People who experience a lot of negative emotions and do not express these experience more health problems, says Dutch researcher Aline Pelle. She discovered that heart failure patients with a negative outlook reported their complaints to a physician or nurse far less often. The personality of the partner can also exert a considerable influence on these patients.
Aline Pelle investigated patients with a so-called type D personality. These people experience a lot of negative emotions and do not express these for fear of being rejected by others. It was already known that such a type of personality in heart failure patients is associated with anxiety and depression and a reduced state of health. However, Aline Pelle also described which processes might contribute to this.
Many of the patients with a negative outlook were found not to contact the physician or specialist nurse in the event of heart failure symptoms. As a result of this they were six times more likely to experience a worse state of health than non-type D heart failure patients.
Better not a cheerful partner
Pelle established that not just the patient's personality but also that of the partner had a significant effect on the patient's mood. In particular, the combination within the couple proved to be particularly important. Type D patients with a non-type D partner reported the lowest marriage quality, even lower than that of type D patients with a partner with just as negative an outlook.
No cause for death
Although a type D personality is associated with a range of negative health outcomes, Pelle's results did not demonstrate a correlation with an increased risk of dying from heart failure. This observation refutes the results from a previous study.
Aline Pelle's research was part of Johan Denollet's Vici project. He received a Vici grant from NWO's Innovational Research Incentives Scheme in 2004.
суббота, 14 мая 2011 г.
Symptoms Of Depression Associated With Development Of Diabetes In Older Adults
Older adults who have had symptoms of depression whether those symptoms occurred once, increased or remained steady over a 10-year period may be more likely to develop diabetes than those without depressive symptoms, according to a report in the April 23 issue of Archives of Internal Medicine, one of the JAMA/Archives journals.
Previous research suggests that high levels of symptoms of depression, including irritability and trouble sleeping, are associated with increased risk of development of type 2 diabetes, according to background information in the article. However, with few exceptions, most of the studies have defined symptoms of depression based on a single survey filled out by participants. "Given the episodic nature of depression and depressive symptoms, a single self-report of symptoms may not fully characterize the association between depressive symptoms and diabetes," the authors write.
Mercedes R. Carnethon, Ph.D., of Feinberg School of Medicine, Northwestern University, Chicago, and colleagues followed a group of 4,681 participants age 65 and older (average age 72.7) who did not have diabetes at the beginning of the study in 1989. Each year for 10 years, the participants were evaluated for the presence of 10 symptoms of depression, including those related to mood, irritability, calorie intake, concentration and sleep. Symptoms were scored on a scale of zero to 30, with scores of eight or higher indicating high levels of symptoms. Sociodemographic characteristics, clinical measures including height and weight, and information about medication use that would indicate the development of diabetes were also updated annually.
At the beginning of the study, the average depressive symptom score was 4.5, and one-fifth of participants had a score of eight or higher. During the follow-up period, scores increased by at least five points in nearly half the participants, and 234 individuals developed diabetes. Rates of diabetes were higher among those with a score of eight or higher, compared with those who had scores below eight.
"In this sample of older adults, a single report of high depressive symptoms, an increase in symptoms with time and persistently high symptoms over time are each associated with an excess incidence of diabetes," the authors write. "Furthermore, increasing symptoms with time are associated with incident diabetes beyond initial high depressive symptoms and the association between increasing scores and incident diabetes was strongest among those with initially low baseline scores."
These associations were not explained by considering other risk factors for diabetes, including physical activity, smoking and body mass index. "The pathophysiologic mechanism for this association remains unclear," the authors write.
"Our findings in this population of older adults are of particular public health importance because there are 35 million U.S. adults older than 65 years," they conclude. Because an estimated 2 million older adults experience depression or a related illness and 15.3 percent of those over 65 have diabetes, "findings from this study of a novel and highly prevalent risk factor for diabetes have important implications for a substantial subset of our population."
American Medical Association (AMA)
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Previous research suggests that high levels of symptoms of depression, including irritability and trouble sleeping, are associated with increased risk of development of type 2 diabetes, according to background information in the article. However, with few exceptions, most of the studies have defined symptoms of depression based on a single survey filled out by participants. "Given the episodic nature of depression and depressive symptoms, a single self-report of symptoms may not fully characterize the association between depressive symptoms and diabetes," the authors write.
Mercedes R. Carnethon, Ph.D., of Feinberg School of Medicine, Northwestern University, Chicago, and colleagues followed a group of 4,681 participants age 65 and older (average age 72.7) who did not have diabetes at the beginning of the study in 1989. Each year for 10 years, the participants were evaluated for the presence of 10 symptoms of depression, including those related to mood, irritability, calorie intake, concentration and sleep. Symptoms were scored on a scale of zero to 30, with scores of eight or higher indicating high levels of symptoms. Sociodemographic characteristics, clinical measures including height and weight, and information about medication use that would indicate the development of diabetes were also updated annually.
At the beginning of the study, the average depressive symptom score was 4.5, and one-fifth of participants had a score of eight or higher. During the follow-up period, scores increased by at least five points in nearly half the participants, and 234 individuals developed diabetes. Rates of diabetes were higher among those with a score of eight or higher, compared with those who had scores below eight.
"In this sample of older adults, a single report of high depressive symptoms, an increase in symptoms with time and persistently high symptoms over time are each associated with an excess incidence of diabetes," the authors write. "Furthermore, increasing symptoms with time are associated with incident diabetes beyond initial high depressive symptoms and the association between increasing scores and incident diabetes was strongest among those with initially low baseline scores."
These associations were not explained by considering other risk factors for diabetes, including physical activity, smoking and body mass index. "The pathophysiologic mechanism for this association remains unclear," the authors write.
"Our findings in this population of older adults are of particular public health importance because there are 35 million U.S. adults older than 65 years," they conclude. Because an estimated 2 million older adults experience depression or a related illness and 15.3 percent of those over 65 have diabetes, "findings from this study of a novel and highly prevalent risk factor for diabetes have important implications for a substantial subset of our population."
American Medical Association (AMA)
515 N. State St.
Chicago, IL 60610
United States
ama-assn
Improving Sleep Quality Could Ease Disability In Rheumatoid Arthritis Patients
A study in the Feb. 15 issue of the Journal of Clinical Sleep Medicine found that poor sleep quality correlated with higher levels of depressive symptoms, greater pain severity, increased fatigue, and greater functional disability in patients with Rheumatoid Arthritis (RA). The study suggests that addressing sleep problems via pharmacological or behavioral interventions may have a critical impact on the health and lives of patients with RA.
The study represents a cross-sectional examination of the relationship between sleep quality and functional disability in 162 patients with RA. The sample had an average age of 58.5 years, and 76 percent were female. All patients had been diagnosed with RA for at least two years; on average, patients had RA for 14 years.
Participants completed the following questionnaires: Pittsburgh Sleep Quality Index (PSQI), Beck Depression Inventory-II, Medical Outcomes Study Short Form - 36, and the Health Assessment Questionnaire. The results provided input on their sleep quality, depression, fatigue, and functional disability and pain severity, respectively. Patients also provided sociodemographic information and their medical history.
Results show that sleep quality has an indirect effect on functional disability after controlling for age, gender and number of comorbities. According to the PSQI results, 61 percent of patients were poor sleepers and 33 percent reported having pain that disturbed their sleep three or more times per week.
"The primary finding of our study is that poor sleep quality is associated with greater functional disability among patients with RA and this relationship may be explained by pain severity and fatigue," said lead author Dr. Faith S. Luyster, research assistant professor at the University of Pittsburgh School of Nursing in Pittsburgh, Pa. "These results highlight the importance of addressing sleep complaints among patients with RA. By treating sleep problems either pharmacologically or behaviorally, symptoms and activity limitations associated with RA may be reduced."
The study's finding that poorer sleep quality is associated with greater pain severity is consistent with recent evidence suggesting that sleep disruption may lower pain threshold and enhance pain in RA and otherwise healthy adults.
According to the National Institute of Health, RA is an inflammatory disease affecting about 1.3 million U.S. adults, and causes pain, swelling, stiffness, and loss of function in the joints. Disturbed sleep has been found to be a major concern among persons with RA.
Physical disability resulting from polyarticular joint disease in patients with RA may limit their ability to carry out daily activities such as dressing, walking, grooming, and writing - tasks that can be further restricted by fatigue, pain severity, and depression.
It is possible that functional disability may affect depression, pain severity and fatigue, which in turn may affect sleep quality. It is likely that the relationships are bidirectional to some extent.
"Not sleeping well at night can contribute to greater pain sensitivity and fatigue during the day which in turn can limit a patient's ability to engage in activities of daily living and discretionary activities," Luyster said.
Luyster noted that treating sleep disturbances in RA patients might have beneficial effects beyond improving sleep.
The study, "Sleep Quality and Functional Disability in Patients with Rheumatoid Arthritis," was supported by grants from the National Institute of Health.
The study represents a cross-sectional examination of the relationship between sleep quality and functional disability in 162 patients with RA. The sample had an average age of 58.5 years, and 76 percent were female. All patients had been diagnosed with RA for at least two years; on average, patients had RA for 14 years.
Participants completed the following questionnaires: Pittsburgh Sleep Quality Index (PSQI), Beck Depression Inventory-II, Medical Outcomes Study Short Form - 36, and the Health Assessment Questionnaire. The results provided input on their sleep quality, depression, fatigue, and functional disability and pain severity, respectively. Patients also provided sociodemographic information and their medical history.
Results show that sleep quality has an indirect effect on functional disability after controlling for age, gender and number of comorbities. According to the PSQI results, 61 percent of patients were poor sleepers and 33 percent reported having pain that disturbed their sleep three or more times per week.
"The primary finding of our study is that poor sleep quality is associated with greater functional disability among patients with RA and this relationship may be explained by pain severity and fatigue," said lead author Dr. Faith S. Luyster, research assistant professor at the University of Pittsburgh School of Nursing in Pittsburgh, Pa. "These results highlight the importance of addressing sleep complaints among patients with RA. By treating sleep problems either pharmacologically or behaviorally, symptoms and activity limitations associated with RA may be reduced."
The study's finding that poorer sleep quality is associated with greater pain severity is consistent with recent evidence suggesting that sleep disruption may lower pain threshold and enhance pain in RA and otherwise healthy adults.
According to the National Institute of Health, RA is an inflammatory disease affecting about 1.3 million U.S. adults, and causes pain, swelling, stiffness, and loss of function in the joints. Disturbed sleep has been found to be a major concern among persons with RA.
Physical disability resulting from polyarticular joint disease in patients with RA may limit their ability to carry out daily activities such as dressing, walking, grooming, and writing - tasks that can be further restricted by fatigue, pain severity, and depression.
It is possible that functional disability may affect depression, pain severity and fatigue, which in turn may affect sleep quality. It is likely that the relationships are bidirectional to some extent.
"Not sleeping well at night can contribute to greater pain sensitivity and fatigue during the day which in turn can limit a patient's ability to engage in activities of daily living and discretionary activities," Luyster said.
Luyster noted that treating sleep disturbances in RA patients might have beneficial effects beyond improving sleep.
The study, "Sleep Quality and Functional Disability in Patients with Rheumatoid Arthritis," was supported by grants from the National Institute of Health.
Patients Hospitalized For Mental Illness In Ontario See Decrease In Signs Of Depression, Aggression
In 2007-2008, there were more than 52,000 admissions to mental health beds in Ontario, and new data show that the vast majority of these showed improvements during their hospital stay. For example, the analysis found that 83% of people hospitalized for mental illness were showing signs of depression at the time of their admission. Of those, 75% showed a decrease in signs of depression by the time they were discharged. Likewise, the majority of patients who showed signs of aggression at the time of admission for a mental illness (representing 29% of mental health hospitalizations) saw a decrease in aggressive behaviour at the time of discharge.
The analysis released on March 31st by the Canadian Institute for Health Information (CIHI) presents new information relating to the characteristics and care needs of people 15 years of age and older admitted to a mental health bed in Ontario. Four out of five admissions were for people who had been living in a private residence before being admitted to hospital, and almost 9 out of 10 (89%) of those returned to that living setting upon discharge.
Exploring Hospital Mental Health Service Use in Ontario, 2007-2008 also demonstrates differences in life situations faced by those hospitalized for mental illness. People admitted to a mental health bed in Ontario were less likely than the general population to be employed (24% versus 64%), less likely to be married or living with a partner (29% versus 60%) and less likely to have received postsecondary education (39% versus 59%).
About CIHI
The Canadian Institute for Health Information (CIHI) collects and analyzes information on health and health care in Canada and makes it publicly available. Canada's federal, provincial and territorial governments created CIHI as a not-for-profit, independent organization dedicated to forging a common approach to Canadian health information. CIHI's goal: to provide timely, accurate and comparable information. CIHI's data and reports inform health policies, support the effective delivery of health services and raise awareness among Canadians of the factors that contribute to good health.
Source
Canadian Institute for Health Information
The analysis released on March 31st by the Canadian Institute for Health Information (CIHI) presents new information relating to the characteristics and care needs of people 15 years of age and older admitted to a mental health bed in Ontario. Four out of five admissions were for people who had been living in a private residence before being admitted to hospital, and almost 9 out of 10 (89%) of those returned to that living setting upon discharge.
Exploring Hospital Mental Health Service Use in Ontario, 2007-2008 also demonstrates differences in life situations faced by those hospitalized for mental illness. People admitted to a mental health bed in Ontario were less likely than the general population to be employed (24% versus 64%), less likely to be married or living with a partner (29% versus 60%) and less likely to have received postsecondary education (39% versus 59%).
About CIHI
The Canadian Institute for Health Information (CIHI) collects and analyzes information on health and health care in Canada and makes it publicly available. Canada's federal, provincial and territorial governments created CIHI as a not-for-profit, independent organization dedicated to forging a common approach to Canadian health information. CIHI's goal: to provide timely, accurate and comparable information. CIHI's data and reports inform health policies, support the effective delivery of health services and raise awareness among Canadians of the factors that contribute to good health.
Source
Canadian Institute for Health Information
Skin Condition Associated With Depression, Anxiety And Suicidal Feelings
Individuals with psoriasis appear to have an increased risk of depression, anxiety and suicidality, according to a report in the August issue of Archives of Dermatology, one of the JAMA/Archives journals.
Psoriasis affects 1 percent to 3 percent of the general population, and estimates suggest 0.4 percent to 2.3 percent of adults have the condition but have not been diagnosed. "Psoriasis has long been recognized to be associated with potentially adverse effects on mental health," the authors write. "In the 1960s, a popular ad campaign labeled the emotional burden of this skin disease as the 'heartbreak of psoriasis.' However, there have been relatively few studies evaluating psychological outcomes in patients with psoriasis."
Shanu Kohli Kurd, M.D., M.S.C.E, M.H.S., and colleagues at the University of Pennsylvania, Philadelphia, studied data from electronic medical records in the United Kingdom from 1987 to 2002. The analyses included 146,042 patients with mild psoriasis, 3,956 patients with severe psoriasis and 766,950 patients without psoriasis (five control patients for each patient with psoriasis, selected from the same practice and similar entry dates). Patients were defined as having new-onset depression, anxiety or suicidality if corresponding diagnostic codes appeared in their records after follow-up began.
Of patients with mild or severe psoriasis, 25.9 per 1,000 individuals per year were diagnosed with depression, 20.9 per 1,000 per year with anxiety and 0.9 per 1,000 per year with suicidality. The rate of these cases attributable to psoriasis was 11.8 per 1,000 individuals per year for depression, 8.1 per 1,000 per year for anxiety and 0.4 per 1,000 per year for suicidality.
"Stated another way, the excess risk attributable to psoriasis is one case of depression for every 39 patients with severe psoriasis per year (or per 87 patients in patients with mild psoriasis per year)," the authors write. "The excess risks associated with psoriasis for anxiety and suicidality correspond to one case per 123 and 2,500 patients with psoriasis per year, respectively." Considering this data and the prevalence of psoriasis in the U.K., the authors estimate that there are more than 10,400 diagnoses of depression, 7,100 of anxiety and 350 of suicidality related to psoriasis each year.
