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

The study concludes that while recent reports indicate that there is a problem with underdiagnosis of bipolar disorder, an equal if not greater problem exists with overdiagnosis.

“Clinicians are inclined to diagnose disorders that they feel more comfortable treating,” said study author Mark Zimmerman, M.D., director of outpatient psychiatry at Rhode Island Hospital and associate professor of psychiatry and human behavior at Brown University

“We hypothesize that the increased availability of medications that have been approved for the treatment of bipolar disorder might be influencing clinicians who are unsure whether or not a patient has bipolar disorder or borderline personality disorder to err on the side of diagnosing the disorder that is medication responsive,” he noted.

The study method involved 700 psychiatric outpatients who were interviewed using the the Structured Clinical Interview for DSM-IV (SCID).

The SCID is a comprehensive psychiatric diagnostic interview conducted by a trained professional that was designed to offer the greatest reliability in making psychiatric diagnoses. Bipolar disorder, also known as manic-depression, is a mental disorder characterized by mood swings from depressive episodes to manic episodes.

Study participants also completed a self-administered questionnaire between May 2001 and March 2005. The questionnaire asked patients whether they had been previously diagnosed with bipolar or manic-depressive disorder by a health care professional. Family history of bipolar disorder was used as an index of diagnostic validity.

Of the 700 patients, 145 reported they had been previously diagnosed as having bipolar disorder; however, fewer than half of the 145 patients (43.4 percent) were diagnosed with bipolar disorder based on the SCID.

Further, the study showed that patients diagnosed with bipolar disorder based on the SCID had a significantly higher morbid risk of bipolar disorder in first-degree relatives.

Unnecessary side effects are a significant concern of overdiagnosis. Because mood stabilizers are the treatment of choice for bipolar disorder, overdiagnosing can unnecessarily expose patients to serious medication side effects, including possible impact to renal, endocrine, hepatic, immunologic and metabolic functions.

Zimmerman expressed concern for drug companies’ marketing messages to physicians: “This bias is reinforced by the marketing message of pharmaceutical companies to physicians, which has emphasized the literature on the delayed and underrecognition of bipolar disorder, and may be sensitizing clinicians to avoid missing the diagnosis of bipolar disorder.”

Zimmerman concludes, “The results of this study suggest that bipolar disorder is being overdiagnosed and we recommend that clinicians use a standardized, validated method in diagnosing bipolar disorder.”

The report is from the Rhode Island Methods to Improve Diagnostic Assessment and Services (MIDAS) Project, for which Zimmerman is the principal investigator. Zimmerman said, “The MIDAS project is unique in its integration of research quality diagnostic methods into a community-based outpatient practice affiliated with an academic medical center.”

The study was published online by the Journal of Clinical Psychiatry. Zimmerman will present the findings at the annual meeting of the American Psychiatric Association on Wednesday, May 7.

Source: Rhode Island Hospital

The findings were similar regardless of whether the country was considered a high-income (Belgium, France, The Netherlands, Germany, Italy, Spain, Japan, the USA and New Zealand) or middle- or low-income (Colombia, Lebanon, People’s Republic of China, South Africa, Ukraine) country.

The goals of the World Health Organization’s (WHO) 15-country, 73,441-person study were to establish the degree and type of disability, and level of treatment, of specific mental and physical disorders. The WHO’s World Mental Health Surveys were carried out in six countries classified by the World Bank as low- and middle-income and nine as high-income.

The researchers measured treatment sought and received for both physical and mental disorders, and assessed the level and type of disability attributed to them by respondents. The four disability areas explored were home management, ability to work, social life and close personal relationships.

In addition to finding that subjects generally attributed more of their disability to a mental disorder rather than a physical disorder, the researchers discovered that the higher level of disability associated with mental disorders was much more pronounced in social and personal relationships than in productive roles, such as work and housework.

The study also found that the proportion of people receiving treatment at the time of interview was much lower for mental than for physical disorders in high-income countries, and even more so in low- and middle-income countries.

These results are consistent with previous comparative burden-of-illness studies in suggesting that musculoskeletal disorders and major depression are the most disabling disorders across the socioeconomic spectrum.

The researchers comment that these new results imply that mental disorders are disabling more because they create psychological barriers rather than physical barriers to functioning. Among these barriers are limitations in cognitive and motivational capacity, regulation of feelings, embarrassment and stigma.

Disability in productive role functioning, such as work and home management, was generally comparable for mental and physical disorders.

The researchers found it disturbing to find that only a minority of people with severe mental disorders receive treatment and that treatment is substantially more common for severe physical disorders, the researchers say.

Combined with the burden of disability that mental disorders produce, the low treatment rates call for more attention to be paid to mental disorders, they believe. Treatment effectiveness trials show that common anxiety and mood disorders can often be successfully treated, although long-term outcomes are more uncertain and further research is needed.

