Historically, the causes of Alzheimer’s have proven very difficult to pin down. In recent years, science has been closing in on solving the puzzle, particularly regarding some of the hereditary, “early onset” forms of the illness.

Unusual by-products of cell metabolism, clumps of protein aggregates, have been shown to have a toxic effect on brain cells and certain gene mutations have been shown to be associated with increasing production of these by-products, though the evidence for an exact mechanism has remained hidden.

In the new research, scientists have shown how a minor mutation results in unexpected changes in a very delicate chemical balance, creating build-up of the toxic by-products.

The mutation, the substitution of a single base among the 3 billion found in human DNA, seems to have the greatest effect on a fragment of a specific protein that is abundantly present in living cells. The difference causes a subtle change in the shape of the fragment at a critical point, which can slightly shift the odds towards an inappropriate biochemical reaction that sidetracks the metabolic path.

The increase in the reaction simply tips the balance of chemical processes, causing the build-up of a substance that kills brain cells, leading to the early deterioration of mental capacity and, eventually, death.

“It is a really tiny change but it has tremendous consequences,” said Andrij Baumketner, lead author on the study and a faculty member in the department of physics and optical science at the University of North Carolina at Charlotte. The finding, published in the April 7 issue of the Publication of the National Academy of Sciences, was co-authored by Mary Griffin Krone and Joan-Emma Shea, both from the department of chemistry and biochemistry at the University of California at Santa Barbara.

The group studied the effects caused by the Dutch Mutation, a mutation that has been discovered to be associated with a specific, hereditary form of Alzheimer’s disease. The mutation is small, the simple substitution of one DNA base for another, resulting in the change of only one amino acid residue – glutamic acid changing to the very similar glutamine – among hundreds of amino acids that form a protein known as the amyloid precursor protein (APP).

The greatest effect of the Dutch-type mutation on APP, whose primary biological function is unknown, seems to be through a fragment known as amyloid-beta peptide that is created when cells break down the protein. Studies have shown that mutated forms of the fragment have greater tendency to stick to bond together and form protein clumps or aggregates. Some forms of the amyloid-beta clumps have been shown to be toxic to brain cells.

Why the change in one amino acid would cause this peptide to form clumps more readily has, until now, been unclear. Amyloid-beta peptide, unlike most other proteins present in the cell, is largely lacking in specific shape (conformation), the characteristic that usually controls how proteins interact with each other.

However the fragment does have two places in its sequence of amino acids – a section known as the “bend” and an area known as the “central hydrophobic cluster” where the polypeptide chain does conform to a more-or-less fixed shape. These areas, in fact, seem to be involved when the fragments bond together into clumps.

The researchers created complex computer models of the two structured areas of the fragment and found that the single amino acid change caused by the mutation had a subtle effect on their properties. In order for fragments to bond together, the structured areas must first undergo a “conformational change” (a change in structural shape) from the conformations they normally have as single, water-soluble amyloid-beta peptides into a “transition state” conformation that leads up to forming clumps.

The researchers found that mutation increased the likelihood that the structures would be in a form similar to the transition state before the reaction occurred. When the structured areas were already in the required transition state, bonding was encouraged because less energy was required for the bonding reaction to take place.

“We knew quite a bit about what these peptides are from experimental studies, but we didn’t know the microscopic details,” noted Baumketner. “An experiment never gives you atomic resolution – you always have to guess what is actually going on with the molecules. But with a computer simulation you start with atoms and how they interact and you end with atoms, so there is no question with missing any details.”

The detail of the simulations showed that, because the mutation made the protein fragments more likely to be in a transition state for bonding, bonds between fragments were more likely to be formed than broken (in the reverse reaction), so clumps of fragments accumulated. The end result of the subtle, mutation-driven change in the protein fragment’s shape was the tipping the reaction’s balance enough to allow clumps composed of multiple fragments to occur and to build up –with a disastrous effect on brain tissue.

“The barrier between the reactants and the products is the conformational difference between the peptide and its transition state,” Baumketner said. “The fewer changes the peptide needs to undergo, the easier it is for it to change. The mutation predisposes the single amyloid-beta peptide to jump onto the barrier that keeps the reaction from happening.”

The ultimate problem responsible for Alzheimer’s Disease, Baumketner notes, is that the design of the protein affected is so “close to the edge” in the reactions it must undergo that extremely small changes can cause problems, like the formation of toxic by-products.

“It looks like whoever designed the proteins in our bodies only made the beta peptides to be right on the edge of where they have to be for us to be alive,” he said facetiously. “You make a small push and you push it over the edge and then there is no return. If you were farther from the edge, that would be fine, and you could tolerate one mutation.

“There is lots of discussion about why this happens – is it the failure of evolution? Maybe evolution never has had a chance to optimize us against this. Humans now live to be much older, but evolution never has had a chance before to detect and avoid these problems through natural selection. When the lifespan was 35 years, you didn’t have a large problem with Alzheimer’s. Now you do.”

Source: University of North Carolina at Charlotte

Health promotion programs such as smoking cessation, cardiovascular fitness and overall wellness activities are underrepresented for people living with mental illness.

The relative absence of programming to help improve health is appalling given the high rates of nicotine dependence and deaths from cardiovascular and respiratory illnesses among this population.

According to Professor Steve Kisely, from Griffith University’s School of Medicine, health services are failing to provide appropriate smoking cessation strategies to people with problems including depression, schizophrenia or post-traumatic stress disorder.

He said smoking rates in people with mental illness were twice the rates in the general population.

“Deaths from largely preventable diseases including cancer and cardiovascular disease outnumber deaths from suicide in psychiatric patients by ten to one. There is a forgotten epidemic of physical illness in the mentally ill - another example of the inequities in our health system.”

In a recent review of the medical evidence for smoking interventions in mental illness, Professor Kisley said health professionals were not routinely including smoking status in patient treatment plans, encouraging smokers to quit, referring them for counselling or offering effective drug therapies.

Yet the literature review found that a combination of long term pharmacotherapy and psychological interventions for smoking cessation were as effective in people with mental illness as they were in the general population.

“These people can spend up to 40 per cent of their income on cigarettes and are significantly disadvantaged by their smoking. Smoking may also interfere with other medications they are taking and increase the risk of adverse side effects,” he said.

Professor Kisely said the most effective treatments for smoking cessation were a combination of psychological treatments such as cognitive behavioural therapy and nicotine replacement therapies or other prescription medicines such as bupropion (Zyban).

The study also concluded that treatment to stop smoking would be more effective when integrated into patients’ overall mental health care.

Source: Research Australia

For others, strong ties to ethnicity can actually make the negative effects of discrimination worse. And the mental health effects of such discrimination may shift over a lifetime as Asian-Americans continue to examine their ethnic ties, say researchers.

Anti-Asian racism is prevalent in the United States but research into the psychological ramifications of those experiences is scarce, said lead author Tiffany Yip, PhD, of Fordham University.

Using the first nationally representative sample of Asian adults in the United States, Yip, Gilbert C. Gee, PhD, of the University of California Los Angeles, and David T. Takeuchi, PhD, of the University of Washington, examined whether ethnic identity protected a person against the negative effects of discrimination and whether age and birthplace also played a role.