"It is important to identify these psychiatric disorders because they represent substantial morbidity that can be improved with a variety of pharmacological and non-pharmacological approaches," the authors conclude. "Recent data suggest that psychiatric co-morbidity may negative affect response to certain psoriasis treatments (e.g., photochemotherapy), while other studies suggest that control of psoriasis is associated with improvements in psychological symptoms. Future studies are necessary to determine the mechanisms by which psoriasis is associated with depression, anxiety and suicidality as well as approaches to prevent such adverse outcomes in patients with psoriasis."
Arch Dermatol. 2010;146[8]:848-855. 2010;146[8]:891-895.
Psoriasis affects 1 percent to 3 percent of the general population, and estimates suggest 0.4 percent to 2.3 percent of adults have the condition but have not been diagnosed. "Psoriasis has long been recognized to be associated with potentially adverse effects on mental health," the authors write. "In the 1960s, a popular ad campaign labeled the emotional burden of this skin disease as the 'heartbreak of psoriasis.' However, there have been relatively few studies evaluating psychological outcomes in patients with psoriasis."
Shanu Kohli Kurd, M.D., M.S.C.E, M.H.S., and colleagues at the University of Pennsylvania, Philadelphia, studied data from electronic medical records in the United Kingdom from 1987 to 2002. The analyses included 146,042 patients with mild psoriasis, 3,956 patients with severe psoriasis and 766,950 patients without psoriasis (five control patients for each patient with psoriasis, selected from the same practice and similar entry dates). Patients were defined as having new-onset depression, anxiety or suicidality if corresponding diagnostic codes appeared in their records after follow-up began.
Of patients with mild or severe psoriasis, 25.9 per 1,000 individuals per year were diagnosed with depression, 20.9 per 1,000 per year with anxiety and 0.9 per 1,000 per year with suicidality. The rate of these cases attributable to psoriasis was 11.8 per 1,000 individuals per year for depression, 8.1 per 1,000 per year for anxiety and 0.4 per 1,000 per year for suicidality.
"Stated another way, the excess risk attributable to psoriasis is one case of depression for every 39 patients with severe psoriasis per year (or per 87 patients in patients with mild psoriasis per year)," the authors write. "The excess risks associated with psoriasis for anxiety and suicidality correspond to one case per 123 and 2,500 patients with psoriasis per year, respectively." Considering this data and the prevalence of psoriasis in the U.K., the authors estimate that there are more than 10,400 diagnoses of depression, 7,100 of anxiety and 350 of suicidality related to psoriasis each year.
"It is important to identify these psychiatric disorders because they represent substantial morbidity that can be improved with a variety of pharmacological and non-pharmacological approaches," the authors conclude. "Recent data suggest that psychiatric co-morbidity may negative affect response to certain psoriasis treatments (e.g., photochemotherapy), while other studies suggest that control of psoriasis is associated with improvements in psychological symptoms. Future studies are necessary to determine the mechanisms by which psoriasis is associated with depression, anxiety and suicidality as well as approaches to prevent such adverse outcomes in patients with psoriasis."
Arch Dermatol. 2010;146[8]:848-855. 2010;146[8]:891-895.
Physical And Psychological Torture Have Similar Mental Effects
Forms of ill treatment during captivity that do not involve physical pain - such as psychological manipulation, deprivation, humiliation and forced stress positions - appear to cause as much mental distress and traumatic stress as physical torture, according to a report in the March issue of Archives of General Psychiatry, one of the JAMA/Archives journals.
Most widely accepted definitions of torture encompass both physical and mental pain and suffering, according to background information in the article. "After reports of human rights abuses by the U.S. military in Guantanamo Bay, Iraq and Afghanistan, a U.S. Defense Department working group report on detainee interrogations and a U.S. Justice Department memorandum on U.S. torture policy argued for a fairly narrow definition of torture that excludes mental pain and suffering caused by various acts that do not cause severe physical pain," the study authors write. The detention and interrogation procedures that are excluded from this definition include blindfolding and hooding, forced nudity, isolation and psychological manipulations.
Metin Basoglu, M.D., Ph.D., King's College, University of London, and colleagues interviewed 279 survivors of torture from Sarajevo in Bosnia and Herzegovina, Luka in Republica Srpska, Rijeka in Croatia and Belgrade in Serbia between 2000 and 2002. The survivors (average age 44.4, 86.4 percent men) were asked which of 54 war-related stressors and 46 different forms of torture they had experienced. Each participant then rated each event on scales of zero to four for distress (where zero was not at all distressing and four was extremely distressing) and loss of control (where zero was completely in control and four was not at all in control or completely helpless). Then, they reported how distressed or out of control they felt overall during the torture. Clinicians also assessed the survivors for post-traumatic stress disorder (PTSD) and other psychiatric conditions.
The participants reported an average of 19 war-related stressors and 19.3 types of torture. An average of 96.3 months had passed since their last torture experience. More than three-fourths (174) of the survivors had PTSD related to their torture at some point in their lives, 55.7 percent (128) had current PTSD, 17 percent (39) were currently depressed and 17.4 percent (40) had a past episode of major depression.
To more easily compare forms of torture, the researchers divided events into seven broad categories: sexual torture; physical torture; psychological manipulations, such as threats of rape or witnessing the torture of others; humiliating treatment, including mockery and verbal abuse; exposure to forced stress positions, such as bondage with rope or other restrictions of movement; loud music, cold showers and other sensory discomforts; and deprivation of food, water or other basic needs.
Participants who had undergone physical torture rated their experiences from 3.2 to 3.8 on the distress scale. Sixteen of the 33 stressors from other categories were rated in the same range of distress. "Sham executions, witnessing torture of close ones, threats of rape, fondling of genitals and isolation were associated with at least as much if not more distress than some of the physical torture stressors," the authors write. "There was thus substantial overlapping between physical torture and other stressors in terms of associated distress. The control ratings also showed a similar pattern."
Physical torture was not significantly associated with PTSD or depression, suggesting that both physical and non-physical treatments caused the conditions at similar rates. "The traumatic stress impact of torture (physical or non-physical torture and ill treatment) seemed to be determined by perceived uncontrollability and distress associated with the stressors," the authors continue.
The authors concluded that aggressive interrogation techniques or detention procedures involving deprivation of basic needs, exposure to adverse environmental conditions, forced stress positions, hooding or blindfolding, isolation, restriction of movement, forced nudity, threats, humiliating treatment and other psychological manipulations do not appear to be substantially different from physical torture in terms of the extent of mental suffering they cause, the underlying mechanisms of traumatic stress and their long-term traumatic effects. These findings do not support the distinction between torture versus "other cruel, inhuman and degrading treatment." Although international conventions prohibit both types of acts, "such a distinction nevertheless reinforces the misconception that cruel, inhuman and degrading treatment causes lesser harm and might therefore be permissible under exceptional circumstances. These findings point to a need for a broader definition of torture based on scientific formulations of traumatic stress and empirical evidence rather than on vague distinctions or labels that are open to endless and inconclusive debate and, most important, potential abuse."
(Arch Gen Psychiatry. 2007;64:277-285.)
This study was supported by grants from the Bromley Trust. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.
Editorial: No Difference Between Torture, Other Forms of Maltreatment
The distinction between torture and degrading treatment is not only useless, but also dangerous, writes Steven H. Miles, M.D., University of Minnesota, Minneapolis, in an accompanying editorial.
"Ba??o?°lu and colleagues show that the severity of long-lasting adverse mental effects is unrelated to whether the torture or degrading treatment is physical or psychological and unrelated to objective measures of the severity of techniques," Dr. Miles writes.
"The wrongness of these inflicted harms is compounded by the fact that most abused prisoners, including those in the present war on terror, are innocent or ignorant of terrorist activities. Innocent or not, torture survivors rarely get the mental health treatment they need. In addition, soldiers who participate in atrocities are themselves at increased risk of post-traumatic stress disorder."
Human rights - respecting nations and medical societies must band together to reinforce international authority against torture, he concludes. "In the 18th century, Europe abandoned legal interrogational torture on the twin conclusions that it was an affront to human dignity and a poor way to acquire information. Empirical research such as the article by Basoglu and colleagues can help us find that persuasive holding ground again."
(Arch Gen Psychiatry. 2007;64:275-276.)
Please see the article for additional information, including author contributions and affiliations, financial disclosures, funding and support, etc.
Contact: Metin Basoglu
JAMA and Archives Journals
Most widely accepted definitions of torture encompass both physical and mental pain and suffering, according to background information in the article. "After reports of human rights abuses by the U.S. military in Guantanamo Bay, Iraq and Afghanistan, a U.S. Defense Department working group report on detainee interrogations and a U.S. Justice Department memorandum on U.S. torture policy argued for a fairly narrow definition of torture that excludes mental pain and suffering caused by various acts that do not cause severe physical pain," the study authors write. The detention and interrogation procedures that are excluded from this definition include blindfolding and hooding, forced nudity, isolation and psychological manipulations.
Metin Basoglu, M.D., Ph.D., King's College, University of London, and colleagues interviewed 279 survivors of torture from Sarajevo in Bosnia and Herzegovina, Luka in Republica Srpska, Rijeka in Croatia and Belgrade in Serbia between 2000 and 2002. The survivors (average age 44.4, 86.4 percent men) were asked which of 54 war-related stressors and 46 different forms of torture they had experienced. Each participant then rated each event on scales of zero to four for distress (where zero was not at all distressing and four was extremely distressing) and loss of control (where zero was completely in control and four was not at all in control or completely helpless). Then, they reported how distressed or out of control they felt overall during the torture. Clinicians also assessed the survivors for post-traumatic stress disorder (PTSD) and other psychiatric conditions.
The participants reported an average of 19 war-related stressors and 19.3 types of torture. An average of 96.3 months had passed since their last torture experience. More than three-fourths (174) of the survivors had PTSD related to their torture at some point in their lives, 55.7 percent (128) had current PTSD, 17 percent (39) were currently depressed and 17.4 percent (40) had a past episode of major depression.
To more easily compare forms of torture, the researchers divided events into seven broad categories: sexual torture; physical torture; psychological manipulations, such as threats of rape or witnessing the torture of others; humiliating treatment, including mockery and verbal abuse; exposure to forced stress positions, such as bondage with rope or other restrictions of movement; loud music, cold showers and other sensory discomforts; and deprivation of food, water or other basic needs.
Participants who had undergone physical torture rated their experiences from 3.2 to 3.8 on the distress scale. Sixteen of the 33 stressors from other categories were rated in the same range of distress. "Sham executions, witnessing torture of close ones, threats of rape, fondling of genitals and isolation were associated with at least as much if not more distress than some of the physical torture stressors," the authors write. "There was thus substantial overlapping between physical torture and other stressors in terms of associated distress. The control ratings also showed a similar pattern."
Physical torture was not significantly associated with PTSD or depression, suggesting that both physical and non-physical treatments caused the conditions at similar rates. "The traumatic stress impact of torture (physical or non-physical torture and ill treatment) seemed to be determined by perceived uncontrollability and distress associated with the stressors," the authors continue.
The authors concluded that aggressive interrogation techniques or detention procedures involving deprivation of basic needs, exposure to adverse environmental conditions, forced stress positions, hooding or blindfolding, isolation, restriction of movement, forced nudity, threats, humiliating treatment and other psychological manipulations do not appear to be substantially different from physical torture in terms of the extent of mental suffering they cause, the underlying mechanisms of traumatic stress and their long-term traumatic effects. These findings do not support the distinction between torture versus "other cruel, inhuman and degrading treatment." Although international conventions prohibit both types of acts, "such a distinction nevertheless reinforces the misconception that cruel, inhuman and degrading treatment causes lesser harm and might therefore be permissible under exceptional circumstances. These findings point to a need for a broader definition of torture based on scientific formulations of traumatic stress and empirical evidence rather than on vague distinctions or labels that are open to endless and inconclusive debate and, most important, potential abuse."
(Arch Gen Psychiatry. 2007;64:277-285.)
This study was supported by grants from the Bromley Trust. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.
Editorial: No Difference Between Torture, Other Forms of Maltreatment
The distinction between torture and degrading treatment is not only useless, but also dangerous, writes Steven H. Miles, M.D., University of Minnesota, Minneapolis, in an accompanying editorial.
"Ba??o?°lu and colleagues show that the severity of long-lasting adverse mental effects is unrelated to whether the torture or degrading treatment is physical or psychological and unrelated to objective measures of the severity of techniques," Dr. Miles writes.
"The wrongness of these inflicted harms is compounded by the fact that most abused prisoners, including those in the present war on terror, are innocent or ignorant of terrorist activities. Innocent or not, torture survivors rarely get the mental health treatment they need. In addition, soldiers who participate in atrocities are themselves at increased risk of post-traumatic stress disorder."
Human rights - respecting nations and medical societies must band together to reinforce international authority against torture, he concludes. "In the 18th century, Europe abandoned legal interrogational torture on the twin conclusions that it was an affront to human dignity and a poor way to acquire information. Empirical research such as the article by Basoglu and colleagues can help us find that persuasive holding ground again."
(Arch Gen Psychiatry. 2007;64:275-276.)
Please see the article for additional information, including author contributions and affiliations, financial disclosures, funding and support, etc.
Contact: Metin Basoglu
JAMA and Archives Journals
Transcendental Meditation Shown To Reduce Depression: New Studies
The Transcendental Meditation® technique may be an effective approach to reduce symptoms of depression, according to two new studies to be presented at the 31st Annual Meeting of the Society of Behavioral Medicine in Seattle, Washington April 9th, 2010.
The studies, conducted at Charles Drew University in Los Angeles and University of Hawaii in Kohala included African Americans and Native Hawaiians, 55 years and older, who were at risk for cardiovascular disease. Participants were randomly allocated to the Transcendental Meditation program or health education control group, and assessed with a standard test for depression - the Center for Epidemiological Studies-Depression (CES-D) inventory over 9-12 months.
"Clinically meaningful reductions in depressive symptoms were associated with practice of the Transcendental Meditation program," said Sanford Nidich, EdD, lead author and senior researcher at the Institute for Natural Medicine and Prevention at Maharishi University of Management. "The findings of these studies have important implications for improving mental health and reducing the risk of cardiovascular morbidity and mortality," said Dr. Nidich.
Participants in both studies who practiced the Transcendental Meditation program showed significant reductions in depressive symptoms compared to health education controls. The largest decreases were found in those participants who had indications of clinically significant depression, with those practicing Transcendental Meditation showing an average reduction in depressive symptoms of 48%.
"These results are encouraging and provide support for testing the efficacy of Transcendental Meditation as a therapeutic adjunct in the treatment of clinical depression," said Hector Myers, PhD, study co-author and professor and director of Clinical Training in the Department of Psychology at U.C.L.A.
The results of these studies are timely. For older Americans, depression is a particularly debilitating disease, with approximately 20% suffering from some form of depression. Overall, 18 million men and women suffer from depression in the United States. Depression is a major risk factor for cardiovascular disease, with even a moderate level of depressive symptoms associated with increased cardiac events.
"The clinically significant reductions in depression without drugs or psychotherapy in these studies suggest the Transcendental Meditation program may improve mental and associated physical health in older high risk subjects," said Robert Schneider MD FACC, director of MUM's Institute for Natural Medicine and Prevention.
"The importance of reducing depression in the elderly at risk for heart disease cannot be overestimated," said Gary P. Kaplan MD PhD, Clinical Associate Professor of Neurology NYU School of Medicine. "Any technique not involving extra medication in this population is a welcome addition. I look forward to further research on the Transcendental Meditation technique and prevention of depression in other at-risk elderly populations, including those with stroke and other chronic diseases."
The studies were funded by grants from the National Institutes of Health - National Heart Lung and Blood Institute and National Center for Complementary and Alternative Medicine.
Facts on Study Design
The first study was conducted in collaboration with Dr. Hector Myers at the Charles R. Drew University of Medicine and Science in Los Angeles. It included a subgroup of 59 African American men and women, 55 years and older, with a minimum carotid artery wall thickness of 0.65 for women and 0.72 for men.
The second study was conducted in collaboration with Dr. Andrew Grandinetti at the University of Hawaii. Data was collected on 53 Native Hawaiian men in Kohala, Hawaii, 55 years and older, who had at least one additional major risk factor for cardiovascular disease.