Despite this uncertainty, the findings of this study strongly imply that more attention should be given to the treatment of mental disorders, particularly in middle- and low- income countries.

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

Reference:

Kessler R. C. et al. (2008). Disability and treatment of specific mental and physical disorders across the world. British Journal of Psychiatry 192, 5, 368-375.

The new findings suggest that such false parenting assumptions can not only impair parent-child interactions, but also rob kids of much-needed cognitive stimulation.

“There are numerous parenting books telling people what to expect when they’re pregnant,” said Heather Paradis, M.D., a pediatric fellow at the University of Rochester Medical Center.

“But once a baby is born, an astonishing number of parents are not only unsure of what to anticipate as their child develops, but are also uncertain of when, how or how much they are to help their babies reach various milestones, such as talking, grabbing, discerning right from wrong, or even potty-training.”

Moms and dads often misinterpret their baby’s behaviors. Some parents expect too much of babies too soon and grow frustrated while others underestimate their child’s abilities, preventing them from learning on their own.

Using data from the Early Childhood Longitudinal Study’s Birth Cohort (ECLS-B), Paradis and her colleagues analyzed the average parenting knowledge of a nationally-representative sample of parents of more than 10,000 9-month-old babies. These parents first answered an 11-point survey designed to distinguish informed parents from less-informed parents (asking questions such as “Should a 1-year-old child be able to tell between right from wrong”” and “Should a 1-year-old child be ready to begin toilet-training””). Those who scored 4 or fewer correct answers were considered to have low-level knowledge of typical infant development.

Paradis and colleagues then compared these knowledge scores to both scores from (1) a 73-point videotape analysis of the same families’ parent-child interactions while teaching a new task, and (2) from these parents’ self-reports of how often they engaged their child in enrichment activities (e.g. reading books, telling stories, or singing songs).

The analysis revealed that 31.2 percent of parents of infants had low-level knowledge of infant development, and that this low-level knowledge correlated with lower parental education level and income. Still, even when controlling for maternal age, education, income and mental state (e.g., depression), low-level knowledge of infant development still significantly and independently predicted parents being both less likely to enjoy healthy interactions with their infants during learning tasks and less likely to engage their children in regular enrichment activities

“This is a wake-up call for pediatricians,” Paradis said. “At office visits, we have a prime opportunity to intervene and help realign parents’ expectations for their infants, and in turn, promote healthy physical, social, and emotional development for these children. On the other hand, we still have more work cut out for us – additional research is needed to explore how these unrealistic expectations form in the first place.”

The findings were presented Sunday at the Pediatric Academic Society meeting in Honolulu, Hawaii.

Source: Pediatric Academic Society

Employees disciplined or fired routinely used chokeholds, headlocks and threats of violence to restrain patients at the hospitals, according to the article. In 2007, the state confirmed 137 cases of abuse against patients.

The state schools for people with disabilities, which have twice as many residents, have an average of 300 confirmed abuse cases per year. The U.S. Justice Department has had to intervene twice in recent years in these schools.

Hundreds of other employees have been fired for other violations, including sleeping on the job and overmedicating patients, the records show.

State officials say there will always be some reports of abuse and neglect in an institutional setting. And they say they take any allegations of mistreatment seriously. But the records show that as in other state-run facilities, abuse and neglect are systemic, The Dallas Morning News reported.

According to the newspaper, some mental health advocates fear the mentally ill patients in state hospitals may continue to face greater risks. Patients of the psychiatric hospitals are largely indigent, transient and not connected to their families, so they have few allies as they bounce through the mental health system.

In 2003, lawmakers stripped $100 million from the state’s mental health budget, funding that has only partially been replaced. Texas ranks 48th in the country in per capita funding for people with mental illness.

The Texas state psychiatric system has 18,000 patient admissions every year, patients who are overseen and cared for by over 7,400 employees. The state hospitals have approximately 2,500 patients daily.

Source: The Dallas Morning News

The researchers examined 1,237 Swedish children born between 1977 and 2003 who were diagnosed with autism before age 10, and compared them with 30,925 control subjects matched for gender, year of birth and hospital.

The link between autism and a parent’s hospitalization for a mental disorder, such as depression or schizophrenia, was present regardless of the timing of the parent’s diagnosis relative to the child’s diagnosis.

“We are trying to determine whether autism is more common among families with other psychiatric disorders. Establishing an association between autism and other psychiatric disorders might enable future investigators to better focus on genetic and environmental factors that might be shared among these disorders,” said study author Julie Daniels, Ph.D., an assistant professor in the UNC School of Public Health’s epidemiology and maternal and child health departments.

“Earlier studies have shown a higher rate of psychiatric disorders in families of autistic children than in the general population,” she said. “We wanted to see if the parents of autistic children were more likely to be diagnosed with mental disorders.