These findings are published in the May issue of Developmental Psychology, published by the American Psychological Association.

Data came from the National Latino and Asian American Study, a household survey conducted between 2002 and 2003 that included 2,047 Asian adults 18-75 years old. The interviews were conducted at the participants’ homes in a variety of languages, including Cantonese, Mandarin, Tagalog and Vietnamese.

The participants were questioned about any negative feelings they may have had in the previous 30 days.

Participants were also asked about their perceptions of racial and ethnic discrimination. They were asked how often they felt discriminated against because of their race and how close they felt their ideas and feelings were to other people of the same racial and ethnic descent.

The researchers controlled for socioeconomic status, gender, age at immigration and where the participants lived. Overall, the researchers found that discrimination was associated with psychological distress; respondents said they felt depressed more often if they had been discriminated against.

The analysis uncovered an unexpected result when the researchers looked at age and whether the participant was born in the United States. For those born outside the United States, embracing one’s ethnic identity did not guard against the negative effects of discrimination on psychological wellness.

However, for Asians born in the United States, ethnic attachment did affect whether discrimination made people feel more distressed, and its effect varied by age. “Among adults in their 40s, feeling strongly about their own background can counteract the negative effects of discrimination,” said Yip.

Surprisingly, more analysis showed that U.S.-born participants in their 30s and those above the age of 50 who described themselves as having a strong ethnic identity had more mental distress from discrimination than those participants with a weaker ethnic attachment.

“This may be because people in their forties, who are entering middle age, cope more effectively with stress and are better able to deal with emotional reactions to negative events, such as racism,” said Yip. However, research has suggested that as people enter their 50s, they are actively trying to maximize happiness and minimize unhappiness, so experiencing discrimination during this time may be especially harmful for people who have a strong sense of connection to their ethnic background.

The researchers acknowledge that much more work needs to be done to understand how discrimination influences psychological well-being.

“A better understanding of these issues could help us create resources that can protect against racial discrimination in this country, especially for those who are not born in the United States,” said Yip.

Source: American Psychological Association

While the elderly are cared for by their adult children regardless of their marital status, researchers found British adult children help their elderly parents according to current need (i.e. health) rather than past behavior.

According to the scientists, this contrasts with other countries such as the US, where parents with a history of divorce see less of their children and receive less help from them.

In the UK a parent that is living alone is more likely to receive help from children than parents with partners. Children also give more help as the parent ages.

For every extra year of the parent’s age, he/she is 9 percent more likely to receive help from children not living at the same address. And parents with health problems are 75 percent more likely than those without health problems to be helped by their children.

Curiously, divorced parents get more help from children than if they are widowed, but both groups receive more help than if they still have a partner.

And it helps to have more children. Parents with more children receive more support; however, step children give step parents less support.

The research was carried out by a team from the Institute of Gerontology at King’s College London. They analyzed data from an annual survey of over five thousand British households (British Household Panel Survey) from 1991 to 2003. They compared this information with a survey of over 3500 people at around retirement age (55-69 years) in 1988, and an Italian family survey.

The researchers led by Dr Karen Glaser found that children now help their elderly parents more than in the past. In 1988, 34 percent of parents aged 61-69 received regular or frequent help from their children; by 2001/2 this had risen to 43 percent. Almost two-thirds of older parents (aged 70 or over in 2001/2) received help from their children.

Typically help included one or more of the following:

• Transportation (44 percet of parents)
• Help with the shopping (32 percent)
• Decorating, gardening or house repairs (25 percent)
• Providing or cooking meals (17 percent)
• Dealing with personal affairs (letters, bills) (16 percent)
• Washing, ironing or cleaning (11 percent)

“Our research dispels the myth that modern Britain is becoming less caring,” says Dr Karen Glaser. “While families experience more divorce and separation, many children continue to care for parents according to their needs.”

Comparing the UK with Italy, the researchers found the family oriented Italians care more for elderly parents regardless of need, whereas the pragmatic British gave support depending on the health situation of the elderly.

Source: Economic & Social Research Council

Women have greater rates of depression and some types of anxiety disorders than men, while men have greater rates of alcohol-use disorders than women.

In the study of emotional and alcohol-craving responses to stress, scientists discovered that when men become upset, they are more likely than women to want alcohol.

Results will be published in the July issue of Alcoholism: Clinical & Experimental Research and are currently available at OnlineEarly.

“We know that women and men respond to stress differently,” said Tara M. Chaplin, associate research scientist at Yale University School of Medicine and first author of the study.

“For example, following a stressful experience, women are more likely than men to say that they feel sad or anxious, which may lead to risk for depression and anxiety disorders. Some studies have found that men are more likely to drink alcohol following stress than women. If this becomes a pattern, it could lead to alcohol-use disorders.”

As part of a larger study, the researchers exposed 54 healthy adult social drinkers (27 women, 27 men) to three types of imagery scripts – stressful, alcohol-related, and neutral/relaxing – in separate sessions, on separate days and in random order. Chaplin and her colleagues then assessed participants’ subjective emotions, behavioral/bodily responses, cardiovascular arousal as indicated by heart rate and blood pressure, and self-reported alcohol craving.

“After listening to the stressful story, women reported more sadness and anxiety than men,” said Chaplin, “as well as greater behavioral arousal. But, for the men … emotional arousal was linked to increases in alcohol craving. In other words, when men are upset, they are more likely to want alcohol.”

These findings – in addition to the fact that the men drank more than the women on average – meant that the men had more experience with alcohol, perhaps leading them to turn to alcohol as a way of coping with distress, added Chaplin.

“Men’s tendency to crave alcohol when upset may be a learned behavior or may be related to known gender differences in reward pathways in the brain,” she said. “And this tendency may contribute to risk for alcohol-use disorders.”

There is a greater societal acceptance of “emotionality,” particularly sadness and anxiety, in women than in men, noted Chaplin.

“Women are more likely than men to focus on negative emotional aspects of stressful circumstances, for example, they tend to ‘ruminate’ or think over and over again about their negative emotional state,” she said.

“Men, in contrast, are more likely to distract themselves from negative emotions, to try not to think about these emotions. Our finding that men had greater blood pressure response to stress, but did not report greater sadness and anxiety, may reflect that they are more likely to try to distract themselves from their physiological arousal, possibly through the use of alcohol.”

Source: Yale University

The report cites research which it says shows that some teens are using drugs to alleviate feelings of depression (”self-medicating”), when in fact, using marijuana can compound the problem. The report found, for instance, that teenagers who smoke marijuana at least once a month are three times more likely to have suicidal thoughts than non-users.

The report, from the White House Office of National Drug Control Policy (ONDCP), suggests that up to two million teens felt depressed at some point during the past year, and depressed teens are more than twice as likely as non-depressed teens to have used marijuana during that same period.

Depressed teens are also almost twice as likely to have used illicit drugs as non-depressed teens. They are also more than twice as likely as their peers to abuse or become dependent on marijuana. Marijuana use is associated with depression, suicidal thoughts, and suicide attempts.