Measurements with the Center for Epidemiological Studies Depression (CES-D) Rating Scale were taken at baseline, 3-month posttest, and 9-12 month posttest, comparing Transcendental Meditation to health education controls.
Both African Americans and Native Hawaiians suffer from higher rates of cardiovascular disease compared to whites. African Americans have approximately 1.5 times the rate of cardiovascular morbidity and mortality and Native Hawaiians have 2 to 4 times the rate of cardiovascular disease compared to the whites.
Facts on Depression
12.4 million women and 6.4 million men in the U.S. suffer from depression.
Approximately 20% of the elderly suffers from some form of depression according the National Institutes of Health.
Depression is an important risk factor for the development and progression of cardiovascular disease (CVD). Research has found that a dose-response effect exists whereby the level of depressive symptoms is linearly associated with the prevalence of cardiac events. Even a moderate level of depressive symptoms increases the risk for cardiac events.
The Medical Outcomes Study determined that depression was more impairing in terms of patient functioning and well being than arthritis, diabetes mellitus, and hypertension, among others, and is more disruptive for social functioning than all of the chronic medical conditions.
Research has shown that approximately 50% of patients suffering from major depression can be left undiagnosed by general practitioners.
Depression accounts for $83.1 billion in medical care and workplace costs.
The studies, conducted at Charles Drew University in Los Angeles and University of Hawaii in Kohala included African Americans and Native Hawaiians, 55 years and older, who were at risk for cardiovascular disease. Participants were randomly allocated to the Transcendental Meditation program or health education control group, and assessed with a standard test for depression - the Center for Epidemiological Studies-Depression (CES-D) inventory over 9-12 months.
"Clinically meaningful reductions in depressive symptoms were associated with practice of the Transcendental Meditation program," said Sanford Nidich, EdD, lead author and senior researcher at the Institute for Natural Medicine and Prevention at Maharishi University of Management. "The findings of these studies have important implications for improving mental health and reducing the risk of cardiovascular morbidity and mortality," said Dr. Nidich.
Participants in both studies who practiced the Transcendental Meditation program showed significant reductions in depressive symptoms compared to health education controls. The largest decreases were found in those participants who had indications of clinically significant depression, with those practicing Transcendental Meditation showing an average reduction in depressive symptoms of 48%.
"These results are encouraging and provide support for testing the efficacy of Transcendental Meditation as a therapeutic adjunct in the treatment of clinical depression," said Hector Myers, PhD, study co-author and professor and director of Clinical Training in the Department of Psychology at U.C.L.A.
The results of these studies are timely. For older Americans, depression is a particularly debilitating disease, with approximately 20% suffering from some form of depression. Overall, 18 million men and women suffer from depression in the United States. Depression is a major risk factor for cardiovascular disease, with even a moderate level of depressive symptoms associated with increased cardiac events.
"The clinically significant reductions in depression without drugs or psychotherapy in these studies suggest the Transcendental Meditation program may improve mental and associated physical health in older high risk subjects," said Robert Schneider MD FACC, director of MUM's Institute for Natural Medicine and Prevention.
"The importance of reducing depression in the elderly at risk for heart disease cannot be overestimated," said Gary P. Kaplan MD PhD, Clinical Associate Professor of Neurology NYU School of Medicine. "Any technique not involving extra medication in this population is a welcome addition. I look forward to further research on the Transcendental Meditation technique and prevention of depression in other at-risk elderly populations, including those with stroke and other chronic diseases."
The studies were funded by grants from the National Institutes of Health - National Heart Lung and Blood Institute and National Center for Complementary and Alternative Medicine.
Facts on Study Design
The first study was conducted in collaboration with Dr. Hector Myers at the Charles R. Drew University of Medicine and Science in Los Angeles. It included a subgroup of 59 African American men and women, 55 years and older, with a minimum carotid artery wall thickness of 0.65 for women and 0.72 for men.
The second study was conducted in collaboration with Dr. Andrew Grandinetti at the University of Hawaii. Data was collected on 53 Native Hawaiian men in Kohala, Hawaii, 55 years and older, who had at least one additional major risk factor for cardiovascular disease.
Measurements with the Center for Epidemiological Studies Depression (CES-D) Rating Scale were taken at baseline, 3-month posttest, and 9-12 month posttest, comparing Transcendental Meditation to health education controls.
Both African Americans and Native Hawaiians suffer from higher rates of cardiovascular disease compared to whites. African Americans have approximately 1.5 times the rate of cardiovascular morbidity and mortality and Native Hawaiians have 2 to 4 times the rate of cardiovascular disease compared to the whites.
Facts on Depression
12.4 million women and 6.4 million men in the U.S. suffer from depression.
Approximately 20% of the elderly suffers from some form of depression according the National Institutes of Health.
Depression is an important risk factor for the development and progression of cardiovascular disease (CVD). Research has found that a dose-response effect exists whereby the level of depressive symptoms is linearly associated with the prevalence of cardiac events. Even a moderate level of depressive symptoms increases the risk for cardiac events.
The Medical Outcomes Study determined that depression was more impairing in terms of patient functioning and well being than arthritis, diabetes mellitus, and hypertension, among others, and is more disruptive for social functioning than all of the chronic medical conditions.
Research has shown that approximately 50% of patients suffering from major depression can be left undiagnosed by general practitioners.
Depression accounts for $83.1 billion in medical care and workplace costs.
Study Indicates Effectiveness Of Online Screenings In Connecting Individuals At Risk For Depression To Treatment
Screening for Mental Health, Inc., the leading nonprofit provider of online and in-person mental health screening programs, today released results from a follow-up study of participants in the 2008 National Depression Screening Day® (NDSD) online program. The study found that over half of participants sought depression treatment in the three months following their initial screening. NDSD, the nation's oldest voluntary, community-based screening program for depression and related disorders, provides individuals with the opportunity to complete a validated screening questionnaire, receive educational information about depression, and obtain a recommendation and referral for further evaluation if warranted.
"The results of this study are very encouraging as they reinforce the effectiveness of anonymous, web-based screening programs in connecting individuals at risk for depression with treatment resources," said Douglas G. Jacobs, M.D., Associate Clinical Professor of Psychiatry at Harvard Medical School and founder of Screening for Mental Health, Inc. "Early detection of mental health disorders such as depression greatly increases the chances that an individual will receive the appropriate treatment and experience a better quality of life."
The study was conducted by Robert Aseltine, Ph.D., Professor of Behavioral Sciences and Community Health and Director of the Institute for Public Health Research at the University of Connecticut Health Center. Dr. Aseltine surveyed 322 participants who completed the depression screening tool online between October and December of 2008 and sought to evaluate the success of online screenings in leading individuals into treatment. According to the Depression and Bipolar Support Alliance, nearly two thirds of people suffering from depression do not seek help, but the NDSD survey suggests that confidential online screenings, which are highly accessible and nonthreatening to users, may help to improve these statistics.
Findings from the survey include:
- 55% of participants sought depression treatment within three months of screening.
- 31% of these had never previously been treated for depression.
- Of those seeking treatment, 52% received both counseling and medication, 28% received medication only, and 13% received counseling only.
- Over one third of participants with a likelihood of depression said that medication had helped "a lot."
- 55% of those who initially scored "Very Likely for Depression"-the highest possible score range in the NDSD screening-were no longer in that range at follow up.
- 46% of those who initially scored "Likely for Depression" were in the "Unlikely for Depression" range at follow up.
In recognition of National Depression Screening Day on Thursday, October 8th, 2009 community organizations, primary care providers, colleges and military installations throughout the nation will offer free, anonymous mental health screenings to educate members of the public on the symptoms of depression and the appropriate course of action to take. Individuals will have the opportunity to complete a brief questionnaire, and speak with a health care professional regarding their personal situations. In addition to the in-person events, members of the public can also take the screening online at MentalHealthScreening.
"The goal of NDSD is to reach that portion of the population with depression who are not seeking help," said Jacobs. "We have found these questionnaires and screenings to be a critical first step in educating individuals on how to seek help themselves or help loved ones who may be struggling with depression by recognizing certain behaviors."
Source
Mental Health, Inc.
"The results of this study are very encouraging as they reinforce the effectiveness of anonymous, web-based screening programs in connecting individuals at risk for depression with treatment resources," said Douglas G. Jacobs, M.D., Associate Clinical Professor of Psychiatry at Harvard Medical School and founder of Screening for Mental Health, Inc. "Early detection of mental health disorders such as depression greatly increases the chances that an individual will receive the appropriate treatment and experience a better quality of life."
The study was conducted by Robert Aseltine, Ph.D., Professor of Behavioral Sciences and Community Health and Director of the Institute for Public Health Research at the University of Connecticut Health Center. Dr. Aseltine surveyed 322 participants who completed the depression screening tool online between October and December of 2008 and sought to evaluate the success of online screenings in leading individuals into treatment. According to the Depression and Bipolar Support Alliance, nearly two thirds of people suffering from depression do not seek help, but the NDSD survey suggests that confidential online screenings, which are highly accessible and nonthreatening to users, may help to improve these statistics.
Findings from the survey include:
- 55% of participants sought depression treatment within three months of screening.
- 31% of these had never previously been treated for depression.
- Of those seeking treatment, 52% received both counseling and medication, 28% received medication only, and 13% received counseling only.
- Over one third of participants with a likelihood of depression said that medication had helped "a lot."
- 55% of those who initially scored "Very Likely for Depression"-the highest possible score range in the NDSD screening-were no longer in that range at follow up.
- 46% of those who initially scored "Likely for Depression" were in the "Unlikely for Depression" range at follow up.
In recognition of National Depression Screening Day on Thursday, October 8th, 2009 community organizations, primary care providers, colleges and military installations throughout the nation will offer free, anonymous mental health screenings to educate members of the public on the symptoms of depression and the appropriate course of action to take. Individuals will have the opportunity to complete a brief questionnaire, and speak with a health care professional regarding their personal situations. In addition to the in-person events, members of the public can also take the screening online at MentalHealthScreening.
"The goal of NDSD is to reach that portion of the population with depression who are not seeking help," said Jacobs. "We have found these questionnaires and screenings to be a critical first step in educating individuals on how to seek help themselves or help loved ones who may be struggling with depression by recognizing certain behaviors."
Source
Mental Health, Inc.
Relapse Of Depression Prevented In Many Women By Monthly Interpersonal Psychotherapy
Most women with recurrent depression may be able to prevent subsequent depressive episodes with monthly maintenance interpersonal psychotherapy (IPT), say researchers from the University of Pittsburgh School of Medicine in a study published in the May issue of the American Journal of Psychiatry.
Researchers found that once-per-month maintenance IPT, a form of therapy which focuses on relationships and interpersonal events that tend to trigger depression, was effective in preventing recurrence of depression in women who achieved remission through IPT alone. In fact, women who received prophylactic IPT once a month were no more likely to have a recurrence of their depression than those who received IPT two or four times a month. Maintenance IPT was found to be less effective for preventing recurrence in women who achieved remission through combination IPT and antidepressant therapy.
"Studies have shown that when a person recovers from depression by using medication, the best way for them to stay well is to continue on the same dosage of medication. However, many people, especially women of childbearing age or those taking medications for other conditions, may not feel comfortable taking antidepressants for long periods of time," said Ellen Frank, Ph.D., professor of psychiatry, University of Pittsburgh School of Medicine. "We found that interpersonal psychotherapy is a valid alternative to help women with recurrent depression remain symptom-free, especially women who were able to recover from a depressive episode using therapy alone."
The Pittsburgh study looked at 99 women whose depressive episodes remitted after outpatient treatment with IPT alone and 32 women who achieved remission with outpatient IPT and antidepressant treatment. The women were randomly assigned to receive maintenance IPT focused on preventing future depressive episodes at intervals of once per week, twice per month or once per month over the course of two years, or until they had a subsequent depressive episode.
Of those who initially remitted with IPT alone, 74 completed the two-year maintenance phase. Only 19, or 26 percent, had a recurrence of depression. Of those who remitted with IPT and antidepressant therapy, 26 completed the maintenance phase. Half had a recurrence of depression. In both groups there was no significant difference in recurrence rates between those who received maintenance IPT weekly, bi-monthly or monthly.
"Our study indicates, as many prior studies have, that not every person's depression is the same, nor should each person be treated the same way," said Dr. Frank. "Some people respond best to therapy, others to medication and others to a combination of the two. It's important that clinicians evaluate their patients carefully to determine the best treatment for each individual."
The study was funded by the National Institute of Mental Health.
Other authors include David J. Kupfer, M.D., Daniel J. Buysse, M.D., Holly A. Swartz, M.D., Paul A. Pilkonis, Ph.D., Patricia R. Houck, M.S.H., Paola Rucci, Ph.D., Danielle M. Novick, M.S., Victoria J. Grochocinski, Ph.D., and Deborah M. Stapf, B.S., all of the University of Pittsburgh.
Contact: Jocelyn Uhl Duffy
University of Pittsburgh Schools of the Health Sciences
Researchers found that once-per-month maintenance IPT, a form of therapy which focuses on relationships and interpersonal events that tend to trigger depression, was effective in preventing recurrence of depression in women who achieved remission through IPT alone. In fact, women who received prophylactic IPT once a month were no more likely to have a recurrence of their depression than those who received IPT two or four times a month. Maintenance IPT was found to be less effective for preventing recurrence in women who achieved remission through combination IPT and antidepressant therapy.
"Studies have shown that when a person recovers from depression by using medication, the best way for them to stay well is to continue on the same dosage of medication. However, many people, especially women of childbearing age or those taking medications for other conditions, may not feel comfortable taking antidepressants for long periods of time," said Ellen Frank, Ph.D., professor of psychiatry, University of Pittsburgh School of Medicine. "We found that interpersonal psychotherapy is a valid alternative to help women with recurrent depression remain symptom-free, especially women who were able to recover from a depressive episode using therapy alone."
The Pittsburgh study looked at 99 women whose depressive episodes remitted after outpatient treatment with IPT alone and 32 women who achieved remission with outpatient IPT and antidepressant treatment. The women were randomly assigned to receive maintenance IPT focused on preventing future depressive episodes at intervals of once per week, twice per month or once per month over the course of two years, or until they had a subsequent depressive episode.
Of those who initially remitted with IPT alone, 74 completed the two-year maintenance phase. Only 19, or 26 percent, had a recurrence of depression. Of those who remitted with IPT and antidepressant therapy, 26 completed the maintenance phase. Half had a recurrence of depression. In both groups there was no significant difference in recurrence rates between those who received maintenance IPT weekly, bi-monthly or monthly.
"Our study indicates, as many prior studies have, that not every person's depression is the same, nor should each person be treated the same way," said Dr. Frank. "Some people respond best to therapy, others to medication and others to a combination of the two. It's important that clinicians evaluate their patients carefully to determine the best treatment for each individual."
The study was funded by the National Institute of Mental Health.
Other authors include David J. Kupfer, M.D., Daniel J. Buysse, M.D., Holly A. Swartz, M.D., Paul A. Pilkonis, Ph.D., Patricia R. Houck, M.S.H., Paola Rucci, Ph.D., Danielle M. Novick, M.S., Victoria J. Grochocinski, Ph.D., and Deborah M. Stapf, B.S., all of the University of Pittsburgh.
Contact: Jocelyn Uhl Duffy
University of Pittsburgh Schools of the Health Sciences
When People With Alzheimer's Disease Should Stop Driving: AAN Issues Guideline
The American Academy of Neurology has issued a new guideline to help determine when people with Alzheimer's disease or another type of dementia should stop driving. The guideline is published in the April 12, 2010, online issue of Neurology®, the medical journal of the American Academy of Neurology, and was presented April 12, 2010, at the American Academy of Neurology's Annual Meeting in Toronto.
"While some people with dementia can still drive safely for a time, nearly all people with dementia will eventually have to give up driving," said lead guideline author Donald J. Iverson, MD, with the Humboldt Neurological Medical Group, Inc. in Eureka, Calif., and Fellow of the American Academy of Neurology. "It's important for doctors to discuss this with patients and caregivers soon after the diagnosis since restricted driving will affect the patient's quality of life and may lead to other health concerns such as depression."