The large sample size in the study also enabled researchers to distinguish between psychiatric histories of mothers versus fathers in relation to autism.

“Our research shows that mothers and fathers diagnosed with schizophrenia were about twice as likely to have a child diagnosed with autism. We also saw higher rates of depression and personality disorders among mothers, but not fathers,” Daniels said.

This information will help researchers look among related diseases, such as psychiatric disorders, for causes of autism, Daniels said. “It may eventually help identify opportunities to prevent or treat the disorder.”

The study appears in the May 2008 issue of the journal Pediatrics.

Source: Pediatrics

Cross-sectional studies, which collect information at a single point in time, generally find that young Americans report having more lifetime alcohol problems than older Americans, despite having had less time to develop these problems. But these studies are hampered by the fact that people of different ages may remember or report problems to different degrees.

“By looking at two different cross-sectional surveys that asked the same questions in the same manner, but were conducted 10 years apart, we were able to compare, for example, 30 - 40 year olds in 2001 with 30 - 40 year olds in 1991,” explained Richard A. Grucza, an epidemiologist at Washington University School of Medicine and the study’s corresponding author.

“Essentially, this allowed us to correct for the effects of age on reporting. When we did this, we found that the tendency for young people to have higher levels of lifetime alcohol dependence clearly remained for women, although it disappeared for men.”

For this study, researchers examined two large, national surveys: the National Longitudinal Alcohol Epidemiologic Survey (NLAES), conducted in 1991 and 1992; and the National Epidemiological Survey on Alcohol and Related Conditions (NESARC), conducted in 2001 and 2002. They compared lifetime prevalence rates from the same age groups and demographics, while simultaneously controlling for age-related factors.

“Epidemiologic surveys document the prevalence of an illness such as alcohol dependence in the entire population rather than just one segment of the population, such as those seeking treatment,” noted Shelly F. Greenfield, associate clinical director of the Alcohol and Drug Abuse Treatment Program at McLean Hospital. “This allows us to track trends in illnesses -– including whether certain people are more vulnerable for a particular disease, at what age they manifest symptoms, and how quickly the illness progresses.”

“We found that for women born after World War II, there are lower levels of abstaining from alcohol, and higher levels of alcohol dependence, even when looking only at women who drank,” said Grucza. “However, we didn’t see any significant tendency for more recently born men to have lower levels of abstention, or higher levels of alcohol dependence.” He added that these results shed more light on a “closing gender-gap in alcoholism,” showing that it is probably due to higher levels of problems among women, while men have been more or less steady in their levels of dependence.

One possible explanation is that between 1934 and 1964, the social acceptability of women’s drinking increased. As it was more socially acceptable for women to drink, a greater number of them became drinkers. Because women have a heightened vulnerability to the effects of alcohol –- that is, greater blood alcohol levels at similar ‘doses’ of alcohol -– we would expect a higher incidence of alcoholism and related drinking problems, said the researchers.

Grucza drew an analogy between women’s drinking habits and culture and immigration. “Clearly there were many changes in the cultural environment for women born in the 40s, 50s and 60s compared to women born earlier,” he said. “Women entered the work force, were more likely to go to college, were less hampered by gender stereotypes, and had more purchasing power. They were freer to engage in a range of behaviors that were culturally or practically off-limits, and these behaviors probably would have included excessive drinking and alcohol problems.”

He noted that U.S. immigrants from cultures with conservative values vis-à-vis drinking tend to adhere to their own cultural norms, while their children are likely to adopt U.S. norms, which are comparatively lax regarding alcohol.

“We can think of U.S. culture as having been traditionally dominated by white men,” added Grucza. “As women have ‘immigrated’ into this culture, they have become ‘acculturated’ with regard to alcohol use. But Black women – who still have the lowest rates of drinking among the demographic groups we looked at – have a second barrier between them and the dominant U.S. culture, namely, their race, that may be keeping them from adopting the standards of the dominant culture with respect to alcohol use.”

Greenfield suggested that specially designed prevention programs that target female drinkers might help to lower drinking rates, and also delay the age of drinking initiation, which could help prevent later alcohol problems. “It would also be helpful to educate women about the gender differences in metabolism of alcohol, and the associated heightened female vulnerability to alcohol’s adverse health consequences at lower doses than men,” she said.

Grucza agreed that interventions for women need further investigation. “Whenever we see change in a disorder in the population, there is an opportunity to take a closer look at which risk factors for the disorder might be changing at the same time,” he said. “The classic example of this would be the rise in lung cancer in the late 20th century, a time in which sales of commercially produced cigarettes also skyrocketed. In this case, we obviously wouldn’t want to change the progress made by women over the last 50 - 60 years, but we can look at specific changes in their drinking behavior and start to speculate about what interventions might work.”

Results are published in the May issue of Alcoholism: Clinical & Experimental Research.

Source: Alcoholism: Clinical & Experimental Research