“Marijuana is not the answer. Too many young people are making a bad situation worse by using marijuana in a misguided effort to relieve their symptoms of depression,” said John P. Walters, Director, National Drug Control Policy.

“Parents must not dismiss teen moodiness as a passing phase. Look closely at your teen’s behavior because it could be a sign of something more serious.”

Although marijuana use among teens has dropped by 25 percent since 2001, more teens use marijuana than all other illicit drugs combined. The new report, Teen Marijuana Use Worsens Depression: An Analysis of Recent Data Shows ‘Self-Medicating’ Could Actually Make Things Worse (PDF), also found the following:

• Using marijuana can lead to depression and other mental illnesses;
• The percentage of depressed teens is equal to the percentage of depressed adults, but depressed teens are more likely than depressed adults to use marijuana and other illicit drugs;
• Teen girls who use marijuana daily are more likely to develop depression than girls who do not use marijuana;
• Depressed teens are also more likely than non-depressed teens to engage in other risky behaviors such as daily cigarette use and heavy alcohol use.

“Don’t be fooled into thinking that pot is harmless,” said Dr. Drew Pinksy, internist, addiction expert, and host of VH1’s Celebrity Rehab. “Marijuana is an addictive drug. Teens who are already depressed and use marijuana may increase their odds of suffering from even more serious mental health problems.”

In fact, the potency of smoked marijuana has risen consistently over the past decades and higher potency translates into serious health consequences for teens. Some studies show that higher potency marijuana may be contributing to an increase in the number of American teens seeking treatment for marijuana dependence.

The risks associated with recent and long-term marijuana use include schizophrenia, other forms of psychosis, and even suicide. “Not only are adolescents at greater risk for drug abuse, but they may suffer more consequences,” said Nora D. Volkow, M. D., Director of the National Institute on Drug Abuse. “There is also some evidence that in vulnerable teens-because of genetic factors-the abuse of marijuana can trigger a schizophreniform disorder.”

The report was released to coincide with May’s Mental Health Awareness Month.

Source: U.S. National Drug Control Policy

The FDA approval was specifically for maintenance treatment of manic or mixed episodes, and as add-on treatment to lithium or valproate, for children ages 10 to 17 who have Bipolar I Disorder, the more severe type of bipolar disorder.

Abilify was recently approved for the acute treatment of manic and mixed episodes associated with Bipolar I Disorder with or without psychotic features in pediatric patients (aged 10-17), in February 2008.

It was also approved by the FDA for the acute treatment of Schizophrenia in adolescents (aged 13-17) in October 2007.

The FDA first approved Abilify for the treatment of manic and mixed episodes associated with Bipolar I Disorder with or without psychotic features in adults in September 2004, and for the treatment of Schizophrenia in adults in November 2002.

The safety and effectiveness of Abilify in pediatric patients with Bipolar Mania were established in a four-week, placebo-controlled clinical trial in 197 pediatric patients (aged 10-17).

The safety and effectiveness of Abilify in adolescents with schizophrenia were established in a six-week, placebo-controlled clinical trial in 202 pediatric patients (aged 13-17). Although maintenance efficacy in these patient populations has not been systematically evaluated, maintenance efficacy can be extrapolated from adult data along with comparisons of Abilify pharmacokinetic parameters in adults and pediatric patients.

There is no body of evidence available to answer the question of how long the adolescent patient treated with Abilify should be maintained. It is generally recommended that responding patients be continued beyond the acute response, but at the lowest dose needed to maintain remission. Periodic reassessment should be conducted to determine the need for maintenance treatment.

The FDA approval for Abilify as an adjunct treatment combined with lithium or valproate was made despite the lack of research that specifically examined Abilify’s safety and efficacy in children. The pharmaceutical company said, however, that “such efficacy and lack of pharmacokinetic interaction between Abilify and lithium or valproate can be extrapolated from adult data along with comparisons of Abilify pharmacokinetic parameters in adult and pediatric patients.”

“We are extremely pleased to receive expanded indications on the use of ABILIFY in these patient populations,” said Taro Iwamoto, Ph.D., Chief Executive Officer, President and Chief Operating Officer, Otsuka Pharmaceutical Development and Commercialization, Inc.

“Expanding the clinical uses of an important therapy such as ABILIFY gives caregivers and pediatric patients with Bipolar I Disorder or Schizophrenia a new treatment option in their fight against serious disease,” said Elliott Sigal, M.D., Ph.D., Executive Vice President, Chief Scientific Officer and President, Research and Development, Bristol-Myers Squibb.

Otsuka Pharmaceutical Co., Ltd. and Bristol-Myers Squibb Company, makers of Abilify, made the announcement yesterday via a press release.

Source: Compiled from a press release issued by Bristol-Myers Squibb

Mental health charity Rethink has branded the findings on attitudes towards people with mental health problems as “shocking, ignorant, and unacceptable in today’s society.”

In addition to the 1-in-8 finding, the Department of Health’s survey data showed that:

• Nearly six out of ten people describe a person with a mental illness as “someone who has to be kept in a psychiatric or mental hospital”
• One third of people think that people with mental health problems should not have the same rights to a job as everyone else
• Only 31% of people think that mental hospitals are an outdated means of treating people

“These findings show just how bad the situation can be for people with mental health problems,” said Paul Corry, Rethink’s director of public affairs.

“Archaic, bigoted opinions about mental illness still prevail and clearly demonstrate the urgent need for action to change people’s views. It is particularly disappointing to see the deterioration in people’s tolerance towards people with mental illness.”

Rethink research for Moving People has found that nearly nine out of 10 people with mental health problems have been affected by stigma and discrimination, with two thirds saying they have stopped doing things because of the stigma they face.

Corry noted, “The Moving People anti-stigma campaign will lay firm foundations for ending mental health discrimination in the UK, but long term it is essential that the government plows hefty resources into tackling the problem, as has been done in Scotland and New Zealand. The government could also lead by example and employ more people with mental health problems within its departments, and encourage other public sector bodies to do the same.”

Janey Antoniou, who has schizophrenia, recalls one example of the stigma she encountered: “I had a neighbor who used to run inside when she saw me because she had seen me taken to the hospital by the police in my dressing gown. The fact that I’d walked down the road with a briefcase thousands of times seemed irrelevant.”

Rethink, on behalf of anti-stigma coalition group Moving People, is in the process of devising an anti-stigma marketing campaign which aims to reach 30 million people across England in an attempt to challenge attitudes and change behavior. The anti-stigma marketing campaign will be launched in January 2009.

The study, by researchers at the University of Illinois and the California Institute of Technology, used functional magnetic resonance imaging (fMRI) to scan the brains of people making a series of tough decisions about how to allocate donations to children in a Ugandan orphanage.

“Morality is a question of broad interest,” Ming Hsu, one of the study’s authors, said.

“What makes us moral, and how do we make trade-offs in difficult situations?”

The subjects were told that each child would start out with a monetary equivalent of 24 meals, an actual gift from the research team to the orphanage. An undetermined number of meals would have to be cut from some children’s allotments, however. The number of meals cut and the individual children who would be affected depended on how the subjects selected from options the researchers presented.