The guideline recommends doctors use the Clinical Dementia Rating (CDR) scale to identify people with dementia at an increased risk of unsafe driving. The CDR provides a tool for clinicians to integrate information from caregivers and from direct examination of the patient to develop a comprehensive view of the dementia severity.
Evidence shows driving skills deteriorate with increasing dementia severity. "While patients with mild dementia, as a group, are higher-risk drivers, more recent studies report that as many as 76 percent are still able to pass an on-road driving test and can safely drive," said Iverson. "Faced with these facts, we needed to provide guidelines for doctors caring for these patients to identify those people at higher risk of unsafe driving, without unnecessarily restricting those who are safe drivers."
The guidelines also found that caregivers should trust their instincts. A study found that caregivers who rate a patient's driving as "marginal" or "unsafe" were often proven correct when the patient took an on-road driving test. On the other hand, patients who deemed their own driving as "safe" were not necessarily accurate in their own assessments.
Caregivers and family members play a role in identifying warning signs from unsafe drivers with dementia. These include:
Decreased miles being driven
Collisions
Moving violations
Avoiding certain driving situations, such as driving at night or in the rain
Aggressive or impulsive personality traits
"It is important that the decision to stop driving be directed by a doctor who is trained and experienced in working with people with dementia and their families," Iverson said. "Doctors should be aware that assessing driving ability is a complex process. More than one source of information is needed to make a judgment. In some situations, a dementia specialist may be needed."
Doctors, patients and caregivers must also know their state laws, since some states require that doctors report any medical conditions that may impact their ability to drive safely.
The guideline is an update of the 2000 American Academy of Neurology guideline on driving with dementia.
"While some people with dementia can still drive safely for a time, nearly all people with dementia will eventually have to give up driving," said lead guideline author Donald J. Iverson, MD, with the Humboldt Neurological Medical Group, Inc. in Eureka, Calif., and Fellow of the American Academy of Neurology. "It's important for doctors to discuss this with patients and caregivers soon after the diagnosis since restricted driving will affect the patient's quality of life and may lead to other health concerns such as depression."
The guideline recommends doctors use the Clinical Dementia Rating (CDR) scale to identify people with dementia at an increased risk of unsafe driving. The CDR provides a tool for clinicians to integrate information from caregivers and from direct examination of the patient to develop a comprehensive view of the dementia severity.
Evidence shows driving skills deteriorate with increasing dementia severity. "While patients with mild dementia, as a group, are higher-risk drivers, more recent studies report that as many as 76 percent are still able to pass an on-road driving test and can safely drive," said Iverson. "Faced with these facts, we needed to provide guidelines for doctors caring for these patients to identify those people at higher risk of unsafe driving, without unnecessarily restricting those who are safe drivers."
The guidelines also found that caregivers should trust their instincts. A study found that caregivers who rate a patient's driving as "marginal" or "unsafe" were often proven correct when the patient took an on-road driving test. On the other hand, patients who deemed their own driving as "safe" were not necessarily accurate in their own assessments.
Caregivers and family members play a role in identifying warning signs from unsafe drivers with dementia. These include:
Decreased miles being driven
Collisions
Moving violations
Avoiding certain driving situations, such as driving at night or in the rain
Aggressive or impulsive personality traits
"It is important that the decision to stop driving be directed by a doctor who is trained and experienced in working with people with dementia and their families," Iverson said. "Doctors should be aware that assessing driving ability is a complex process. More than one source of information is needed to make a judgment. In some situations, a dementia specialist may be needed."
Doctors, patients and caregivers must also know their state laws, since some states require that doctors report any medical conditions that may impact their ability to drive safely.
The guideline is an update of the 2000 American Academy of Neurology guideline on driving with dementia.
People With Severe Depression 'Find It Harder To Judge Facial Expressions'
New research shows people with severe depression find it harder to interpret facial expressions than healthy people - particularly expressions of disgust.
The study, published in the August issue of the British Journal of Psychiatry, was carried out by researchers from the University of Otago in New Zealand. Researchers Katie Douglas and Professor Richard Porter asked 68 people who had been diagnosed with severe depression to take part in a facial expression recognition task. They were shown a total of 96 faces displaying 5 basic emotions: angry, happy, sad, fearful and disgusted expressions. The participants were also shown faces displaying neutral expressions. Their performance was compared with a control group of 50 healthy individuals.
The researchers found that the control group were significantly better than the depression group at recognising facial expressions of disgust, indicating an impairment in the ability of people with severe depression to recognise disgusted facial expressions.
Researcher Professor Richard Porter, of the Department of Psychological Medicine at the University of Otago, said: "The specific impairment we found in the ability of people with severe depression to recognise disgusted facial expressions has not been previously reported. However, disgust recognition has been shown to be impaired in patients with Parkinson's disease who are not taking medication. We know that people with Parkinson's disease don't have enough of a brain chemical called dopamine. It's possible that the ability to recognise disgust is associated with dopamine dysfunction in people with severe depression as well.
"Another explanation is that people's emotional processing is affected when they are severely depressed. Admission to a psychiatric hospital is stressful, and patients are removed from their usual social environment and placed in close proximity with other distressed individuals."
The researchers have called for further research into whether people who are successfully treated for severe depression become better at disgust recognition. If so, this could possibly be used as a marker of treatment outcome for people with major depression.
The study also found differences in the way the two groups interpreted neutral faces. Those people with depression were more likely to interpret neutral faces as sad, and less likely to interpret neutral faces as happy compared to the control group - findings which are consistent with previous research studies.
References:
"Recognition of disgusted facial expressions in severe depression,"
Douglas GM and Porter RJ (2010)
British Journal of Psychiatry, 197: 156-157
Heart Attack Patients With Depression Less Likely To Receive Priority Care In Emergency Rooms
Heart attack patients with a history of depression presenting at emergency departments were less likely to receive priority care than people with other conditions, found a study published in CMAJ (Canadian Medical Association Journal).
Several studies indicate that people with heart attacks and depression have worse outcomes than people without, although emergency department care has not been looked at as a possible contributor. In the United States, more than six million patients with mental health issues are seen in emergency departments each year and six million people visit for chest pain.
This study, by researchers from the Institute of Clinical Evaluative Sciences, looked at data on 6,874 patients admitted to 96 acute care hospitals in Ontario, Canada from April 2004 to March 2005. They found that 680 of these heart attack patients had a history of depression recorded in their medical charts, and 39% of these were assigned a low priority triage score in the emergency department, compared with 32.7% of the other patients with heart attacks.
"Ten per cent of acute myocardial infarction patients seen in the emergency department had a history of depression recorded in their chart, and it was associated with an increased risk of receiving a low priority emergency department triage score, as well as delays in diagnostic testing and definitive care," writes Dr. Clare Atzema, Institute for Clinical Evaluative Sciences, with coauthors. "Interestingly, other components of the medical history, including the traditional cardiac risk factors of diabetes, smoking, hypercholesterolemia and hypertension, were not associated with triage score in the models; only depression affected the score."
As well, a lower triage priority based on charted depression resulted in delays in diagnosis and treatment by physicians, nurses, cardiologists and laboratory teams.
The authors suggest this lower prioritizing by emergency staff may be based on assumptions that patients' symptoms are anxiety-related rather than due to an actual heart attack. Less than 10% of patients who come to emergency rooms with heart attack symptoms, such as chest pain or shortness of breath, are found to be suffering from the condition. Therefore staff are actively looking for other possible sources for the patients' symptoms.
"We suspect that mistriage of these patients is not due to purposeful discrimination by emergency department staff, but rather that most emergency department staff are unaware of data that suggests a link between depression and coronary artery disease," write the authors. They suggest this information needs to be disseminated to emergency room staff.
Link to article
Source
Canadian Medical Association Journal
Several studies indicate that people with heart attacks and depression have worse outcomes than people without, although emergency department care has not been looked at as a possible contributor. In the United States, more than six million patients with mental health issues are seen in emergency departments each year and six million people visit for chest pain.
This study, by researchers from the Institute of Clinical Evaluative Sciences, looked at data on 6,874 patients admitted to 96 acute care hospitals in Ontario, Canada from April 2004 to March 2005. They found that 680 of these heart attack patients had a history of depression recorded in their medical charts, and 39% of these were assigned a low priority triage score in the emergency department, compared with 32.7% of the other patients with heart attacks.
"Ten per cent of acute myocardial infarction patients seen in the emergency department had a history of depression recorded in their chart, and it was associated with an increased risk of receiving a low priority emergency department triage score, as well as delays in diagnostic testing and definitive care," writes Dr. Clare Atzema, Institute for Clinical Evaluative Sciences, with coauthors. "Interestingly, other components of the medical history, including the traditional cardiac risk factors of diabetes, smoking, hypercholesterolemia and hypertension, were not associated with triage score in the models; only depression affected the score."
As well, a lower triage priority based on charted depression resulted in delays in diagnosis and treatment by physicians, nurses, cardiologists and laboratory teams.
The authors suggest this lower prioritizing by emergency staff may be based on assumptions that patients' symptoms are anxiety-related rather than due to an actual heart attack. Less than 10% of patients who come to emergency rooms with heart attack symptoms, such as chest pain or shortness of breath, are found to be suffering from the condition. Therefore staff are actively looking for other possible sources for the patients' symptoms.
"We suspect that mistriage of these patients is not due to purposeful discrimination by emergency department staff, but rather that most emergency department staff are unaware of data that suggests a link between depression and coronary artery disease," write the authors. They suggest this information needs to be disseminated to emergency room staff.
Link to article
Source
Canadian Medical Association Journal
A New Classification Of Different Types Of Depression
A new classification of depressive subtypes of depression has been proposed in the current issue of Psychotherapy and Psychosomatics. Lichtenberg and Belmaker argue that a simple diagnosis is no longer sufficient to guide treatment.
Recent years have witnessed a growing awareness of problems that call for a reassessment of how best to classify depression. It is unlikely that a syndrome as polymorphic and widely diagnosed as major depressive disorder (MDD) will reflect a single process. Attempts to delineate different forms of depression by statistically analyzing the symptomatology of large samples of patients without taking into consideration life events or childhood history have been unsuccessful. It may be necessary to consider childhood trauma, marital and employment stress, and medical health in diagnosing subtypes of depression. Epidemiologic data on the effects of childhood trauma, unemployment and divorce on depression incidence are strong. DSM-IV does make one allowance for circumstances by including a bereavement exclusion. However, it seems that bereavement is not different from other losses and stresses that are associated with depression.
In clinical practice, depression is often resistant to standard antidepressant medication, and a large percentage of patients respond just as well to placebo. The DSM broad diagnosis of MDD does not encourage a search for subtypes of depression that may require specific treatment. Most studies are commercially sponsored multicenter projects, and lump many possible subgroups under the rubric of MDD.
In fact, most clinicians subtype depression as a matter of course when describing patients to colleagues. It may be that the era of large commercial studies of antidepressants using MDD as a diagnosis is over. It may be possible to kick start the system by subtyping depression to encourage a period of small investigator-initiated studies of potential new treatments by subtype. In this paper, the Authors propose an intuition-based proposal for heuristically classifying depressions which, of course, is not an evidence-based replacement of the present DSM-IV MDD. These subtypes are the following:
Type A: Depression with Anxiety, characterized by an enduring tendency to experience anxiety and depression, and to show poor resilience under stress.
Type B: Acute Depression. This subtype has episodes that are relatively discreet and develop with no apparent precipitating stress, or the stress may be disproportionate to the intensity and duration of the depression. The severity of the depression can deteriorate into intense psychological pain and psychomotor retardation or agitation. Several authors have suggested that this subtype of depression should be termed 'melancholia'.
Type C: Adult Depression after Childhood Trauma. This form of depression may be unique. Individuals suffering early trauma or loss may develop lasting neurobiological changes, which render them vulnerable to stress throughout their life. In particular, sensitization of the hypothalamic-pituitary-adrenal (HPA) axis may remain throughout life.
Type D: Depressive Reaction to Separation Stress. This can be precipitated by acute psychosocial trauma such as bereavement, divorce, job loss or forced emigration, and may sometimes be more severe than other forms of depression. For months, and sometimes years afterwards, some may experience sadness, apathy, insomnia and pessimism.
Type E: Postpartum Depression. This has a typical peak onset in the first 3 months following delivery. There are vast reductions in estradiol and progesterone levels postpartum, but their exact relevance to the development of depression remains unproven. Psychosocial factors, such as an unsupportive partner or an unwanted pregnancy, have also repeatedly been found to be relevant to the development of postpartum depression.
Type F: Late-Life Depression. This occurs in elderly people with no prior personal or family history of depression, but often with risk factors for cardiovascular disease, such as hypertension, diabetes mellitus, smoking or hypercholesterolemia. The patient describes a gradual loss of energy and interest, and a diminishing ability to cope. Cognitive testing may show impairment.
Type G: Psychotic Depression. This form features delusions and severe disturbances in work and social function. Hyperactivity of the HPA axis as measured by dexamethasone nonsuppression is present in at least half of the patients. Antipsychotic medication in addition to antidepressants is indicated.
Type H: Atypical Depression. This subtype characterizes patients who show hypersomnia and hyperphagia instead of the insomnia and weight loss typical of acute depression. They have more anxiety, including panic disorder and social phobia, and they are more likely to be a suicide risk and to abuse drugs.
Type I: Bipolar Depression. This occurs in patients with previous episodes of mania and should also be considered in depressed patients with a strong family history of bipolar disorder.
Type J: Depression Secondary to Substance Abuse or to a Medical Condition. This subtype, which is recognized by DSM-IV, is a diverse group of disorders that can be difficult to treat. It is a striking biological fact that substances and medical conditions as diverse as therapeutic corticosteroids, illicit cocaine use or pancreatic carcinoma can cause depression.
Perhaps it is time for a paradigm shift. The subtypes discussed above can be operationalized, and new treatment trials powered for the smaller populations available for each subtype. The large pool of world depression investigators occupied with multicenter clinical trials of diminishing returns might be encouraged to initiate smaller trials in some of the specific subtypes. There is no guarantee of success in such a paradigm shift, but it is time for a change.
Subtyping of depression could lead to identification of subtypes that are more responsive to current pharmacological treatment, and aid in separating out the large burden of worldwide depression for which current antidepressants are not a highly effective treatment. This could help resolve the controversy over the appropriateness of current antidepressant education campaigns in the developing world.
Recent years have witnessed a growing awareness of problems that call for a reassessment of how best to classify depression. It is unlikely that a syndrome as polymorphic and widely diagnosed as major depressive disorder (MDD) will reflect a single process. Attempts to delineate different forms of depression by statistically analyzing the symptomatology of large samples of patients without taking into consideration life events or childhood history have been unsuccessful. It may be necessary to consider childhood trauma, marital and employment stress, and medical health in diagnosing subtypes of depression. Epidemiologic data on the effects of childhood trauma, unemployment and divorce on depression incidence are strong. DSM-IV does make one allowance for circumstances by including a bereavement exclusion. However, it seems that bereavement is not different from other losses and stresses that are associated with depression.
In clinical practice, depression is often resistant to standard antidepressant medication, and a large percentage of patients respond just as well to placebo. The DSM broad diagnosis of MDD does not encourage a search for subtypes of depression that may require specific treatment. Most studies are commercially sponsored multicenter projects, and lump many possible subgroups under the rubric of MDD.
In fact, most clinicians subtype depression as a matter of course when describing patients to colleagues. It may be that the era of large commercial studies of antidepressants using MDD as a diagnosis is over. It may be possible to kick start the system by subtyping depression to encourage a period of small investigator-initiated studies of potential new treatments by subtype. In this paper, the Authors propose an intuition-based proposal for heuristically classifying depressions which, of course, is not an evidence-based replacement of the present DSM-IV MDD. These subtypes are the following:
Type A: Depression with Anxiety, characterized by an enduring tendency to experience anxiety and depression, and to show poor resilience under stress.
Type B: Acute Depression. This subtype has episodes that are relatively discreet and develop with no apparent precipitating stress, or the stress may be disproportionate to the intensity and duration of the depression. The severity of the depression can deteriorate into intense psychological pain and psychomotor retardation or agitation. Several authors have suggested that this subtype of depression should be termed 'melancholia'.
