Tuesday, July 22, 2008 5:41 PM
posted by Aric Thorpe, MHR Sudden Death May Follow on Anniversary of Parent's Demise Findings from an intriguing study found a relationship between the anniversary of one's parent's death and one's own sudden death. The study, reported at an American College of Cardiology meeting, revealed that 13 out of 102 sudden deaths occurred on the anniversary of one's parent's demise. Out of the 13 (12.7%) 10 of the sudden deaths (77%) occurred in males. Sudden death was not associated with family members other than parents. Interestingly, 4 of the patients who experienced sudden death on the anniversary of their parent's death died at the same age as their parent. The following is an excerpt of an article from Medpage Today that reviews the study:
He said that patients and physicians need to be aware that psychological factors can trigger sudden death.
Physicians, he said, should ask patients about the deaths of close family members and should take action to prevent sudden death, including psychological therapy, stress reduction, behavior modification, management of cardiovascular risk factors, and treatment with medications like beta-blockers or aspirin.
Recently, psychological and chronobiological factors -- including the anniversary effect -- have been identified as triggers for sudden death or lethal arrhythmia, he said. So he and colleagues examined the life circumstances surrounding the 102 sudden deaths in patients ages 37 to 79.
More than two-thirds (68%) of the cases had underlying coronary artery disease.
Seven patients died on the anniversary of their father's death, five on the anniversary of their mother's death, and one on the anniversary of the deaths of both parents.
Click here to read the rest of this article from Medpage Today
link to this post  10:30 AM
posted by Rolf B. Gainer, Ph.D. Leveling the Barriers A Medicare bill which became effective last week creates a five year phase-in plan to bring mental health co-payments into line with other Medicare co-pay requirements. While we continue to wait for the Mental Health Parity legislation to clear, the Medicare initiative represents an important step to treating mental health conditions on an equal footing with other medical problems. Research studies point out that out-of-pocket costs are the greatest deterrent to a person seeking treatment. As Medicare recipients represent our older and disabled citizens, the easing of the co-pay burden may encourage people to seek earlier treatment for mental health problems.
Medicare's move is a big step forward.
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Monday, July 21, 2008 2:02 PM
posted by Aric Thorpe, MHR Brain Activity Shows Susceptibility to Obsessive-Compulsive Disorder A recent study pinpointed a region of the brain affected in those with obsessive compulsive disorder (OCD). According to the study published in the July 18 issue of Science, an area of the brain associated with unlearning behavior and allowing for flexibility in behavior, the lateral orbitofrontal cortex, was under active in the brain’s of participants who were diagnosed with OCD or in unaffected relatives. The researchers believe that MRI scans measuring activity in the lateral orbitofrontal cortex could be useful for future research; however, they will most likely not be used for common screening of OCD as other detection tools are highly successful. The following is an excerpt of an article from Medpage Today that discusses the study:
Patients with obsessive-compulsive disorder and their unaffected relatives showed less activity in the lateral orbitofrontal cortex on functional MRI compared with controls, reported Samuel R. Chamberlain, Ph.D., of the University of Cambridge, and colleagues in the July 18 issue of Science.
These findings from a small, case-control study suggest that this and related brain regions have an impact not only on day-to-day flexibility -- which involves the ability to suppress intrusive thoughts and repetitive rituals -- but also development of these pathologic compulsions, the researchers said.
Reduced function in brain areas related to unlearning may be a marker for vulnerability to obsessive-compulsive disorder "that exists in people at increased genetic risk, even in the absence of chronic treatment or symptom confounders," they wrote.
This kind of marker would likely be limited to research use for now since imaging is not needed for diagnosis or treatment decisions, commented Kenneth M. Heilman, M.D., of the University of Florida in Gainesville, Fla., who was not involved in the study.
The disorder often runs in families, with first-degree relatives of patients at up to an eight-fold risk of developing symptoms themselves.
But because little progress has been made in finding responsible genes, researchers have been looking for brain-based markers as objective, measurable traits.
Click here to read the rest of this article
Click here for more information on OCD
link to this post Friday, July 18, 2008 12:31 PM
posted by Aric Thorpe, MHR Impaired Vision Plus Poor Health Possible Suicide Risk According to a study published in the July issue of the Archives of Ophthalmology poor vision along with related indirect effects of poor health may be linked to an increase in risk of suicide. The study, conducted by Byron L. Lam, M.D., of the Bascom Palmer Eye Institute at the University of Miami, revealed that those with poor vision and indirect effects such as poor health had a risk of suicide that was 18% greater than those that do not suffer from these conditions. In addition to increased risk of suicide, researchers relayed that the psychosocial and health consequences of having impaired vision are many; social seclusion, increased risk of motor accidents, depression, falls, factures, cognitive impairment, and difficulty with activities of daily living are just a few mentioned in the study. Additionally, those with impaired vision have been associated with an overall increase in mortality risk, researchers said. The following is an excerpt of an article from Medpage Today that reviews findings from the study:
Dr. Lam's team reviewed data from National Health Interview Surveys (1986-1996) including data on 137,479 noninstitutionalized adults.