Every decision pitted efficiency (the total number of meals given) against equity (how much the burden of lost meals was shared among the children).

One could choose to take 15 meals from a single child, for example, or 13 meals from one child and five from another. In the first option the total number of meals lost would be lower. Efficiency would be preserved, but one child would bear the brunt of all the cuts. In the second option more children would share the burden of lost meals but more meals would be lost. The equity was better — but at a cost to efficiency.

“This dilemma illustrates the core issues of distributive justice, which involves tradeoffs between considerations that are at once compelling but which cannot be simultaneously satisfied,” the authors wrote.

The study was designed to address the psychological and neurological dimensions of two longstanding debates about distributive justice. First, is equity or efficiency more critical to our sense of justice” And second, are such questions solved by reason alone, or does emotion also play a role”

In the experiment, subjects watched an animation on a computer screen. In the animation, a ball traveled from right to left toward a lever that could direct the ball toward one or the other option. Photographs of the affected children represented each option, with numbers for the number of meals that would be lost to those children if that option were selected. By moving the lever, the subjects steered the ball to the option they preferred. At the end of each trial, the subject’s choice was highlighted in red.

In these trials, subjects overwhelmingly chose to preserve equity at the expense of efficiency.

“They were all quite inequity averse,” noted Hsu.

The findings support other studies that show that most people are fairly intolerant of inequity.

The animation, in conjunction with the fMRI, allowed the researchers to view activity in the brain at critical moments in the decision-making process. After analyzing the data, they found that different brain regions — the insula, putamen and caudate — were activated differently, and at different points in the process, Hsu said.

Activation of the insula varied from trial to trial in relation to changes in equity, while activity in the putamen corresponded to changes in efficiency, he said.

In contrast, the caudate appeared to integrate both equity and efficiency once a decision was made.

The involvement of the insula appears to support the notion that emotion plays a role in a person’s attitude towards inequity, Hsu said.

The insula is known to play a key role in the awareness of bodily states and emotions. Studies have shown that it is activated in people experiencing hunger or drug-related cravings, and in those feeling intense emotions such as anger, fear, disgust or happiness. Other research has implicated the insula in mediating fairness.

The putamen and the caudate are activated during reward-related learning.

“You’re seeing the signal in the insula and the putamen initially,” Hsu said. “When they hit the lever you see the insula activation. And when the ball gets to the end you see (activation of) the caudate.”

“The putamen is responding only to the chosen efficiency, which is how many meals get taken away from the kids or how many meals they end up with,” Hsu said. The insula, however, responded to how equitably the burden of lost meals was distributed.

Together, the results “show how the brain encodes two considerations central to the distributive justice calculus and shed light on the cognitivist/sentimentalist debate regarding the psychological underpinnings of distributive justice,” the authors wrote.

The research appears in the current issue of the journal Science.

Source: University of Illinois at Urbana-Champaign

Scans show untreated depressed people have fewer serotonin and opioid receptors, and that variation is linked to symptoms and treatment response. But the research also showed the numbers of these receptors can vary greatly from person to person.

The lead University of Michigan researcher, Jon-Kar Zubieta, M.D., Ph.D., says these new results bolster what other researchers have been finding in recent years.

“There’s a substantial amount of biological difference even among people who have major depression, which is just as important as the biological differences between people with depression and people without,” he says.

“The more we can understand about these differences, the better we can address treatment to the individual and have the greatest effect on symptoms.”

Zubieta presented data from positron emission tomography, or PET, scans of the brains of patients who met the criteria for major depression but had not yet received treatment for it.

Those scans were compared with scans of the brains of non-depressed comparison volunteers.

In one group of depressed and non-depressed volunteers, the scans were made using a tracer that can reveal the location and concentration of a particular type of receptor. Called the 5HT1a receptor, it allows brain cells to receive signals from serotonin, a chemical neurotransmitter produced by the brain.

Serotonin levels in the brain are linked to depression, but the importance of 5HT1a receptor concentrations in the brains of depressed people has been cloudy. That’s why Zubieta’s team chose to scan only people who had not yet received antidepressant medications, since some such medications may actually encourage the brain’s cells to make more serotonin receptors — and masking the actual level of receptors that the person has naturally.

In the study, 5HT1a receptor concentrations were markedly lower in depressed people compared with non-depressed people, in both the left and right hippocampus region of the brain.

But even among depressed people, the lower a person’s the 5HT1 receptor levels were, the worse he or she scored on assessments of their ability to function day-to-day. They were also less likely to get relief from symptoms when the researchers prescribed a common antidepressant.

This finding of individual variation may help explain why some patients find great relief from a medication that doesn’t help other equally depressed patients, says Zubieta.

The other group of depressed and non-depressed volunteers received PET scans with a tracer that allowed the researchers to see the mu-opioid receptors (which bind endorphins) in their brains. These receptors are the gateway for signals sent by chemicals which are involved in stress response including response to pain.

In this group of depressed and non-depressed volunteers, the researchers studied the distribution of the mu-opioid receptors and looked at how active the receptors were when the volunteers were asked to summon a sad memory or scenario to mind.

Depressed volunteers had lower concentrations of mu-opioid receptors to begin with. But when they underwent the “sadness challenge”, those receptors were much more active than the receptors in non-depressed people. And, just as with the serotonin 5HT1a receptors, the fewer mu-opioid receptors a person had, the less well they responded to an antidepressant medication.

Zubieta and his colleagues are now working to submit these new data for publication. At the same time, they are continuing to recruit depressed volunteers who are not taking medication for more brain imaging studies.

The preliminary findings were presented Tuesday at the American Psychiatric Association’s annual meeting in Washington, D.C.

Source: University of Michigan Depression Center

According to the survey of 87,000 U.S. adults released yesterday by the U.S. Centers for Disease Control and Prevention (CDC), people who sleep less than six hours a night were shown to be more likely to be obese, have higher smoking and alcohol rates, and are less likely to engage in physical activity than those receiving 7 to 9 hours of sleep. People who sleep more than nine hours are also more likely to be obese.

According to another study published on May 1 that examined the research literature on the link between sleep and obesity, researchers found a consistent pattern of increased odds of being a short sleeper if you are obese, both in childhood and adulthood.

The research adds weight to a stream of studies that have found obesity and other health problems in those who don’t get proper shuteye, said Dr. Ron Kramer, a Colorado physician and a spokesman for the American Academy of Sleep Medicine.

“The data is all coming together that short sleepers and long sleepers don’t do so well,” Kramer said.

No cause and effect relationship can be shown by either study — it’s not clear whether those who sleep poorly are more likely to gain weight, or if obesity causes one to get less sleep. The study also did not account for the influence of other factors, such as a mental health concern such as depression, which can contribute to heavy eating, smoking, sleeplessness and other problems.

CDC Study Results

Obesity was seen amongst 33 percent of those who got less than 6 hours of sleep and 26 percent of those who slept longer than 9 hours. Obesity was a concern for only 22 percent of those who received 7 to 8 hours of sleep.

Smoking was highest for people who got under six hours of sleep, with 31 percent saying they were current smokers (as opposed to the national average of 21 percent). People who received 7 to 8 hours of sleep per night smoked less, 18 percent, according to the survey data.