Type C: Adult Depression after Childhood Trauma. This form of depression may be unique. Individuals suffering early trauma or loss may develop lasting neurobiological changes, which render them vulnerable to stress throughout their life. In particular, sensitization of the hypothalamic-pituitary-adrenal (HPA) axis may remain throughout life.
Type D: Depressive Reaction to Separation Stress. This can be precipitated by acute psychosocial trauma such as bereavement, divorce, job loss or forced emigration, and may sometimes be more severe than other forms of depression. For months, and sometimes years afterwards, some may experience sadness, apathy, insomnia and pessimism.
Type E: Postpartum Depression. This has a typical peak onset in the first 3 months following delivery. There are vast reductions in estradiol and progesterone levels postpartum, but their exact relevance to the development of depression remains unproven. Psychosocial factors, such as an unsupportive partner or an unwanted pregnancy, have also repeatedly been found to be relevant to the development of postpartum depression.
Type F: Late-Life Depression. This occurs in elderly people with no prior personal or family history of depression, but often with risk factors for cardiovascular disease, such as hypertension, diabetes mellitus, smoking or hypercholesterolemia. The patient describes a gradual loss of energy and interest, and a diminishing ability to cope. Cognitive testing may show impairment.
Type G: Psychotic Depression. This form features delusions and severe disturbances in work and social function. Hyperactivity of the HPA axis as measured by dexamethasone nonsuppression is present in at least half of the patients. Antipsychotic medication in addition to antidepressants is indicated.
Type H: Atypical Depression. This subtype characterizes patients who show hypersomnia and hyperphagia instead of the insomnia and weight loss typical of acute depression. They have more anxiety, including panic disorder and social phobia, and they are more likely to be a suicide risk and to abuse drugs.
Type I: Bipolar Depression. This occurs in patients with previous episodes of mania and should also be considered in depressed patients with a strong family history of bipolar disorder.
Type J: Depression Secondary to Substance Abuse or to a Medical Condition. This subtype, which is recognized by DSM-IV, is a diverse group of disorders that can be difficult to treat. It is a striking biological fact that substances and medical conditions as diverse as therapeutic corticosteroids, illicit cocaine use or pancreatic carcinoma can cause depression.
Perhaps it is time for a paradigm shift. The subtypes discussed above can be operationalized, and new treatment trials powered for the smaller populations available for each subtype. The large pool of world depression investigators occupied with multicenter clinical trials of diminishing returns might be encouraged to initiate smaller trials in some of the specific subtypes. There is no guarantee of success in such a paradigm shift, but it is time for a change.
Subtyping of depression could lead to identification of subtypes that are more responsive to current pharmacological treatment, and aid in separating out the large burden of worldwide depression for which current antidepressants are not a highly effective treatment. This could help resolve the controversy over the appropriateness of current antidepressant education campaigns in the developing world.
No Link Found Between Internet Dependence And Gambling Addiction
A study of university students found no overlap between those reporting excessive Internet use and those with problem gambling. However, both addictive behaviors are associated with psychological issues such as depression, anxiety, stress, and loneliness, according to a provocative Rapid Communication in Cyberpsychology, Behavior, and Social Networking, a peer-reviewed journal published by Mary Ann Liebert, Inc. The article is available free online here.
Both Internet dependence and problem gambling are typically viewed as behavioral addictions, and as such might be expected to affect the same individuals. But as N.A. Dowling, PhD, from the University of Melbourne, and M. Brown from Monash University, both in Australia, conclude in the article entitled, "Commonalities in the Psychological Factors Associated with Problem Gambling and Internet Dependence," these seem to be separate disorders that share common underlying psychological profiles, which has implications for their management.
Based on their assessment of a small group of university students in Australia, the authors report that similar vulnerabilities, attributable to feelings of anxiety, stress, depression, loneliness, and social isolation, appear to contribute to excesses in Internet use and gambling behavior. Effective treatments would likely integrate multiple types of interventions that target the specific problem behavior and the general tendency to addiction.
"It is clear that effectively evaluating and treating these disorders requires a clear understanding of the individual symptomatology and internal conflicts particular to each patient," says Brenda K. Wiederhold, PhD, MBA, BCIA, Editor-in-Chief of Cyberpsychology, Behavior, and Social Networking, from the Interactive Media Institute, San Diego, CA.
Both Internet dependence and problem gambling are typically viewed as behavioral addictions, and as such might be expected to affect the same individuals. But as N.A. Dowling, PhD, from the University of Melbourne, and M. Brown from Monash University, both in Australia, conclude in the article entitled, "Commonalities in the Psychological Factors Associated with Problem Gambling and Internet Dependence," these seem to be separate disorders that share common underlying psychological profiles, which has implications for their management.
Based on their assessment of a small group of university students in Australia, the authors report that similar vulnerabilities, attributable to feelings of anxiety, stress, depression, loneliness, and social isolation, appear to contribute to excesses in Internet use and gambling behavior. Effective treatments would likely integrate multiple types of interventions that target the specific problem behavior and the general tendency to addiction.
"It is clear that effectively evaluating and treating these disorders requires a clear understanding of the individual symptomatology and internal conflicts particular to each patient," says Brenda K. Wiederhold, PhD, MBA, BCIA, Editor-in-Chief of Cyberpsychology, Behavior, and Social Networking, from the Interactive Media Institute, San Diego, CA.
Depressed Heart Failure Patients May Benefit From Exercise Plus Psychological Counseling
Aerobic exercise combined with cognitive behavioral therapy may improve physical function, reduce depressive symptoms and enhance quality of life in depressed heart failure patients, researchers reported at the American Heart Association's 9th Scientific Forum on Quality of Care and Outcomes Research in Cardiovascular Disease and Stroke.
In a new study, researchers divided 74 heart failure patients with depression into four groups: one group received a 12-week, home-based program of exercise and psychological counseling; a second received psychological counseling alone; a third received exercise alone; and a fourth received usual care.
"By combining exercise with psychological counseling, these depressed patients do better in all parameters compared to the other groups," said Rebecca Gary, Ph.D., lead author of the study and assistant professor in the School of Nursing at Emory University in Atlanta, Ga. "This may be the best method for improving their depression, symptom severity, and quality of life."
Participants in the randomized, controlled pilot study were average age 66. The majority of patients were Caucasian and 57 percent were women. All participants were diagnosed with clinical depression, determined by psychiatric tests, using DSM-IV criteria and the Hamilton Rating Scale for Depression.
The participants were either New York Heart Association class II or class III heart failure patients. Class II patients have a slight limitation of physical activity. They are comfortable at rest but ordinary physical activity results in fatigue, palpitation, dyspnea or angina. Class III patients have a marked limitation of physical activity. They are comfortable at rest but less than ordinary activity causes fatigue, palpitation, dyspnea or angina.
"What makes this study different from other studies of exercise in heart failure patients is that all these patients were clinically depressed," Gary said.
The four groups were assessed at four time intervals: baseline, after the 12-week intervention program, following the three-month telephone follow-up and at six months.
The exercise component was a 12-week, progressive program, with low-to-moderate intensity exercise, involving walking outdoors. Patients were encouraged to walk three times per week for at least 30 minutes. Patients in the combined program or exercise-only group received heart rate monitors and were taught how to self-monitor their exertion level, and when to stop exercising. All patients, despite initial symptoms and some being quite debilitated, achieved these goals.
A physical function test, the six-minute walk test, was administered at each of the time intervals.
"The cognitive behavioral therapy was geared toward changing the attitude of the patients about their illness," Gary said. "We wanted them to change their negative thoughts and beliefs and restructure and reformat how they think about their illness and limitations. For example, we developed a volunteer and activities sign-up sheet in each community that provided transportation for those who wanted to get out of the home or contribute in some way."
Cognitive therapy sessions were conducted, one-on-one in the home, once a week, for 12 weeks by psychiatric nurse specialists and Ph.D. students trained in counseling techniques.
Patients in the combined exercise and behavioral therapy group improved significantly better in the six-minute walk test than the other groups.
The combined group lowered depression symptoms by 10 points over the usual care group. A decrease in scores of 50 percent or more or a HAM-D score of less than 8 indicates remission of depression symptoms. Interestingly, although depressive symptoms were also reduced in the counseling-only group, they perceived their quality of life to be worse than the combined group or exercise group. The combined group lowered depression symptoms by 10 points over the usual care group.
Co-authors are: S. Dunbar, D.S.N.; E. Cress, Ph.D.; and G. Cotsonsis, Ph.D.
The study received funding from the American Heart Association "Beginning Grant in Aid" program from the association's Southeast Affiliate.
The American Heart Association/American Stroke Association has a national movement, Start!, that encourages all Americans to incorporate walking into their lives. The hub of the Start! movement is MyStart! Online, a free, Web-based fitness and nutrition tracker that offers constant, measurable, personal improvement. Available at americanheart/start.
Statements and conclusions of abstract authors presented at American Heart Association/American Stroke Association scientific meetings are solely those of the abstract authors and do not necessarily reflect association policy or position. The association makes no representation or warranty as to their accuracy or reliability.
NR08-1052 (QCOR 08/Gary)
Abstract 118
In a new study, researchers divided 74 heart failure patients with depression into four groups: one group received a 12-week, home-based program of exercise and psychological counseling; a second received psychological counseling alone; a third received exercise alone; and a fourth received usual care.
"By combining exercise with psychological counseling, these depressed patients do better in all parameters compared to the other groups," said Rebecca Gary, Ph.D., lead author of the study and assistant professor in the School of Nursing at Emory University in Atlanta, Ga. "This may be the best method for improving their depression, symptom severity, and quality of life."
Participants in the randomized, controlled pilot study were average age 66. The majority of patients were Caucasian and 57 percent were women. All participants were diagnosed with clinical depression, determined by psychiatric tests, using DSM-IV criteria and the Hamilton Rating Scale for Depression.
The participants were either New York Heart Association class II or class III heart failure patients. Class II patients have a slight limitation of physical activity. They are comfortable at rest but ordinary physical activity results in fatigue, palpitation, dyspnea or angina. Class III patients have a marked limitation of physical activity. They are comfortable at rest but less than ordinary activity causes fatigue, palpitation, dyspnea or angina.
"What makes this study different from other studies of exercise in heart failure patients is that all these patients were clinically depressed," Gary said.
The four groups were assessed at four time intervals: baseline, after the 12-week intervention program, following the three-month telephone follow-up and at six months.
The exercise component was a 12-week, progressive program, with low-to-moderate intensity exercise, involving walking outdoors. Patients were encouraged to walk three times per week for at least 30 minutes. Patients in the combined program or exercise-only group received heart rate monitors and were taught how to self-monitor their exertion level, and when to stop exercising. All patients, despite initial symptoms and some being quite debilitated, achieved these goals.
A physical function test, the six-minute walk test, was administered at each of the time intervals.
"The cognitive behavioral therapy was geared toward changing the attitude of the patients about their illness," Gary said. "We wanted them to change their negative thoughts and beliefs and restructure and reformat how they think about their illness and limitations. For example, we developed a volunteer and activities sign-up sheet in each community that provided transportation for those who wanted to get out of the home or contribute in some way."
Cognitive therapy sessions were conducted, one-on-one in the home, once a week, for 12 weeks by psychiatric nurse specialists and Ph.D. students trained in counseling techniques.
Patients in the combined exercise and behavioral therapy group improved significantly better in the six-minute walk test than the other groups.
The combined group lowered depression symptoms by 10 points over the usual care group. A decrease in scores of 50 percent or more or a HAM-D score of less than 8 indicates remission of depression symptoms. Interestingly, although depressive symptoms were also reduced in the counseling-only group, they perceived their quality of life to be worse than the combined group or exercise group. The combined group lowered depression symptoms by 10 points over the usual care group.
Co-authors are: S. Dunbar, D.S.N.; E. Cress, Ph.D.; and G. Cotsonsis, Ph.D.
The study received funding from the American Heart Association "Beginning Grant in Aid" program from the association's Southeast Affiliate.
The American Heart Association/American Stroke Association has a national movement, Start!, that encourages all Americans to incorporate walking into their lives. The hub of the Start! movement is MyStart! Online, a free, Web-based fitness and nutrition tracker that offers constant, measurable, personal improvement. Available at americanheart/start.
Statements and conclusions of abstract authors presented at American Heart Association/American Stroke Association scientific meetings are solely those of the abstract authors and do not necessarily reflect association policy or position. The association makes no representation or warranty as to their accuracy or reliability.
NR08-1052 (QCOR 08/Gary)
Abstract 118
A Lack In Research And Effective Treatments For Body Dysmorphic Disorder
Medication and psychotherapy may be beneficial for patients suffering from body dysmorphic disorder (BDD). But a new Cochrane Review found that much more research is required to determine the most effective treatment and whether both approaches should be used in combination.
Body dysmorphic disorder affects as many as one in 20 people. Patients suffering from BDD worry obsessively about their physical appearance, with concerns frequently but not exclusively focused on the skin, hair and nose, and often have very low levels of self-esteem. Many are also diagnosed with depression and around a quarter may attempt suicide. According to Cochrane Researchers, however, there is currently very little evidence regarding the relative effectiveness of drug treatment and psychotherapy approaches.
"Given the number of people suffering from BDD and the level of distress caused, it is surprising that so little data is available on treatments. This is certainly a field that deserves additional attention and funding," said lead researcher, Jonathan Ipser, who works at the MRC Research Unit for Anxiety and Stress Disorders at the University of Stellenbosch, South Africa.
Ipser and colleagues carried out a systematic review of currently available evidence, analysing data from four trials, which together included 169 patients. They found that over half of people treated in a single trial with the antidepressant fluoxetine for 12 weeks showed improvement, compared to less than a quarter of those given a placebo. And in two 12 week trials of cognitive behavioural therapy (CBT), symptom severity was significantly reduced. Both types of treatment were well tolerated, with no severe adverse effects reported.
"Both approaches seem to be acceptable to patients with this condition, as shown by low drop-out rates in trials. There was also some suggestion that psychotherapy could reduce the risk of future relapse, although we need more data on long term treatment effects to confirm this," said Ipser.
Body dysmorphic disorder affects as many as one in 20 people. Patients suffering from BDD worry obsessively about their physical appearance, with concerns frequently but not exclusively focused on the skin, hair and nose, and often have very low levels of self-esteem. Many are also diagnosed with depression and around a quarter may attempt suicide. According to Cochrane Researchers, however, there is currently very little evidence regarding the relative effectiveness of drug treatment and psychotherapy approaches.
"Given the number of people suffering from BDD and the level of distress caused, it is surprising that so little data is available on treatments. This is certainly a field that deserves additional attention and funding," said lead researcher, Jonathan Ipser, who works at the MRC Research Unit for Anxiety and Stress Disorders at the University of Stellenbosch, South Africa.
Ipser and colleagues carried out a systematic review of currently available evidence, analysing data from four trials, which together included 169 patients. They found that over half of people treated in a single trial with the antidepressant fluoxetine for 12 weeks showed improvement, compared to less than a quarter of those given a placebo. And in two 12 week trials of cognitive behavioural therapy (CBT), symptom severity was significantly reduced. Both types of treatment were well tolerated, with no severe adverse effects reported.
"Both approaches seem to be acceptable to patients with this condition, as shown by low drop-out rates in trials. There was also some suggestion that psychotherapy could reduce the risk of future relapse, although we need more data on long term treatment effects to confirm this," said Ipser.
Champix May Have Led To TV Editors Suicide
A coroner has linked an anti-smoking drug to the death of a television editor who killed himself.
Omer Jama, 39, who worked for Sky Sports, was found dead at his home two months after being prescribed Champix to help him quit smoking.
An inquest in Bolton was told that Mr Jama had slashed his wrists and stabbed himself in the thigh and stomach.
However, the coroner, Jennifer Leeming, said she could not record a verdict of suicide and instead recorded an open verdict.
She said: "For me to register that he took his own life I would have to be satisfied he did the act which led to his death and he knew what he was doing."
"On the evidence before me I cannot say that was the case."