Participants reported demographic information along with details of visual impairment and other health conditions. Verified deaths of participants up to 2002 were reported through the National Death Index. Structural equation modeling was used to determine the relationship between reported visual impairment and suicide.
During a mean 11 years of follow-up, there were 200 suicides.
After controlling for survey design, age, sex, race, marital status,
number of non-ocular health conditions, and self-rated health, the direct effect of visual impairment on death from suicide was elevated but not significant (hazard ratio 1.50, 95% confidence interval 0.90 to 2.49).
However, the approximate indirect effect of visual impairment on suicide via poorer self-rated health was a significant 5% (HR 1.05, 95% CI 1.02 to 1.08).
For the number of non-ocular health conditions, the rate was a significant 12% (HR 1.12, 95% CI 1.01 to 1.24).
Click here to read the rest of this article from Medpage Today
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link to this post Thursday, July 17, 2008 4:43 PM
posted by Aric Thorpe, MHR Neonatal risks posed by mothers taking psychotropic drugs during pregnancy Currently, there is very little known about neonatal risks posed by mothers taking psychotropic drugs during pregnancy. However, two studies have provided some new data on neonatal outcomes associated with psychotropic drugs. The following is an excerpt of an article from Journal Watch that discusses the findings:
Using large medical, demographic, and public drug insurance registries in Quebec, researchers focused on women with psychiatric diagnoses (mostly, mood or anxiety disorders) and antidepressant use for at least 1 month in the year before pregnancy. Researchers compared first-trimester antidepressant exposure and duration in 2140 healthy infants and 189 infants with any major congenital malformation in the year after birth. Antidepressants commonly used were paroxetine (42%), sertraline (15%), and venlafaxine (13%). The risk for congenital malformation (8%, vs. the usual population rate of 3%) was unrelated to first-trimester antidepressant use, its duration, or therapeutic class. Controlling for ethnicity and for drug, alcohol, and tobacco use, determined in 806 mothers, did not alter results.
Other researchers linked maternal and neonatal British Columbian health records to identify recipients of a serotonin reuptake inhibitor… <click here to read the rest of this article from Journal Watch>
Severe psychiatric conditions should be treated at the discretion of a psychiatrist and at the consent of an educated patient or guardian during pregnancy. However, due to the relatively little known effects of psychotropic drugs on neonatal outcomes cognitive-behavioral therapy should be considered by physicians as an alternative to addressing anxiety and depression during pregnancy.
Click here for more information on the treatment of depression
Click here for more information on the treatment of anxiety disorders
link to this post Tuesday, July 15, 2008 8:32 AM
posted by Aric Thorpe, MHR Anxiety: "Let's get to the root of the problem" PSTD is among a variety of anxiety problems that clinicians are seeking innovations in treatment for, especially in light of the Iraq War. Generalized anxiety disorder, phobias, panic disorder, and obsessive-compulsive disorder result from both our environments as well as genetics. Anxiety is so familiar to us, so integral to our survival; separating environmental influences from genetics to truly discover the underlying cause of anxiety is a difficult task.
Many of the drugs that are currently used, such as benzodiazepines and antidepressants, work to deal with the symptoms of anxiety rather than the origin. However, now scientists are looking for drugs that affect the mechanisms that cause anxiety. Currently researchers are experimenting with propranolol, which is a heart disease drug that disrupts the action of stress hormones like epinephrine, for example. The following is an excerpt of an interesting article from The New York Times that further discusses developments in anxiety research and treatment:
Researchers have been experimenting with a heart disease drug called propranolol, for instance, which interferes with the action of stress hormones like epinephrine. Stress hormones are central to the human response to threat; they prime the body to fight or run, and appear to deepen the neural roots of a terrifying memory in the brain. When the memory returns, these hormones flood again into the bloodstream.
But in one series of studies, people with P.T.S.D. who took propranolol reacted more calmly — on measures of heart rate and sweat gland activity — upon revisiting a painful memory than did similar subjects who took a dummy pill. By blocking receptors on brain cells that are sensitive to stress hormones, experts theorize, the drug may have taken the sting out of the frightening recollections.
Propranolol has not been proved to reliably ease the effects of trauma, but the investigation of such drugs is only beginning. Another candidate, an antibiotic called D-cycloserine, may help severely anxious patients alter the way they think about and react to current everyday concerns.