For alcohol use, those who slept the least were the biggest drinkers. However, alcohol use for those who slept seven to eight hours and those who slept nine hours or more was similar.

In another measure, nearly half of those who slept nine hours or more each night were physically inactive in their leisure time, which was worse even than the lightest sleepers and the proper sleepers. Many of those who sleep nine hours or more may have serious health problems that make exercise difficult.

Sleep journal Study Results

Francesco P. Cappuccio, MD, of Warwick Medical School in the United Kingdom, and colleagues performed a systematic search of publications on the relationship between short sleep duration and obesity risk. The study appeared in the May 1 issue of the journal Sleep.

For the children, 13 population samples from the 12 studies were included in the pool analysis, for a total of 30,002 participants from around the world. The subjects’ age ranged from two to 20 years. Seven of 11 studies reported a significant association between short sleep duration and obesity.

For the adults, 22 population samples from the 17 studies were included in the pool analysis, for a total of 604,509 worldwide participants. The subjects’ age ranged from 15-102 years. Seventeen population samples showed a significant association between short duration of sleep and obesity. Unlike studies in children, all studies in adults showed a consistent and significant negative association between hours of sleep and BMI.

“By appraising the world literature, we were able to show some heterogeneity amongst studies in the world,” said Cappuccio. “However, there is a striking consistent overall association, in that both obese children and adults had a significantly increased risk of being short sleepers compared to normal weight individuals.”

“This study is important as it confirms that this association is strong and might be of public health relevance,” he continued.

“However, it also raises the unanswered question yet of whether this is a cause-effect association. Only prospective longitudinal studies will be able to address the outstanding question.”

While an increasing number of adults are considered overweight, the number of overweight children is also on the rise. According to the National Heart, Lung and Blood Institute, the percentage of overweight children and teens has more than doubled in the past 30 years. Today, about 17 percent of American children aged two to 19 are overweight. An estimated 61 percent of U.S. adults aged 20-74 years are either overweight or obese. About 34 percent of these people are overweight and 27 percent or 50 million people are obese.

While eating healthy and exercising regularly are important precautions to take to reduce one’s chances of being overweight, getting enough sleep is equally as important.

A lack of sleep can lead to increased stress, relationship and work issues, and put one’s general physical health at increased risk.

Sources: National Center for Health Statistics, part of the Centers for Disease Control and Prevention, and the journal Sleep

Data presented from the study showed that the mean time to relapse for patients treated with RLAI was statistically longer than those treated with quetiapine (607 days RLAI versus 533 days with quetiapine, p<0.0001).

The study did not measure the drug’s efficacy on any clinician-rated or patient-rated scales.

For patients living with schizophrenia, relapse may be associated with an increased risk of hospitalization and can have a major negative impact on their quality of life.

Non-compliance or partial compliance remain key barriers in the management of schizophrenia and are often significant contributing factors in relapse. Patients experiencing numerous relapses are at high risk of never regaining previous levels of functioning, therefore, preventing relapse is paramount in order to improve the long-term outcome for people living with the condition.

However, preventing relapse says nothing about whether a drug is effectively managing a patient’s symptoms. A longer time to relapse could simply indicate the drug is better tolerated, but not necessarily more effective at controlling the complex symptoms common in people with schizophrenia.

The study, a 24-month open-label comparative study with no placebo control group, investigated the effect of treatment with RLAI or oral quetiapine on relapse prevention and efficacy maintenance as measured by time to relapse.

710 patients were randomized to receive either RLAI (N=355 (mean dose 32.75 mg)) or oral quetiapine (N=355 (mean dose 396.75 mg)).

The data indicate that not only did RLAI significantly extend time to relapse versus quetiapine (607 days RLAI versus 533 days with quetiapine, p<0.0001), fewer patients in the RLAI treatment arm relapsed over the 24-month trial period compared with oral quetiapine (16.5% and 31.3% respectively). In addition, the treatment completion rates favored RLAI (51.7%) over oral quetiapine (38%) (p <0.0004).1

Safety results demonstrated that RLAI had a comparable safety and tolerability profile to quetiapine, with the majority of both treatment groups reporting treatment-emergent adverse events (67.5% for the RLAI group, 68.5% for the quetiapine group).

However, patients taking the RLAI treatment were over five times more likely to have a sexual dysfunction, such as impotence, ejaculatory failure, or loss of libido as compared to patients taking quetiapine.

Weight gain was observed in both treatment arms with no statistically significant differences in changes in body weight or BMI versus baseline (7% weight gain for RLAI versus 6.2% for quetiapine).

Drowsiness was reported in 1.8% of patients treated with RLAI compared to 11.3% with quetiapine.

Reasons for withdrawing from the study, other than relapse, were equivalent in both treatment groups.

The results were presented at the annual meeting of the American Psychiatric Association.

Source: Compiled from a press release from Janssen-Cilag

“The findings are significant because only a relatively modest amount of work has been done to examine the effects of ADHD treatments by gender,” said Robert Findling, M.D., investigator of the analysis from Case Western Reserve University. “This is an important consideration for parents because not only do they need to recognize that ADHD symptoms present differently in girls than in boys, but also because it is important to understand the role of treatment for both sexes.”

This analysis was conducted using data from an open-label, flexible dose, 12-month extension study in which 326 children received Daytrana, a once-a-day methylphenidate transdermal system. Children who enrolled in this study previously participated in other studies in which they received the ADHD patch, osmotic-release oral system (OROS) methylphenidate or placebo as part of the study design.

The primary objective of this study was to investigate the long term safety profile of ADHD treatment with Daytrana, and the secondary objective examined the efficacy of the medication between genders.

Adverse events were reported in a higher percentage of boys than girls in all dose groups; however, they were generally comparable between genders.

Adverse events were typically mild or moderate and consistent with stimulant treatment. The most common adverse events included decreased appetite, headache, upper respiratory tract infection, cough, fever and decreased weight.

In the study, the efficacy of Daytrana was measured using the ADHD Rating Scale (ADHD-RS-IV), the Clinical Global Impressions-Improvement (CGI-I) scale and the Parent Global Assessment (PGA) rating scale and measurement results were found to be statistically significant on all scales. In the analysis, boys had a 41 percent change on the ADHD-RS-IV (as calculated from a mean baseline score of 11.6, with a mean change from baseline to endpoint of -4.8) and girls had a 23 percent change on the scale (as calculated from a mean baseline score of 11.3, with a mean change from baseline to endpoint of -2.6). Lower scores on the ADHD-RS-IV reflect an improvement in symptom control.

On the CGI-I scale, clinicians rated 83 percent of boys and girls “improved” or “very much improved” at the end of the study compared to week one. Additionally, the PGA rating scale showed that 78 percent of boys and girls “improved” or “very much improved” at the end of the study compared to week one. The results in both the CGI-I and PGA scale were comparable between boys and girls.

Findling added, “These positive findings, along with previously presented research, reinforces that the ADHD patch is an important treatment option for children, especially those who may benefit from an ADHD medication that can accommodate their changing daily needs.”

While this study evaluated the safety and effectiveness of Daytrana for up to 12 months, the ADHD patch has not been studied versus placebo for longer than 7 weeks.