She said that she would write to the European Medicines Agency (EMA), which has been monitoring Champix since it was authorised in the EU in September 2006, to register the death as an "adverse event."
Julie Evans, a forensic toxicology expert, told the inquest that traces of the drug in Mr Jama's blood did not indicate an overdose. But she said reports from the United States had recorded "suicidal" thoughts in patients.
She said: "There is a possibility he could have been influenced by the side effects of the drug."
The EMA, which licensed the drug, issued guidance on its active ingredient, varenicline, to doctors two months after Mr Jama's death last October.
It said "updated warnings" were needed to raise awareness of cases of suicide attempts reported in patients after the drug was allegedly linked to 37 US suicide cases.
Last year, the EMA received 839 reports of adverse reactions, of which 46 were linked to depression and 16 to patients claiming to have suffered suicidal thoughts.
His brother, Ali Jama, 41, said: "It is clear from the evidence of the toxicologist that Champix's influence could have played a part. I would like to see more investigation done."
A spokesman for Pfizer, the makers of Champix, said, no causal link had been established between the drug and depression.
He said: "Depression, rarely including suicidal ideation [suicidal thoughts], has been reported in patients undergoing a smoking cessation attempt. These symptoms have also been reported while quitting with varenicline. A relationship between varenicline and the reported symptoms hasn't been established but in some reports a link couldn't be excluded."
In February, the National Institute for Health and Clinical Excellence recommended that the drug should be prescribed to smokers wanting to kick their habit. However, it said the full side effects of Champix were not yet known.
ash.uk
Omer Jama, 39, who worked for Sky Sports, was found dead at his home two months after being prescribed Champix to help him quit smoking.
An inquest in Bolton was told that Mr Jama had slashed his wrists and stabbed himself in the thigh and stomach.
However, the coroner, Jennifer Leeming, said she could not record a verdict of suicide and instead recorded an open verdict.
She said: "For me to register that he took his own life I would have to be satisfied he did the act which led to his death and he knew what he was doing."
"On the evidence before me I cannot say that was the case."
She said that she would write to the European Medicines Agency (EMA), which has been monitoring Champix since it was authorised in the EU in September 2006, to register the death as an "adverse event."
Julie Evans, a forensic toxicology expert, told the inquest that traces of the drug in Mr Jama's blood did not indicate an overdose. But she said reports from the United States had recorded "suicidal" thoughts in patients.
She said: "There is a possibility he could have been influenced by the side effects of the drug."
The EMA, which licensed the drug, issued guidance on its active ingredient, varenicline, to doctors two months after Mr Jama's death last October.
It said "updated warnings" were needed to raise awareness of cases of suicide attempts reported in patients after the drug was allegedly linked to 37 US suicide cases.
Last year, the EMA received 839 reports of adverse reactions, of which 46 were linked to depression and 16 to patients claiming to have suffered suicidal thoughts.
His brother, Ali Jama, 41, said: "It is clear from the evidence of the toxicologist that Champix's influence could have played a part. I would like to see more investigation done."
A spokesman for Pfizer, the makers of Champix, said, no causal link had been established between the drug and depression.
He said: "Depression, rarely including suicidal ideation [suicidal thoughts], has been reported in patients undergoing a smoking cessation attempt. These symptoms have also been reported while quitting with varenicline. A relationship between varenicline and the reported symptoms hasn't been established but in some reports a link couldn't be excluded."
In February, the National Institute for Health and Clinical Excellence recommended that the drug should be prescribed to smokers wanting to kick their habit. However, it said the full side effects of Champix were not yet known.
ash.uk
Scientists Launch Major Study Into Depression
Depression will affect up to 25% of the population at some point in their lives. It also has been shown to have a strong genetic component. For example, if one of your close family members has depression, your chance of also being a sufferer is three to four times the general population risk.
Now University of Aberdeen researchers have joined forces with the University of Liverpool and the Institute of Psychiatry, King's College London to try to find the genetic causes of depression.
They believe the answers could lie with short DNA sequences which act as 'genetic switches' controlling key genes in an area of the brain that influences mood.
These switches ensure that certain genes are only used in the correct parts of the brain at the proper times and in the right dose. Any changes in these can cause imbalances in the amount of critical proteins in the brain that may increase susceptibility to depression.
Unlike genes, little is know of these switches, technically known as enhancers, because up until now they have been very hard to find.
Recently, however, it was found that these switches were so important in evolution that they have been kept, nearly unchanged, through hundreds of millions of years from a time before the dinosaurs.
Dr Alasdair MacKenzie, Senior Lecturer at the University of Aberdeen, and the scientist leading the study, explained: "Only by comparing the genomes of species as diverse as mice, marsupials and birds has it been possible to identify these switches as, in many cases, they are located far away from the genes they control. The distances involved are as surprising as having a light bulb in London with the switch for controlling it in Liverpool."
Comparing the genomes of different species has helped them to identify the switches responsible for controlling genes known to be involved in depression, as well as addiction, obesity and inflammatory pain.
This new study funded by the Medical Research Council will allow them to build on their earlier work and also analyse common sequence differences found in the general population which can result in increased risk of developing depression.
Researchers in Aberdeen and Liverpool will study the functional effect of these 'switch' sequences. Scientists at the Institute of Psychiatry at King's, led by Dr Gerome Breen and Professor Peter McGuffin, will look at common variations found in these sequences using DNA samples taken from thousands of patients with chronic depression.
It is hoped the three year study - which will also examine why some sufferers do not respond to anti-depressant treatments - will ultimately pave the way for new drugs to treat the condition.
Dr Alasdair MacKenzie said: "This study would have been impossible even four years ago. It is only through advances in the sequencing of the DNA of many different species that we can now use powerful computers to pick out the most important bits of the human genome that includes the switches needed to control genes.
"In addition to depression, this technology has the potential for exploring the causes of a number of other disorders including chronic pain, obesity or even cancer."
Professor Quinn at the University of Liverpool said: "This study hopes to discover how the same genes in different people are controlled in slightly different ways in the parts of the brain that control fear and mood.
"We hope to link differences in the switches that control these genes with susceptibility to distressing conditions such as depression and chronic anxiety. Also, we hope to find out how these differences may change the way that depressed patients respond to their medicines."
Dr Breen, jointly leading the Institute of Psychiatry at King's involvement, said: "We can now analyse millions of genetic variations in the human genome but it is only studies like that that will allows us to track down those that are important in disorders such as depression."
Professor McGuffin added: "We are delighted to be part of such a potentially exciting project and look forward to our collaboration further enlightening clinical research and practice."
Notes
The University of Aberdeen is a centre of excellence for life sciences. Translational research is a particular strength for the University as its health campus is based on one of the largest teaching hospital sites in Europe. Lately the University has made major strategic investments to consolidate its position as one of the world's key centres for R&D in life sciences and medical research. One of the UK's most progressive fundraising higher education institutions, Aberdeen has recently recruited more than 50 senior academic leaders from institutions all over the world.
The University of Liverpool is a member of the Russell Group of leading research-intensive institutions in the UK. It attracts collaborative and contract research commissions from a wide range of national and international organisations valued at more than ??108 million annually.
Institute of Psychiatry
The Institute of Psychiatry is part of King's College London and closely affiliated to the South London and Maudsley NHS Foundation Trust. The Institute is a world-renowned centre for treatment, research and training in psychiatry and mental health. The organisation is involved in pioneering new and improved ways of understanding and treating mental illness and brain disease. Its wide-ranging field of work includes depression, trauma, eating disorders, brain imaging, genetics and psychosis. iop.kcl.ac.uk
King's College London is one of the top 25 universities in the world (Times Higher 2007) and the fourth oldest in England. A research-led university based in the heart of London, King's has 19,300 students from more than 130 countries, and 5,000 employees. King's has an outstanding reputation for providing world-class teaching and cutting-edge research. The College is in the top group of UK universities for research earnings and has an annual income of approximately ??400 million. An investment of ??500 million has been made in the redevelopment of its estate.
Institute of Psychiatry
Now University of Aberdeen researchers have joined forces with the University of Liverpool and the Institute of Psychiatry, King's College London to try to find the genetic causes of depression.
They believe the answers could lie with short DNA sequences which act as 'genetic switches' controlling key genes in an area of the brain that influences mood.
These switches ensure that certain genes are only used in the correct parts of the brain at the proper times and in the right dose. Any changes in these can cause imbalances in the amount of critical proteins in the brain that may increase susceptibility to depression.
Unlike genes, little is know of these switches, technically known as enhancers, because up until now they have been very hard to find.
Recently, however, it was found that these switches were so important in evolution that they have been kept, nearly unchanged, through hundreds of millions of years from a time before the dinosaurs.
Dr Alasdair MacKenzie, Senior Lecturer at the University of Aberdeen, and the scientist leading the study, explained: "Only by comparing the genomes of species as diverse as mice, marsupials and birds has it been possible to identify these switches as, in many cases, they are located far away from the genes they control. The distances involved are as surprising as having a light bulb in London with the switch for controlling it in Liverpool."
Comparing the genomes of different species has helped them to identify the switches responsible for controlling genes known to be involved in depression, as well as addiction, obesity and inflammatory pain.
This new study funded by the Medical Research Council will allow them to build on their earlier work and also analyse common sequence differences found in the general population which can result in increased risk of developing depression.
Researchers in Aberdeen and Liverpool will study the functional effect of these 'switch' sequences. Scientists at the Institute of Psychiatry at King's, led by Dr Gerome Breen and Professor Peter McGuffin, will look at common variations found in these sequences using DNA samples taken from thousands of patients with chronic depression.
It is hoped the three year study - which will also examine why some sufferers do not respond to anti-depressant treatments - will ultimately pave the way for new drugs to treat the condition.
Dr Alasdair MacKenzie said: "This study would have been impossible even four years ago. It is only through advances in the sequencing of the DNA of many different species that we can now use powerful computers to pick out the most important bits of the human genome that includes the switches needed to control genes.
"In addition to depression, this technology has the potential for exploring the causes of a number of other disorders including chronic pain, obesity or even cancer."
Professor Quinn at the University of Liverpool said: "This study hopes to discover how the same genes in different people are controlled in slightly different ways in the parts of the brain that control fear and mood.
"We hope to link differences in the switches that control these genes with susceptibility to distressing conditions such as depression and chronic anxiety. Also, we hope to find out how these differences may change the way that depressed patients respond to their medicines."
Dr Breen, jointly leading the Institute of Psychiatry at King's involvement, said: "We can now analyse millions of genetic variations in the human genome but it is only studies like that that will allows us to track down those that are important in disorders such as depression."
Professor McGuffin added: "We are delighted to be part of such a potentially exciting project and look forward to our collaboration further enlightening clinical research and practice."
Notes
The University of Aberdeen is a centre of excellence for life sciences. Translational research is a particular strength for the University as its health campus is based on one of the largest teaching hospital sites in Europe. Lately the University has made major strategic investments to consolidate its position as one of the world's key centres for R&D in life sciences and medical research. One of the UK's most progressive fundraising higher education institutions, Aberdeen has recently recruited more than 50 senior academic leaders from institutions all over the world.
The University of Liverpool is a member of the Russell Group of leading research-intensive institutions in the UK. It attracts collaborative and contract research commissions from a wide range of national and international organisations valued at more than ??108 million annually.
Institute of Psychiatry
The Institute of Psychiatry is part of King's College London and closely affiliated to the South London and Maudsley NHS Foundation Trust. The Institute is a world-renowned centre for treatment, research and training in psychiatry and mental health. The organisation is involved in pioneering new and improved ways of understanding and treating mental illness and brain disease. Its wide-ranging field of work includes depression, trauma, eating disorders, brain imaging, genetics and psychosis. iop.kcl.ac.uk
King's College London is one of the top 25 universities in the world (Times Higher 2007) and the fourth oldest in England. A research-led university based in the heart of London, King's has 19,300 students from more than 130 countries, and 5,000 employees. King's has an outstanding reputation for providing world-class teaching and cutting-edge research. The College is in the top group of UK universities for research earnings and has an annual income of approximately ??400 million. An investment of ??500 million has been made in the redevelopment of its estate.
Institute of Psychiatry
Linkages Between Serotonin Reuptake Inhibitors And Bone Mass Found By Forsyth Scientists
Scientists at The Forsyth Institute have found that fluoxetine (Prozac), a drug used in the treatment of depression and obsessive-compulsive disorders, increases bone mass. The team of researchers analyzed the ability of fluoxetine to stimulate new bone formation under normal conditions and to block bone loss caused by inflammation or estrogen loss due to ovariectomy. They found that the antidepressant induced the formation of new bone under normal conditions and reversed total bone loss triggered by inflammation.
Bone destruction is characteristic of several chronic inflammatory diseases including rheumatoid arthritis and gum disease. Previous research has shown a correlation between the serotonin transporter -- serotonin is the chemical substance involved in transmitting signals between neurons and which plays a role in anxiety and mood disorders-- and bone destructive cells (osteoclasts). (Fluoxetine is a serotonin reuptake inhibitor (SSRIs).) However, it was not clear what role serotonin played in bone metabolism.
Summary of Study
Trabecular bone, one of two main types of bone, is spongy, and makes up the bulk of the interior of most bones, including the vertebrae. After a six-week treatment with fluoxetine, laboratory mice showed increased trabecular bone volume and total volume in femurs and vertebrae as determined by micro-computed tomography. Fluoxetine-treated animals were not protected from bone loss after ovariectomy, suggesting that its anabolic effect requires the presence of estrogen. The effect on bone loss was also investigated following a bacterial-mediated inflammatory challenge. Injections of lipopolysaccharide (LPS), a component of the membrane of certain strains of bacteria, resulted in an increased number of osteoclasts and net bone loss. However, LPS given with fluoxetine caused new bone formation and a net gain in bone mass. The study concluded that fluoxetine treatment in vivo leads to increased bone mass under normal physiological conditions or inflammatory conditions, but does not prevent bone loss associated with estrogen deficiency.
This research, which will be published in the next issue of the Journal of Cellular Biochemistry, currently available online, was led by Ricardo Battaglino, PhD, Assistant Member of the Staff in the Department of Cytokine Biology at The Forsyth Institute.
"As this class of medication is widely prescribed and used across all age groups, the consequences of the relationship between these drugs and bone metabolism may be very relevant to public health. This work will help us learn more about the underlying causes of osteoporosis and gain a new understanding of bone formation at a molecular level," said Dr. Battaglino. "Furthermore, this research provides exciting clues on how to prevent destructive bone loss and even improve bone mass in certain medical/dental conditions."
The research was funded in part by a grant from the National Institute of Dental and Craniofacial Research. This work was done in collaboration with Ralph Mueller, Ph.D., SNF Professor of Bioengineering at the Institute for Biomedical Engineering University and Swiss Federal Institute of Technology (ETH) in Zurich, Switzerland whose laboratory analyzed changes in bone microarchitecture in response to fluoxetine treatment. Other contributors included Dr. Dana Graves, Boston University School of Dental Medicine, and Dr. Philip Stashenko, Dept. of Cytokine Biology, Forsyth.
The Forsyth Institute is the world's leading independent organization dedicated to scientific research and education in oral, craniofacial and related biomedical sciences.
Contact: Jennifer Kelly
Forsyth Institute
View drug information on Prozac Weekly.
Bone destruction is characteristic of several chronic inflammatory diseases including rheumatoid arthritis and gum disease. Previous research has shown a correlation between the serotonin transporter -- serotonin is the chemical substance involved in transmitting signals between neurons and which plays a role in anxiety and mood disorders-- and bone destructive cells (osteoclasts). (Fluoxetine is a serotonin reuptake inhibitor (SSRIs).) However, it was not clear what role serotonin played in bone metabolism.
Summary of Study
Trabecular bone, one of two main types of bone, is spongy, and makes up the bulk of the interior of most bones, including the vertebrae. After a six-week treatment with fluoxetine, laboratory mice showed increased trabecular bone volume and total volume in femurs and vertebrae as determined by micro-computed tomography. Fluoxetine-treated animals were not protected from bone loss after ovariectomy, suggesting that its anabolic effect requires the presence of estrogen. The effect on bone loss was also investigated following a bacterial-mediated inflammatory challenge. Injections of lipopolysaccharide (LPS), a component of the membrane of certain strains of bacteria, resulted in an increased number of osteoclasts and net bone loss. However, LPS given with fluoxetine caused new bone formation and a net gain in bone mass. The study concluded that fluoxetine treatment in vivo leads to increased bone mass under normal physiological conditions or inflammatory conditions, but does not prevent bone loss associated with estrogen deficiency.
