generally increased after treatment.

Researchers believe the findings demonstrate the need for personalized treatment for breast cancer, especially among young women.

“By tailoring [treatment] and giving cytotoxic therapy only to those who may benefit, we can mitigate some of these side effects, but the long life expectancy for these younger women also provides a window of opportunity for cancer prevention and health promotion activities.”

Source: Journal of the National Cancer Institute

Bipolar disorder is fairly common and can occur at any age. It is estimated that one person in 100 has the disorder. 

Lithium is considered the most effective long-term treatment for bipolar disorder, but it is now prescribed less due to concerns about the drug’s side effects, such as kidney function problems.

Individuals with bipolar disorder experience mood swings from one extreme to another; periods of depression and mania may last several weeks or longer. These phases of feeling high and low are often so intense that they interfere with everyday life. Lithium calms both depression and mania and reduces the risk of suicide.

Driven by the notion that many bipolar patients could benefit from lithium but are missing out because of these worries, the research team led by Professor John Geddes decided to investigate deeper regarding lithium’s side effects.

The researchers reviewed nearly 400 articles concerning the possible negative effects of lithium and made several recommendations designed to guide lithium treatment in the future.

Geddes and colleagues came to the conclusion that there is definitely an increased risk of abnormalities in the thyroid and parathyroid glands. These occur in about 25 percent of patients on lithium therapy compared with 3 percent and 0.1 percent in the general population, respectively.

Lithium use also promotes weight gain, and can slightly reduce the ability of the kidneys to concentrate urine. 

However, the study reveals that evidence linking birth defects with lithium treatment in pregnancy is still inconclusive, and there is very little proof linking lithium with hair loss or skin problems.

The team suggests that doctors discuss the risk of side effects with the patient before starting lithium treatment. Incorporating calcium levels to blood tests would be beneficial based on the high risk of hyperparathyroidism.

The researchers also believe that the uncertainty regarding birth defects should be explained to women of childbearing age, rather than simply not recommending lithium during pregnancy.

Geddes and his team believe that more research is needed on the association between lithium and the kidney.

The results are published in the Lancet medical journal.

Source:  Oxford University

Although GAD is difficult to overcome, new research suggests regular exercise can significantly reduce anxiety symptoms in patients with GAD.

The clinical presentation of GAD typically includes a variety of physical symptoms including fatigue, muscle tension, irritability and poor sleep.

University of Georgia researchers randomly assigned 30 sedentary women diagnosed with GAD to either a control group or six weeks of strength or aerobic exercise training. The women ranged in age from 18-37. Exercise training consisted of two sessions a week of either weight lifting or leg cycling exercise.

Assessment of GAD was then performed by psychologists who were unaware (blinded) of group status.

Researchers found that symptoms of GAD were more likely to retract among the exercise cohort. The largest reduction in symptoms occurred in the group that performed weight-lifting exercises.

All exercisers demonstrated a significant reduction in worry symptoms and moderate-to-large improvements in other symptoms, such as irritability, feelings of tension, low energy and pain, were found.

“Our findings add to the growing body of evidence of the positive effects of exercise training on anxiety,” said researcher and doctoral student Matthew Herring.

“Our study is the first randomized controlled trial focused on the effects of exercise training among individuals diagnosed with GAD. Given the prevalence of GAD and drawbacks of current treatments, including expense and potential negative side effects, our findings are particularly exciting, because they suggest that exercise training is a feasible, well-tolerated potential adjuvant therapy with low risk that can reduce the severity of signs and symptoms of GAD.

“Future research should confirm these findings with large trials and explore potential underlying mechanisms of exercise effects among individuals with GAD.”

Researchers also examined the efficacy of an exercise and medication regimen for the treatment of GAD.

In the study, half of the participants in each group were taking a medication to treat GAD during the exercise program.

Researchers found that the benefit of exercise training extended to all participants, lessening anxiety symptoms to the same degree among those taking medication compared to those not taking medication.

“The large improvements found in this small investigation show that regular exercise has the power to help calm women suffering from GAD, even among those who appear to be resistant to treatment using medication,” said exercise physiologist Patrick O’Connor, Ph.D.

“The results of this research are very exciting because exercise is available to everyone, is relatively inexpensive and has beneficial effects beyond the reduction of anxious and depressive symptoms,” said c0-author and clinical psychologist Cynthia Suveg, Ph.D.

“For individuals suffering from impairing symptoms, these preliminary findings suggest that exercise may offer another potential treatment option that has few, if any, negative side effects. Future research needs to explore the long-term benefits of exercise as well as the conditions under which exercise may be most beneficial and for whom.”

The study has been published online in the journal Psychotherapy and Psychosomatics.

Source: University of Georgia

Woman exercising photo by shutterstock.