Click here to read the rest of this article from the New York Times
Click here for more information on anxiety disorders
link to this post Monday, July 14, 2008 8:42 AM
posted by Aric Thorpe, MHR Heavy drinking associated with different risks for men and women According to a recent study published in the Journal of the American Heart Association, heavy drinking (approximately four drinks a day) is associated with increased mortality in both men and women. The study, authored by Hiroyasu Iso, M.D., Ph.D., of Osaka University, and colleagues, found more specifically that men who drank four drinks a day were at elevated risk for stroke (HR 1.48, 95% CI 1.22 to 1.80), while women were not. Conversely, women who drank at least four drinks a day had a four-fold increase in risk for coronary heart disease; men that drank four drinks a day, however, had a nonsignificant 19% reduction in risk of dying from coronary heart disease. The following is an excerpt of an article from Medpage Today that reviews the study's findings:
Previous cohort studies have explored the connection between drinking alcohol and cardiovascular risk, but none have involved Asian women, "probably because of the low prevalence of drinkers and coronary heart disease," according to the researchers.
To explore the issue, they turned to the Japan Collaborative Cohort Study, in which 34,776 men and 48,906 women living in 45 communities completed a baseline questionnaire that included information about alcohol consumption. The participants (ages 40 to 79 at baseline) were then followed for a median of 14.2 years.
Compared with nondrinkers, both male and female moderate-to-heavy drinkers -- those who consume two or more drinks a day -- tended to be younger, more hypertensive, and more likely to smoke (P<0.001 for all).
During the study, 1,628 participants (864 men and 764 women) died from stroke and 736 (431 men and 305 women) died from coronary heart disease.
Among men, consuming at least four drinks a day was associated with increased mortality from total stroke (HR 1.48, 95% CI 1.22 to 1.80), and hemorrhagic (HR 1.67, 95% CI 1.17 to 2.38), intraparenchymal (HR 1.62, 95% CI 1.07 to 2.45), and ischemic (HR 1.35, 95% CI 1.04 to 1.75) subtypes.
This level of alcohol consumption appeared to be associated with protection against coronary heart disease, but the risk reduction was not statistically significant (HR 0.81, 95% CI 0.61 to 1.08).
Men who drank 69 grams of alcohol -- about six drinks -- a day or more were at an elevated risk of total stroke (HR 1.71, 95% CI 1.31 to 2.24) and total cardiovascular disease (HR 1.28, 95% CI 1.07 to 1.55).
Click here to read the rest of this article from Medpage Today
Click here for information on the treatment of alcoholism
link to this post Friday, July 11, 2008 8:31 AM
posted by Aric Thorpe, MHR Risks of Suicidal Ideation and Behavior with Epilepsy Drugs Reaffirmed The FDA released the results of an analysis of 11 anticonvulsant drugs used primarily for seizures and certain psychiatric conditions in January, which found double the risk of suicidality associated with the drugs. Accordingly, the FDA voted that risks be described in a medication guide that patients taking the drugs would be provided. The FDA has yet to issue a black box warning due to concerns that such a warning would prevent physicians from prescribing such drugs to those that need them. However, Russell Katz, M.D., director of neurology products for the FDA's Center for Drug Evaluation and Research, said that the FDA may still issue a black box warning. The following is an excerpt of an article from Medpage Today that discusses the FDA's findings:
The drugs evaluated were carbamazepine (Carbatrol, Equetro, Tegretol, Tegretol XR), felbamate (Felbatol), gabapentin (Neurontin), lamotrigine (Lamictal), levetiracetam (Keppra), oxcarbazepine (Trileptal), pregabalin (Lyrica), tiagabine (Gabitril), topiramate (Topamax), divalproex sodium (Depakote), and zonisamide (Zonegran).
A meta-analysis of 199 placebo-controlled trials consisting of 27,863 patients on active treatment and 16,029 on placebo found that 0.37% of those receiving one of the 11 drugs and 0.22% of those taking placebo had suicidal ideation or behavior (OR 1.80, 95% CI 1.24 to 2.66).
For three of the drugs, there was no increased risk for suicidality -- carbamazepine (OR 0.66), felbamate (OR not defined), divalproex (OR 0.91). The elevated risk only reached nominal significance for two of the other eight.
Dr. Katz explained why the agency and the committees concluded that the warnings should be applied to all epilepsy drugs.
The committee members "felt that the signal occurred across a whole range of drugs with different mechanisms of action," he said, "so it's perfectly reasonable to conclude that the other drugs that weren't studied were likely to show the same signal."
Click here to read the rest of this article from Medpage Today
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Rolf B. Gainer, Ph.D., Diplomate ABDA, is the Chief Executive Office at Brookhaven Hospital and the Vice President of Rehabilitation Institutes of America. Dr. Gainer has been involved in the design and operation of treatment programs since 1977.
Stephen Harnish, MD is the Medical Director of Brookhaven Hospital. Dr. Harnish is a member of the American Psychiatric Association and is well known in Oklahoma for his informative radio and television appearances.
Aric Thorpe, MHR, is Brookhaven Hospital's Pastoral Liaison Representative. He conducts the quarterly Minister's Lifeline series and provides mental health information to pastors and clergy.
Sarah McGee, BA, serves as the Community Education Provider for Brookhaven Hospital. She provides information on mental health and drug and alcohol treatment to healthcare professionals in Oklahoma and surrounding states. |