This research, which will be published in the next issue of the Journal of Cellular Biochemistry, currently available online, was led by Ricardo Battaglino, PhD, Assistant Member of the Staff in the Department of Cytokine Biology at The Forsyth Institute.
"As this class of medication is widely prescribed and used across all age groups, the consequences of the relationship between these drugs and bone metabolism may be very relevant to public health. This work will help us learn more about the underlying causes of osteoporosis and gain a new understanding of bone formation at a molecular level," said Dr. Battaglino. "Furthermore, this research provides exciting clues on how to prevent destructive bone loss and even improve bone mass in certain medical/dental conditions."
The research was funded in part by a grant from the National Institute of Dental and Craniofacial Research. This work was done in collaboration with Ralph Mueller, Ph.D., SNF Professor of Bioengineering at the Institute for Biomedical Engineering University and Swiss Federal Institute of Technology (ETH) in Zurich, Switzerland whose laboratory analyzed changes in bone microarchitecture in response to fluoxetine treatment. Other contributors included Dr. Dana Graves, Boston University School of Dental Medicine, and Dr. Philip Stashenko, Dept. of Cytokine Biology, Forsyth.
The Forsyth Institute is the world's leading independent organization dedicated to scientific research and education in oral, craniofacial and related biomedical sciences.
Contact: Jennifer Kelly
Forsyth Institute
View drug information on Prozac Weekly.
Unexpected Side Effect: Makes You Happier
In a study published in The Journals of Gerontology (Medical Sciences), researchers found that a brain fitness program measured initially for its impact on cognitive abilities in older adults also had a significant beneficial impact on symptoms of depression.
The findings are part of an ongoing study of older Americans funded by the National Institutes of Health and known as the Advanced Cognitive Training for Independent and Vital Elderly (ACTIVE) study. With 2,832 participants, the ACTIVE study is the largest community-based multi-site randomized controlled trial ever conducted that focuses on maintaining or improving cognitive abilities of older people.
The ACTIVE study randomly assigned participants to four groups: one group did computerized brain exercises, a second group took classes in memory strategies, a third group took classes in reasoning and a fourth group served as a control that engaged in no special activity. Groups that did an activity engaged in the activity for a total of 10 hours. Participants completed those activities by October 1999, and their outcomes have continued to be tracked and published in follow-up reports.
While earlier reporting on the study was on primary measures of cognition and secondary measures of quality of life, this new report on 2,036 participants is the first to focus on secondary measures of how cognitive training affects mood.
Researchers found that participants in the study who engaged in the computerized brain exercises, which were designed to improve visual speed, accuracy and expanse of processing, had significantly better outcomes in key measures related to mood in one-year and five-year follow-ups. Participants in the other three groups did not have similar beneficial outcomes on this measure.
The study used a standard measure of depression known as the CES-D-12, a 12-item scale for depressive symptoms from the Center for Epidemiological Studies. Researchers found that only study participants who used the computer-based brain exercises received some protection against worsening depressive symptoms as compared against the control group. In fact, those who used the computer-based exercises were 30% less at risk than the other groups.
Researchers hypothesized two possible reasons why the brain exercise group was less susceptible to worsening depressive symptoms. First, they observed that the group had experienced an increase in brain processing speed and other quality of life measures that may have made their day to day experiences more positive. Second, they observed that the attentional demands and rewards and the procedural learning requirements of the computer program may have stimulated the chemical system or other parts of the brain that affect mood.
"Earlier findings have shown that these particular brain exercises improve speed of processing, health related quality of life and ability to engage in activities required for independent living," said Fred Wolinsky, PhD of the University of Iowa, the lead author on this study. "This study is important because it shows that a relatively small amount of the right kind of brain fitness training can change the trajectory of aging, even five years later, by helping people experience a happier life. In the end, that's really what we all want for ourselves and our loved ones."
The training used in the study is now commercially available for the first time as part of the InSight brain fitness program from Posit Science. Posit Science distributes its programs to the public through its website, through national insurers and through hundreds of classes at retirement communities, senior centers and adult education programs.
About Posit Science:
Posit Science is the leading provider of clinically validated brain fitness programs. The company works with more than 50 scientists from prestigious universities to design and test its computer-based programs. More than 30 published peer reviewed papers show that in randomized controlled trials the company's patented technologies significantly increase processing speed, improve memory and attention, and enhance the quality of everyday life. While such benefits have been shown across groups in studies, individual results will vary, and Posit Science makes no claims with respect to the prevention or treatment of disease. Posit Science has received grants from the National Institutes of Health and has received numerous awards and accolades. The company's products, scientists and science are currently featured in the PBS documentaries "The Brain Fitness Program" and "Brain Fitness 2: Sight and Sound." In addition to being sold direct to consumer via the company's website, its products are distributed without charge to policyholders by leading health, long term care and auto insurers, are sold by hundreds of authorized providers and are used in hundreds of daily classes at retirement communities, adult education programs and hospitals.
Posit Science
PositScience
The findings are part of an ongoing study of older Americans funded by the National Institutes of Health and known as the Advanced Cognitive Training for Independent and Vital Elderly (ACTIVE) study. With 2,832 participants, the ACTIVE study is the largest community-based multi-site randomized controlled trial ever conducted that focuses on maintaining or improving cognitive abilities of older people.
The ACTIVE study randomly assigned participants to four groups: one group did computerized brain exercises, a second group took classes in memory strategies, a third group took classes in reasoning and a fourth group served as a control that engaged in no special activity. Groups that did an activity engaged in the activity for a total of 10 hours. Participants completed those activities by October 1999, and their outcomes have continued to be tracked and published in follow-up reports.
While earlier reporting on the study was on primary measures of cognition and secondary measures of quality of life, this new report on 2,036 participants is the first to focus on secondary measures of how cognitive training affects mood.
Researchers found that participants in the study who engaged in the computerized brain exercises, which were designed to improve visual speed, accuracy and expanse of processing, had significantly better outcomes in key measures related to mood in one-year and five-year follow-ups. Participants in the other three groups did not have similar beneficial outcomes on this measure.
The study used a standard measure of depression known as the CES-D-12, a 12-item scale for depressive symptoms from the Center for Epidemiological Studies. Researchers found that only study participants who used the computer-based brain exercises received some protection against worsening depressive symptoms as compared against the control group. In fact, those who used the computer-based exercises were 30% less at risk than the other groups.
Researchers hypothesized two possible reasons why the brain exercise group was less susceptible to worsening depressive symptoms. First, they observed that the group had experienced an increase in brain processing speed and other quality of life measures that may have made their day to day experiences more positive. Second, they observed that the attentional demands and rewards and the procedural learning requirements of the computer program may have stimulated the chemical system or other parts of the brain that affect mood.
"Earlier findings have shown that these particular brain exercises improve speed of processing, health related quality of life and ability to engage in activities required for independent living," said Fred Wolinsky, PhD of the University of Iowa, the lead author on this study. "This study is important because it shows that a relatively small amount of the right kind of brain fitness training can change the trajectory of aging, even five years later, by helping people experience a happier life. In the end, that's really what we all want for ourselves and our loved ones."
The training used in the study is now commercially available for the first time as part of the InSight brain fitness program from Posit Science. Posit Science distributes its programs to the public through its website, through national insurers and through hundreds of classes at retirement communities, senior centers and adult education programs.
About Posit Science:
Posit Science is the leading provider of clinically validated brain fitness programs. The company works with more than 50 scientists from prestigious universities to design and test its computer-based programs. More than 30 published peer reviewed papers show that in randomized controlled trials the company's patented technologies significantly increase processing speed, improve memory and attention, and enhance the quality of everyday life. While such benefits have been shown across groups in studies, individual results will vary, and Posit Science makes no claims with respect to the prevention or treatment of disease. Posit Science has received grants from the National Institutes of Health and has received numerous awards and accolades. The company's products, scientists and science are currently featured in the PBS documentaries "The Brain Fitness Program" and "Brain Fitness 2: Sight and Sound." In addition to being sold direct to consumer via the company's website, its products are distributed without charge to policyholders by leading health, long term care and auto insurers, are sold by hundreds of authorized providers and are used in hundreds of daily classes at retirement communities, adult education programs and hospitals.
Posit Science
PositScience
Knee Arthritis Symptoms In Older Adults Adversely Affected By Depression
Clinical depression can exacerbate the symptoms of knee arthritis beyond what is evident on X-rays, according to a new study from the Journal of Bone and Joint Surgery (JBJS). Patients with mild to moderate knee arthritis are especially affected by depression, the study notes.
"Knee osteoarthritis is a common cause of pain and impairment in older adults," said Tae Kyun Kim, MD, study author and director of the Division of Knee Surgery and Sports Medicine at Seoul National University Bundang Hospital's Joint Reconstruction Center. "Often, the level of arthritic symptoms reported by patients is much more severe than what is represented by X-rays, which can make it difficult for the doctor to treat.
"The results of this study indicate that depression can play a major role in the way patients experience the symptoms of knee arthritis, and that even when X-rays show the arthritis is not severe, patients with depression may report significant pain," Dr. Kim said. "The relationship between pain and depression suggests that both should be considered by physicians when treating patients with knee osteoarthritis, particularly in those with X-rays not indicating severe damage to the joint."
The study included 660 men and women aged 65 years or older who were evaluated for the severity of their knee arthritis on X-rays, as well as symptom severity. Patient interviews and questionnaires were used to assess coincident depressive disorders. The study was conducted as a part of the Korean Longitudinal Study on Health and Aging (KLoSHA).
As expected, the researchers found the levels of pain attributed to knee arthritis were higher in patients whose X-rays indicated greater joint damage; however, they also found depressive disorders were associated with an increase in pain in patients with mild to moderate knee arthritis, even when X-rays did not show significant joint damage.
"When evaluating the results of this study, the contribution of depression to knee osteoarthritis symptoms was almost as important as the damage indicated on X-rays," Dr. Kim noted.
Knee arthritis typically affects men and women over 50 years of age, and occurs most frequently in people who are overweight. Common symptoms include:
pain or stiffness in or around the knee;
swelling of the knee;
limited range of motion when walking or moving the knee; or
knee weakness or a feeling of instability.
In more severe cases, the knee joint may appear deformed, such as bowlegged or knock-kneed appearance, either bulging outward or toward the side of the leg. Knee replacement surgery is often performed in patients with severe symptoms.
Although studies have indicated depression is not uncommon among older adults, it remains largely underdiagnosed. According to the National Institute of Mental Health (NIMH):
The risk of depression increases with other illnesses and when ability to function becomes limited.
Estimates of major depression in older people range from 1 percent to 5 percent among those living in the community, to as high as 11.5 percent in hospital patients and 13.5 percent in those who require home healthcare.
An estimated 5 million older adults have mild depression, which is often undiagnosed. Symptoms of depression may include:
feelings of sadness or hopelessness;
loss of interest in activities that were once enjoyed;
change in appetite or sleep patterns;
difficulty thinking and remembering; or
frequent thoughts of death or dying.
"Despite the reported satisfactory outcomes of knee replacement surgery a percentage of patients still experience knee pain and impaired movement," said Dr. Kim said. "Sometimes pain and disability after surgery is medically unexplained, so in these patients screening for depression might be a very good option."
Disclosure:
In support of their research for or preparation of this work, one or more of the authors received, in any one year, outside funding or grants in excess of $10,000 from Pfizer Global Pharmaceuticals (Grant No. 06-05-039) and Seongnam City Government in Korea (Grant No. 800-20050211). Neither they nor a member of their immediate families received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity.
"Knee osteoarthritis is a common cause of pain and impairment in older adults," said Tae Kyun Kim, MD, study author and director of the Division of Knee Surgery and Sports Medicine at Seoul National University Bundang Hospital's Joint Reconstruction Center. "Often, the level of arthritic symptoms reported by patients is much more severe than what is represented by X-rays, which can make it difficult for the doctor to treat.
"The results of this study indicate that depression can play a major role in the way patients experience the symptoms of knee arthritis, and that even when X-rays show the arthritis is not severe, patients with depression may report significant pain," Dr. Kim said. "The relationship between pain and depression suggests that both should be considered by physicians when treating patients with knee osteoarthritis, particularly in those with X-rays not indicating severe damage to the joint."
The study included 660 men and women aged 65 years or older who were evaluated for the severity of their knee arthritis on X-rays, as well as symptom severity. Patient interviews and questionnaires were used to assess coincident depressive disorders. The study was conducted as a part of the Korean Longitudinal Study on Health and Aging (KLoSHA).
As expected, the researchers found the levels of pain attributed to knee arthritis were higher in patients whose X-rays indicated greater joint damage; however, they also found depressive disorders were associated with an increase in pain in patients with mild to moderate knee arthritis, even when X-rays did not show significant joint damage.
"When evaluating the results of this study, the contribution of depression to knee osteoarthritis symptoms was almost as important as the damage indicated on X-rays," Dr. Kim noted.
Knee arthritis typically affects men and women over 50 years of age, and occurs most frequently in people who are overweight. Common symptoms include:
pain or stiffness in or around the knee;
swelling of the knee;
limited range of motion when walking or moving the knee; or
knee weakness or a feeling of instability.
In more severe cases, the knee joint may appear deformed, such as bowlegged or knock-kneed appearance, either bulging outward or toward the side of the leg. Knee replacement surgery is often performed in patients with severe symptoms.
Although studies have indicated depression is not uncommon among older adults, it remains largely underdiagnosed. According to the National Institute of Mental Health (NIMH):
The risk of depression increases with other illnesses and when ability to function becomes limited.
Estimates of major depression in older people range from 1 percent to 5 percent among those living in the community, to as high as 11.5 percent in hospital patients and 13.5 percent in those who require home healthcare.
An estimated 5 million older adults have mild depression, which is often undiagnosed. Symptoms of depression may include:
feelings of sadness or hopelessness;
loss of interest in activities that were once enjoyed;
change in appetite or sleep patterns;
difficulty thinking and remembering; or
frequent thoughts of death or dying.
"Despite the reported satisfactory outcomes of knee replacement surgery a percentage of patients still experience knee pain and impaired movement," said Dr. Kim said. "Sometimes pain and disability after surgery is medically unexplained, so in these patients screening for depression might be a very good option."
Disclosure:
In support of their research for or preparation of this work, one or more of the authors received, in any one year, outside funding or grants in excess of $10,000 from Pfizer Global Pharmaceuticals (Grant No. 06-05-039) and Seongnam City Government in Korea (Grant No. 800-20050211). Neither they nor a member of their immediate families received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity.
Sex and drug use increase teen suicide risk
Teens who engage in high-risk behaviors involving sex and drugs have significantly higher odds of depression, suicidal thoughts and suicide attempts than teens who say no to sex and drugs, according to a study.
"These results suggest that healthcare professionals who identify adolescent patients reporting sexual intercourse or drug use should strongly consider screening for depression and risk of suicide," says study author Denise D. Hallfors, Ph.D., a Senior Research Scientist at the Pacific Institute for Research and Evaluation in Chapel Hill, North Carolina.
Adolescents are no strangers to the phenomena of depression and suicide. Previous research found 28 percent of U.S. high school students experienced severe depression, and the third leading cause of death for 15- to 19-year-olds is suicide. Suicide death rates among 15- to 19-year-olds doubled between 1960 and 2001, according to the study.
Hallfors and colleagues analyzed various sex and drug behavior patterns via data from a survey of nearly 19,000 teens in grades 7 through 12. The data were gathered in the mid-1990s from 132 U.S. schools as part of the National Longitudinal Study of Adolescent Health.
The researchers clustered the teens in 16 groups according to their behaviors. Groups included the abstainers, who eschewed sex and drugs; sex dabblers; alcohol and sex dabblers; teens with multiple sexual partners; and illegal drug users.