Intuniv Update

Intuniv (a non-stimulant selective alpha-2A-agonist) is a new ADHD once-daily medication not yet on the market. Research data presented yesterday showed significant efficacy in reducing attention deficit disorer (ADHD) symptoms for patients taking the medication when compared to patients taking placebo.

The U.S. Food and Drug Administration (FDA) issued an approvable letter for Intuniv on June 20, 2007. Shire, Intuniv’s maker, is conducting additional clinical work which is designed to enhance the label as requested by the FDA.

The pooled analysis evaluated results from these patients on a weight adjusted mg/kg basis from two similarly designed, randomized, double-blind, forced-dose titration, multicenter phase III trials. The primary efficacy measure for both studies was change in the ADHD Rating Scale (ADHD-RS-IV) total score from baseline to endpoint.

All patient groups treated with Intuniv showed significantly greater improvement in ADHD-RS-IV total score from baseline to endpoint than the placebo group (P < .001). The ADHD-RS-IV is a standardized, validated test for assessing symptoms of ADHD and for assessing their response to treatment.

The analysis also studied duration of effect using the Conners’ Parent Rating Scale-Revised Short Form (CPRS-R), which is a comprehensive scale that used observer and self-report ratings to help assess ADHD and evaluate behavioral issues in children and adolescents. The CPRS-R assessments were completed on specified days at approximately 6 PM (after school and before dinner), 8 PM (dinner through bedtime) and 6 AM (waking time/new dose administration time), which represented 12, 14 and 24 hours after the administration of the dose of INTUNIV, respectively.

The data demonstrated significant improvement of ADHD symptoms based on total endpoint CPRS-R scores for all weight adjusted dose groups treated with Intuniv when compared to placebo for all time periods (at 12 hours, P < = .001; at 14 hours, P < .001; and at 24 hours, P=.003).

A separate analysis of the same phase III studies evaluated the percentage of ADHD patients who responded to weight-adjusted treatment with Intuniv versus those participants receiving placebo. Using the change in the ADHD-RS-IV total score from baseline to endpoint as the primary efficacy measure, responders were defined as those with a 25 percent reduction in score from baseline to endpoint.

Findings from the analysis showed that all groups treated with Intuniv responded to the medication in a shorter time period than the placebo group (14 days versus 20 days, respectively, P = .001).

In the phase III studies, adverse events (AEs) were reported in 80.7 percent of patients treated with INTUNIV and 71.8 percent of patients treated with placebo. Overall, the AEs were mostly mild to moderate in severity. Adverse reactions that appeared to be dose-related in patients given INTUNIV included upper abdominal pain, constipation, dizziness, dry mouth, hypotension, sedation, and somnolence. Serious AEs reported in these analyses were uncommon and rates were similar between patients treated with INTUNIV and patients treated with placebo (0.6% of the INTUNIV group and 0.7% of placebo group, respectively).

Intuniv is a once-daily formulation of guanfacine that provides a controlled, steady delivery of drug throughout the day with a delivery system that is designed to minimize the fluctuations between peak and trough concentrations as seen with immediate-release guanfacine. Intuniv is not a controlled substance and does not appear to have a known mechanism for potential abuse or dependence.

Although other ADHD medications work indirectly in the prefrontal cortex, it has been shown that guanfacine works directly by binding selectively to alpha-2A adrenergic cell receptors located in the prefrontal cortex.

The prefrontal cortex is an area of the brain associated with executive functioning, ie, working memory, behavioral inhibition, regulation of attention, distractibility, impulsivity, and frustration tolerance. The selective alpha-2A agonist strengthens working memory and prefrontal cortex neuronal firing.

Safety data showed that adverse events reported by participants using Intuniv were generally mild to moderate in severity, with the most common side effects being sedative in nature. Sedation-related, treatment-emergent adverse events were among the most common but emerged in the first two weeks and were usually transient and mild or moderate in severity.

Treatment-related adverse events greater than 10 percent included drowsiness (32 percent), headache (26 percent), fatigue (18 percent), upper abdominal pain (14 percent) and sedation (13 percent). Small to modest changes in blood pressure, pulse rate, and ECG parameters were also observed.

The findings were presented at the annual meeting of the American Psychiatric Association.

Source: Compiled from press releases published by Shire PLC

In the new study, Ronald C. Kessler, Ph.D. of Harvard University and his colleagues analyzed data from the 2002 National Comorbidity Survey Replication (NCS-R), a nationally representative study of Americans age 18 to 64.

Using data from 4,982 respondents, the researchers calculated the amount of earnings lost in the year prior to the survey among people with serious mental illness (SMI). Serious mental illness is a broad category of illnesses that includes mood and anxiety disorders that have seriously impaired a person’s ability to function for at least 30 days in the year prior to the survey. It also includes cases of any mental disorder associated with life-threatening suicidal behaviors or repeated acts of violence.

Eighty-six percent of respondents reported earning income in the previous year. But those with SMI reported earning significantly less — around $22,545 — than respondents without SMI, who averaged $38,852. Although men with SMI took a greater hit in earnings than women with SMI, men still earned more overall than women with and without SMI.

“The results of this study confirm the belief that mental disorders contribute to enormous losses of human productivity,” said Kessler. “Yet this estimate is probably conservative because the NCS-R did not assess people in hospitals or prisons, and included very few participants with autism, schizophrenia or other chronic illnesses that are known to greatly affect a person’s ability to work. The actual costs are probably higher that what we have estimated.”

Direct costs associated with mental disorders like medication, clinic visits, and hospitalization, are relatively easy to quantify, but they reveal only a small portion of the economic burden these illnesses place on society.

Indirect costs like lost earnings likely account for enormous expenses, but they are very difficult to define and estimate.

By extrapolating these results to the general population, the researchers calculated that SMI costs society $193.2 billion annually in lost earnings. The researchers attributed about 75 percent of this total to the reduced income that people with SMI likely earn, while 25 percent is attributed to the increased likelihood that people with SMI would have no earnings.

The researchers concluded by recommending that future studies on the effectiveness of treatments should consider measuring employment status and earnings over the long term to document the effects of mental disorders on a person’s functioning and ability to remain productive.

“Lost earning potential, costs associated with treating coexisting conditions, Social Security payments, homelessness and incarceration are just some of the indirect costs associated with mental illnesses that have been difficult to quantify,” said NIMH Director Thomas R. Insel, M.D. “This study shows us that just one source of these indirect costs is staggeringly high.”

The study was published in the May 2008 issue of the American Journal of Psychiatry.

Source: National Institute of Mental Health

That percentage suggests that up to approximately 750,000 teens have gambling concerns in the U.S.

In addition, 11 percent of the youth surveyed gambled twice per week or more, a rate that has traditionally been used to describe “frequent” gambling.

Sixty-eight percent of the youth interviewed reported that they had gambled at least once in the past year.

“In a society where young people are increasingly exposed to gambling influences, there is cause for concern,” said John W. Welte, Ph.D., principal investigator on the study.

A total of 2,274 U.S. youth were surveyed from August 2005 through January 2007 for this study. Interviews were conducted in all 50 states and the District of Columbia. The national, random-digit-dial telephone survey was sampled from all phone numbers in the U.S.

The rates of problem gambling found in the study are not, in fact, as high as the rates of problem gambling found in eight previous studies conducted in smaller jurisdictions by other research teams, according to Welte.

Five of those studies were school surveys that obtained data only from youth attending that school or residing in one state or one region of the country. Others were telephone surveys using age-targeted population samples.

Welte said, “The 2.1 percent rate of problem gambling for our national study has a 95 percent confidence level, making it unlikely that we found a lower problem gambling rate by chance.”

Welte is a senior research scientist at RIA and a national expert in the epidemiology of substance abuse and gambling. His co-investigator on the study is Grace M. Barnes, Ph.D., a senior research scientist at RIA and a national expert in substance use pertaining to adolescents, parenting and families.

“As might be expected, all statistically significant results showed that greater gambling involvement is associated with aging into an adult status,” Welte stated. “In fact, gambling may be associated with the transition into adulthood.”

The RIA researchers examined pivotal times of life for youth (employment, student status, living independently from parents, and marriage) and found gambling increased with each major life change. Those who worked full-time were more likely to gamble, those who were not students were more likely to gamble frequently (twice a week or more) and those who lived independently were more likely to gamble and to be problem gamblers (three or more negative consequences during the past year).

“We compared problem gambling rates among youth with problem gambling rates among adults from our national study of U.S. adults in 2000,” Welte said. “As far as gender, it seems likely that females’ gambling involvement tends to emerge in adulthood, while male involvement can be high in adolescence. We found identical problem gambling rates for adult males and young males (4 percent). We found adult females gambling rates were much higher (3 percent) than that of young females (less than one-tenth of a percent). In other words, problem gambling is almost non-existent among female adolescents and young adults.”

Black youth were less likely to have gambled than white youth; but if they gambled, it was likely to be more frequent (30 percent vs. 12 percent respectively). Asians as a racial group showed the lowest gambling involvement. Native Americans were found to have a higher rate of frequent gambling (28 percent) when compared to whites (9 percent) as well as to be higher on measures of problem gambling. This could be a reflection of the rapid spread of legal gambling venues on Native American reservations.

Generally, low socioeconomic groups were less like to gamble, but if they did, were more likely to be problem gamblers. The highest socioeconomic groups are associated with the lowest gambling involvement.

Religion was related to having gambled in the past year with every religious group except Catholics, who were less likely than Protestants (except Baptists), to have gambled at all. Other religions (which include Moslem, Hindu, Buddhist, Jehovah’s Witnesses and others) had a lower rate of having gambling in the past year (42 percent), but if they gambled, they had higher rates of frequent gambling than any other religious group. Similarly, Baptists were less likely than other Protestants to have gambled in the past year, but if they gambled, they had higher rates of frequent gambling.

The study was funded by a $1.8 million grant from the National Institute on Mental Health.

The results will be published in the June 2008 issue of the Journal of Gambling Studies.

Source: University at Buffalo’s Research Institute on Addictions (RIA)

Jerald Block, M.D. presented on warning signs that can help profile teenagers at risk for committing violence.

His presentation was based primarily on his extensive research of the 1999 Columbine high school shootings, which resulted in the deaths of 15 people, including the two students who initiated the attack, Eric Harris and Dylan Klebold.

Based on diaries and police records, Block authored a July 2007 article for the American Journal of Forensic Psychiatry entitled “Lessons from Columbine: Virtual and Real Rage.” Block will also briefly discuss the role of technology in the Red Lake (2005), Virginia Tech (2007), Jokela High School (2007), and North Illinois (2008) school shootings.

The paper on Columbine examines the many factors that may have influenced the shooters and specifically highlights the role that technology played in the tragedy. Prior to the shootings, both teenagers spent a significant amount of time playing first-person-shooter computer games and creating game levels for others to use. In his paper, Block suggests that these virtual worlds became essential for the teens.

Block notes that Harris and Klebold may have been unable to distinguish the boundaries between their virtual lives and their real lives, in effect mixing the two.

“Virtual realities, like the ones that Harris and Klebold experienced, are a double-edged sword,” explained Block, a clinical faculty member in the OHSU Department of Psychiatry. “On one hand, virtual worlds allow people to feel connected and empowered. They also allow participants to escape stress and have an outlet for aggression.”

“On the other hand,” continued Block, “when a heavy user must eliminate or cut back on the virtual, as was the case with these two killers at times, the user can feel lonely, anxious, or angry. In some ways, virtual reality is similar to alcohol. In moderation it can be healthy or even helpful. In excess it can be destructive and isolating. And, when a person goes ‘dry,’ the situation can turn dangerous.”

During the APA meeting, two other experts joined Block in presenting information about school shootings. Katherine Newman, the Malcolm Forbes Class of 1941 Professor of Sociology and Public Affairs from Princeton University, spoke about the communities where school shootings occur and whether we can predict and prevent these tragedies. FBI Special Agent Terri Royster discussed the FBI’s procedure for assessing school shooting threats.

Jerald Block, M.D. presented the new research on the psychiatric factors that can lead to school shootings during the annual meeting of the American Psychiatric Association (APA) in Washington, D.C. on Tuesday.

Source: Oregon Health & Science University

According to their comprehensive review of treatments for depression, they claim that there is a lack of evidence for CBT being more helpful than other forms of psychological support in mild depression or for its efficacy in severe depression. The British Association of Pharmacology also says there is “good evidence” for antidepressants being effective in depression, with benefit increasing the more severe the depression.

This is contrary to recent reports that antidepressants are not much more effective than placebo, except in the most severe depression.

Ian Anderson at the University of Manchester (UK) says the cost effectiveness of CBT should be thoroughly investigated before it is adopted more widely because it is likely to be offered to people with milder depression where he suggests the evidence is poorest.

“There is often not a level playing field in considering evidence for drugs versus psychological treatment, especially in milder depression,” Dr. Anderson explains, adding that specific psychological treatments are relatively expensive compared to drug treatments because treatment involves training of the therapists as well as the costs of administering the intervention.

To measure the effectiveness of these treatments requires “comparison against appropriate control treatment like non-specific supportive treatment in the same way drugs are compared against placebo,” says Dr Anderson. “This is important given the rolling out of CBT for milder depression — probably less expensive means of support are more cost-effective.”

This conclusion is just one of the issues to emerge from a comprehensive review of the evidence for various forms of management of depression, conducted as part of a revision of the 2000 British Association for Psychopharmacology evidence-based guidelines, and published this week by SAGE in the Journal of Psychopharmacology. The aim of the review was to incorporate new evidence and to update the recommendations where appropriate.

Revisions to the guidelines were agreed after a consensus meeting involving experts in depressive disorders and their management, user representatives, and medical and scientific staff from pharmaceutical companies in May 2006 and a subsequent literature review.

The new guidelines also question whether CBT should routinely be combined with antidepressant medication for depression in adolescents—as the UK’s National Institute for Health and Clinical Excellence suggests—citing a lack of evidence. Dr Anderson says some recommendations run contrary to NICE guidance:

• First, the choice between antidepressants and CBT needs to be individually decided rather than routinely recommending CBT first.
• Second, combining CBT with antidepressants should not be routine.

He suggests that doctors should try to adopt a more dimensional approach to depression rather than over-emphasising categories of disease severity such as “not depressed”, “clinical depression”, etc, or relying too heavily on cut-off points such as simply counting symptoms. It is important to consider an individual patient’s situation in a more rounded fashion such as past history, degree of impairment, duration of symptoms and risk of relapse.

“Overall, the guidelines clear up some issues and alter the emphasis on certain treatments for example suggesting that for subthreshold depression, which is not of clinical severity, antidepressants should be considered if it lasts more than 2-3 months,” Dr Anderson says. “We have also challenged the idea that antidepressants need to be given more than once a day or that for most antidepressants you need to follow a long tailing off before starting a new antidepressant.”

“We hope [the guidelines] will set a standard. We have tried to be practical in our advice and addressed issues that other guidelines tend not to be specific about such as managing side-effects of antidepressants. We want to help doctors and patients choose treatments and strategies that have the best chance of helping,” Dr Anderson concludes.

Source: Journal of Psychopharmacology

A study of 74 breast cancer patients at the Ohio State University Medical Center found that 16 percent of them (12 women) suffered from posttraumatic stress disorder (PTSD) 18 months after diagnosis.

Women with PTSD were more than twice as likely as breast cancer patients without the disorder to have suffered from previous mood disorders such as depression before the cancer diagnosis. They were also more than three times more likely to have experienced anxiety disorders.

“What is unique about breast cancer patients with PTSD is that they have already had this double hit of both anxiety and mood disorders even before they got the diagnosis,” said Barbara Andersen, co-author of the study and professor of psychology at Ohio State University.

“So when they are in a new situation that is very anxiety provoking -– cancer diagnosis and treatment -– it is not surprising that they are at risk for developing PTSD.”

The findings suggest that doctors should screen newly diagnosed breast cancer patients for past mood disorders, she said. Those who have histories of mood and anxiety disorders may need help in order to avoid PTSD. However, the results also show that most breast cancer patients aren’t at risk for PTSD.

In addition to the women who had PTSD, another 20 percent (15 women) had “subsyndromal” PTSD, meaning that they experienced significant symptoms of PTSD, but not at the level of those with the full diagnosis.
Women in the two groups — those who had PTSD and those with subsyndromal PTSD — were nearly four times more likely than those with no PTSD to say they were unable to work because of emotional distress.

Patients with subsyndromal PTSD were more likely than others to have had mood disorders, but compared to those who had full PTSD, were much less likely to suffer from anxiety disorders, Andersen said.

The findings showed that past alcohol and substance abuse was also linked to posttraumatic stress disorder symptoms. About one-third of women with PTSD had a past history of alcohol/substance abuse or dependence, compared to one-fifth of subsyndromal women and one-tenth of women with no PTSD.

Another issue for women who had PTSD – as compared to those with subsyndromal PTSD and those with no PTSD — was a history of traumatic life events, the study found. For example, half of the PTSD patients reported having been physically attacked or abused in their lives, compared to less than 17 percent of women in the other two groups.

Although women with subsyndromal symptoms generally fared better than those with the full disorder, in some cases women in both groups faced significant coping difficulties. Women in the two groups were nearly four times more likely than those with no PTSD to say they were unable to work because of emotional distress (42 percent of PTSD group, 40 percent of subsyndromal group, and 11 percent of those with no PTSD.)

“That’s a huge difference, and shows the real-life impact that PTSD symptoms can have on some breast cancer patients,” Andersen said.

While the study suggests most cancer patients aren’t at risk for PTSD, Andersen said mood disorders are another matter.

“I think depression is the mental health condition that needs the most attention as far as treating breast cancer patients, even more so than PTSD” she said. “That’s the direction our research is going, and we are working to develop an intervention to treat cancer patients with depression.”

Their study appears in the April 2008 issue of the Journal of Traumatic Stress.

Source: The Ohio State University

The researchers are quick to note that most adoptees in the study were psychologically healthy and doing well, but that adoption doubles the risk in children for two mental disorders — attention deficit disorder (ADHD) and oppositional defiant disorder.

Approximately 120,000 American children are adopted each year and there are about 1.5 million adoptees under age 18 in total, according to the study.

As domestic adoptions have decreased, the number of international adoptions has increased.

“Worldwide, approximately 40,000 children per year are moved between more than 100 countries through adoption. Despite the popularity of adoption, there is a persistent concern that adopted children may be at heightened risk for mental health or adjustment problems.”

Margaret A. Keyes, Ph.D., of the University of Minnesota, Minneapolis, and colleagues assessed 540 non-adopted adolescents, 514 internationally adopted adolescents and 178 domestically adopted adolescents (ages 11 to 21) to determine if adopted adolescents were at a higher risk for behavioral and emotional problems. Assessments were based on child and parent reports of attention-deficit/hyperactivity, oppositional defiant, conduct, major depressive and separation anxiety disorders, teacher reports of psychological health and contact with mental health professionals.

Adoptees scored moderately higher on continuous measures of behavioral and emotional problems.

“Nevertheless, being adopted approximately doubled the odds of having contact with a mental health professional and of having a disruptive behavior disorder [attention-deficit/hyperactivity, oppositional defiant, or conduct disorder]. Relative to international adoptees, domestic adoptees had higher odds of having [a disruptive] disorder,” the authors write.

“Focusing on internalizing problems, teachers reported that international adoptees were significantly more anxious than non-adopted adolescents and their parents reported significantly more symptoms of internalizing disorders, specifically major depressive disorders and separation anxiety disorders.”

“Although most adopted adolescents are psychologically healthy, they may be at elevated risk for some externalizing disorders, especially among those domestically placed,” the authors conclude.

The study appears in the May issue of Archives of Pediatrics and Adolescent Medicine, one of the JAMA/Archives journals.

Source: Archives of Pediatrics and Adolescent Medicine

Scientists at the University of London’s Pharmacy School found that anti-psychotic medications were prescribed for U.K. children at a rate of less than 4 per 10,000 children in 1992.

Thirteen years later the number of children taking these drugs nearly doubled, with children being prescribed anti-psychotics at a rate of 7 per 10,000.

In the U.S., anti-psychotic prescriptions doubled in just seven years. U.S. researchers previously found that nearly 23 American children out of 10,000 used the drugs in 1996, versus more than 45 per 10,000 in 2001.

The U.K. study examined 16,000 children’s health records from 1992 to 2005. Researchers found most anti-psychotic drugs prescribed were not officially approved for children, with the most commonly prescribed drugs used to treat autism and attention deficit disorder ADHD).

“This highlights the need for long-term safety investigations and ongoing clinical monitoring, particularly if the prescribing rate of these medicines continues to rise,” they said in their research.

Side effects including weight gain and heart problems have been reported in autistic or hyperactive children treated with anti-psychotic drugs, and the researchers claim there is little long-term evidence the drugs are safe.

The findings of the study appear in the May edition of the journal Pediatrics.

Source: Pediatrics