Abstainers had the lowest levels of depression, suicidal thoughts and suicide attempts, while teens in groups associated with sex and drugs, and heavy use of illegal drugs such as marijuana had the highest levels. In between were the dabblers in sex, drugs, alcohol and tobacco.
The results appear in the current issue of the American Journal of Preventive Medicine.
The researchers found girls less likely than boys to pursue high-risk behaviors, but girls who did were more vulnerable than boys to the constellation of depression, suicidal thoughts and suicide attempts.
Another interesting finding involved the association of socioeconomic status with depression. While higher socioeconomic status reduced the likelihood of depression by about half, it increased the risk of suicidal thoughts. Hallfors and colleagues call for more research to examine this phenomenon.
Further research is needed to understand which comes first: sex and drugs or poor mental health. But until then, Hallfors and colleagues advise healthcare professionals to screen all teens for sexual behaviors and drug use. Those who engage in such behaviors-especially those who do more than dabble in them-should be screened for depression and suicide risk also.
"It is particularly important not to miss opportunities to diagnose depression because effective treatments are available, or to overlook suicide risk because suicide can be prevented," Hallfors says.
Funding for the study was from the National Institute of Drug Abuse.
FOR MORE INFORMATION:
Health Behavior News Service: (202) 387-2829 or hbns.
Interviews: Contact Denise Hallfors, PhD, (919) 265-2600 or e-mail HallforsPIRE.
American Journal of Preventive Medicine: Contact the editorial office at (858) 457-7292.
Center for the Advancement of Health
Contact: Ira R. Allen
Director of Public Affairs
202.387.2829
presscfah
"These results suggest that healthcare professionals who identify adolescent patients reporting sexual intercourse or drug use should strongly consider screening for depression and risk of suicide," says study author Denise D. Hallfors, Ph.D., a Senior Research Scientist at the Pacific Institute for Research and Evaluation in Chapel Hill, North Carolina.
Adolescents are no strangers to the phenomena of depression and suicide. Previous research found 28 percent of U.S. high school students experienced severe depression, and the third leading cause of death for 15- to 19-year-olds is suicide. Suicide death rates among 15- to 19-year-olds doubled between 1960 and 2001, according to the study.
Hallfors and colleagues analyzed various sex and drug behavior patterns via data from a survey of nearly 19,000 teens in grades 7 through 12. The data were gathered in the mid-1990s from 132 U.S. schools as part of the National Longitudinal Study of Adolescent Health.
The researchers clustered the teens in 16 groups according to their behaviors. Groups included the abstainers, who eschewed sex and drugs; sex dabblers; alcohol and sex dabblers; teens with multiple sexual partners; and illegal drug users.
Abstainers had the lowest levels of depression, suicidal thoughts and suicide attempts, while teens in groups associated with sex and drugs, and heavy use of illegal drugs such as marijuana had the highest levels. In between were the dabblers in sex, drugs, alcohol and tobacco.
The results appear in the current issue of the American Journal of Preventive Medicine.
The researchers found girls less likely than boys to pursue high-risk behaviors, but girls who did were more vulnerable than boys to the constellation of depression, suicidal thoughts and suicide attempts.
Another interesting finding involved the association of socioeconomic status with depression. While higher socioeconomic status reduced the likelihood of depression by about half, it increased the risk of suicidal thoughts. Hallfors and colleagues call for more research to examine this phenomenon.
Further research is needed to understand which comes first: sex and drugs or poor mental health. But until then, Hallfors and colleagues advise healthcare professionals to screen all teens for sexual behaviors and drug use. Those who engage in such behaviors-especially those who do more than dabble in them-should be screened for depression and suicide risk also.
"It is particularly important not to miss opportunities to diagnose depression because effective treatments are available, or to overlook suicide risk because suicide can be prevented," Hallfors says.
Funding for the study was from the National Institute of Drug Abuse.
FOR MORE INFORMATION:
Health Behavior News Service: (202) 387-2829 or hbns.
Interviews: Contact Denise Hallfors, PhD, (919) 265-2600 or e-mail HallforsPIRE.
American Journal of Preventive Medicine: Contact the editorial office at (858) 457-7292.
Center for the Advancement of Health
Contact: Ira R. Allen
Director of Public Affairs
202.387.2829
presscfah
Caregiver Support Key To Improved Health, Fewer Nursing Home Placements, Jefferson Researchers Find
Helping caregivers take care of themselves is key to enabling them to better deal with family members with dementia, a recent study by Thomas Jefferson University researchers shows. In fact, those caregivers who were provided extra, individualized support had less depression and were able to keep family members in adult day services - and out of nursing homes - much longer than those who did not get the extra attention.
According to Laura N. Gitlin, PhD, director of the Center for Applied Research on Aging and Health (CARAH) at Thomas Jefferson University in Philadelphia - who led the study in conjunction with Karen Reever, former executive director of Mid County Senior Services in Newtown Square, PA - one goal of adult day services (ADS) is to reduce nursing home placements. Families caring for older adults with impairment often use ADS, where their family members can receive meals and participate in therapeutic activities throughout the day. Some ADS centers offer some support for family members in the form of education workshops, but there is no systematic approach to offering caregiver support.
"Research shows that family members who use adult day services often still experience depression and feel burdened because, despite the respite that ADS offers, the caregiver still does the bulk of the work," says Dr. Gitlin. This burden of work can lead to caregiver burn-out, which often results in the need to place the older adult in a nursing home.
Dr. Gitlin and Ms. Reever, along with a team of service providers wanted to see whether providing systematic care management for the family caregiver as part of the daycare service would benefit the patient and family. They looked at three adult day service centers, with two of the centers offering the Adult Day Services Plus (ADS Plus) program, which involved extra services for caregivers. "We worked with Mid County to design and evaluate a program that would be cost-efficient by building on the existing ADS staff," explains Dr. Gitlin. Caregivers were interviewed at the time of registering for adult day services, and their own needs were assessed. Services were tailored for the individual needs of caregivers.
Such services included targeted education, referral for counseling or other services, strategies for caring for oneself, and strategies for managing complex problematic behaviors, such as resistance to care, verbal abuse, and agitation due to confusion.
The findings, reported in The Gerontologist, "were positive and immediate," says Dr. Gitlin. "The caregivers appreciated that they could always call or see the social worker at the adult day center. They said that the program offered them 'a safety net' and shared comments such as 'you were there for me' and 'I felt comforted.' There was an increase in caregiver confidence in managing problematic behaviors and less depression. The care manager succeeded in introducing effective strategies and addressing the caregivers' own needs.
"It will behoove adult day services to pay more systematic attention to the needs of family caregivers as a way to further support the impaired older adult," says Dr. Gitlin.
The study also found that nursing home placement dropped and ADS use increased in those families that received the ADS Plus program. "Older adults are generally in adult daycare for a short time, maybe as a last step before the family finds they need to place their loved one in a nursing home," explains Dr. Gitlin. "A major finding of this study was that over time, participants who received the ADS Plus program used 37 more days of ADS than those without it. As a result, twice the number of patients in the control group entered a nursing home compared to those in the study groups. Increased use of the ADS centers yields enhanced quality of life for both the caregiver and the patient, and it also means increased revenue for the center itself."
The next steps for this research will involve a larger multi-site research demonstration project. "We want to find out if the ADS Plus Program can work in settings that service different families from diverse socioeconomic and cultural backgrounds," says Dr. Gitlin. "There is national interest in exploring these issues. Implementing the ADS Plus program in existing adult day services would not take much effort. "The costs include brief training of existing staff and reshuffling staff hours to enable a systematic approach to working with the family caregiver. After an initial assessment of the family caregiver, most contact can occur by telephone, at the time the family caregiver drops off their family member at the center or via mail. It would require little training and resources to have a great impact."
Contact: Steve Benowitz
Thomas Jefferson University
According to Laura N. Gitlin, PhD, director of the Center for Applied Research on Aging and Health (CARAH) at Thomas Jefferson University in Philadelphia - who led the study in conjunction with Karen Reever, former executive director of Mid County Senior Services in Newtown Square, PA - one goal of adult day services (ADS) is to reduce nursing home placements. Families caring for older adults with impairment often use ADS, where their family members can receive meals and participate in therapeutic activities throughout the day. Some ADS centers offer some support for family members in the form of education workshops, but there is no systematic approach to offering caregiver support.
"Research shows that family members who use adult day services often still experience depression and feel burdened because, despite the respite that ADS offers, the caregiver still does the bulk of the work," says Dr. Gitlin. This burden of work can lead to caregiver burn-out, which often results in the need to place the older adult in a nursing home.
Dr. Gitlin and Ms. Reever, along with a team of service providers wanted to see whether providing systematic care management for the family caregiver as part of the daycare service would benefit the patient and family. They looked at three adult day service centers, with two of the centers offering the Adult Day Services Plus (ADS Plus) program, which involved extra services for caregivers. "We worked with Mid County to design and evaluate a program that would be cost-efficient by building on the existing ADS staff," explains Dr. Gitlin. Caregivers were interviewed at the time of registering for adult day services, and their own needs were assessed. Services were tailored for the individual needs of caregivers.
Such services included targeted education, referral for counseling or other services, strategies for caring for oneself, and strategies for managing complex problematic behaviors, such as resistance to care, verbal abuse, and agitation due to confusion.
The findings, reported in The Gerontologist, "were positive and immediate," says Dr. Gitlin. "The caregivers appreciated that they could always call or see the social worker at the adult day center. They said that the program offered them 'a safety net' and shared comments such as 'you were there for me' and 'I felt comforted.' There was an increase in caregiver confidence in managing problematic behaviors and less depression. The care manager succeeded in introducing effective strategies and addressing the caregivers' own needs.
"It will behoove adult day services to pay more systematic attention to the needs of family caregivers as a way to further support the impaired older adult," says Dr. Gitlin.
The study also found that nursing home placement dropped and ADS use increased in those families that received the ADS Plus program. "Older adults are generally in adult daycare for a short time, maybe as a last step before the family finds they need to place their loved one in a nursing home," explains Dr. Gitlin. "A major finding of this study was that over time, participants who received the ADS Plus program used 37 more days of ADS than those without it. As a result, twice the number of patients in the control group entered a nursing home compared to those in the study groups. Increased use of the ADS centers yields enhanced quality of life for both the caregiver and the patient, and it also means increased revenue for the center itself."
The next steps for this research will involve a larger multi-site research demonstration project. "We want to find out if the ADS Plus Program can work in settings that service different families from diverse socioeconomic and cultural backgrounds," says Dr. Gitlin. "There is national interest in exploring these issues. Implementing the ADS Plus program in existing adult day services would not take much effort. "The costs include brief training of existing staff and reshuffling staff hours to enable a systematic approach to working with the family caregiver. After an initial assessment of the family caregiver, most contact can occur by telephone, at the time the family caregiver drops off their family member at the center or via mail. It would require little training and resources to have a great impact."
Contact: Steve Benowitz
Thomas Jefferson University
First Study To Show That Highly Variable Sleep Schedules Predict Elevated Suicide Risk
Highly variable sleep schedules predict an elevated risk for suicide independent of depression in actively suicidal young adults, according to a research abstract presented Tuesday, June 8, 2010, in San Antonio, Texas, at SLEEP 2010, the 24th annual meeting of the Associated Professional Sleep Societies LLC.
Results indicate that a sample of actively suicidal undergraduate students had a delayed mean bedtime of 2:08 a.m.; restricted total sleep time of 6.3 hours; and highly variable sleep schedules, with time of mean sleep onset varying by three hours and time of sleep offset varying by 2.8 hours. However, accounting for baseline depression severity, sleep variability was the only sleep measurement to individually predict increases in suicidal risk at one week and three weeks. Sleep irregularity also was the only sleep-related variable to predict greater mood lability, which in turn predicted elevated suicidal symptoms.
"To our knowledge, this is the first study to evaluate the unique association between sleep and suicide risk using an objective assessment of sleep and a prospective study design," said principal investigator Rebecca Bernert, PhD, Fellow in the Department of Psychiatry and Behavioral Sciences at Stanford University. "We found that a high degree of irregularity in sleep predicted increases in suicidal symptoms, conferring risk above and beyond the influence of depression. Given that the relationship between sleep disturbances and suicide appears to exist independent of depressed mood, we propose that sleep disturbances may instead confer risk via impaired mood regulation and increased mood lability."
The three-week study was conducted at the Florida State University Laboratory for the Study of the Psychology and Neurobiology of Mood Disorders, Suicide, and Related Conditions. Bernert and laboratory director Thomas Joiner, PhD, studied 49 actively suicidal undergraduate students between the ages of 19 and 23 years; 71 percent were female.
Symptom severity was assessed at baseline, one week and three weeks using the Beck Depression Inventory and Beck Scale for Suicide. Sleep data were obtained by wrist actigraphy for one week, and sleep variability was calculated as the standard deviation of sleep onsets and offsets, summed. Mood lability was evaluated across the same timeframe using daily visual analogue scale mood ratings.
According to Bernert, identifying sleep irregularity as a stand-alone risk factor for suicidal ideation could have important clinical implications.
"Compared to other suicide risk factors such as a past suicide attempt, disturbed sleep is modifiable, often visible and amenable to treatment," she said. "In this way, the study of sleep may inform suicide risk assessment and represent a clinically unique opportunity for intervention."
In 2007 Bernert and Joiner published a review of the literature on sleep disturbances and suicide risk in the journal Neuropsychiatric Disease and Treatment. Among several theories, underlying neurobiological factors such as serotonergic neurotransmission were proposed to play a role in the relationship between sleep and suicide, although this has yet to be tested.
The study was supported by a National Research Service Award from the National Institutes of Health.
Results indicate that a sample of actively suicidal undergraduate students had a delayed mean bedtime of 2:08 a.m.; restricted total sleep time of 6.3 hours; and highly variable sleep schedules, with time of mean sleep onset varying by three hours and time of sleep offset varying by 2.8 hours. However, accounting for baseline depression severity, sleep variability was the only sleep measurement to individually predict increases in suicidal risk at one week and three weeks. Sleep irregularity also was the only sleep-related variable to predict greater mood lability, which in turn predicted elevated suicidal symptoms.
"To our knowledge, this is the first study to evaluate the unique association between sleep and suicide risk using an objective assessment of sleep and a prospective study design," said principal investigator Rebecca Bernert, PhD, Fellow in the Department of Psychiatry and Behavioral Sciences at Stanford University. "We found that a high degree of irregularity in sleep predicted increases in suicidal symptoms, conferring risk above and beyond the influence of depression. Given that the relationship between sleep disturbances and suicide appears to exist independent of depressed mood, we propose that sleep disturbances may instead confer risk via impaired mood regulation and increased mood lability."
The three-week study was conducted at the Florida State University Laboratory for the Study of the Psychology and Neurobiology of Mood Disorders, Suicide, and Related Conditions. Bernert and laboratory director Thomas Joiner, PhD, studied 49 actively suicidal undergraduate students between the ages of 19 and 23 years; 71 percent were female.
Symptom severity was assessed at baseline, one week and three weeks using the Beck Depression Inventory and Beck Scale for Suicide. Sleep data were obtained by wrist actigraphy for one week, and sleep variability was calculated as the standard deviation of sleep onsets and offsets, summed. Mood lability was evaluated across the same timeframe using daily visual analogue scale mood ratings.
According to Bernert, identifying sleep irregularity as a stand-alone risk factor for suicidal ideation could have important clinical implications.
"Compared to other suicide risk factors such as a past suicide attempt, disturbed sleep is modifiable, often visible and amenable to treatment," she said. "In this way, the study of sleep may inform suicide risk assessment and represent a clinically unique opportunity for intervention."
In 2007 Bernert and Joiner published a review of the literature on sleep disturbances and suicide risk in the journal Neuropsychiatric Disease and Treatment. Among several theories, underlying neurobiological factors such as serotonergic neurotransmission were proposed to play a role in the relationship between sleep and suicide, although this has yet to be tested.
The study was supported by a National Research Service Award from the National Institutes of Health.
Common Mental Disorders May Be More Common Than We Think
The prevalence of anxiety, depression and substance dependency may be twice as high as the mental health community has been led to believe.
It depends on how one goes about measuring.
Duke University psychologists Terrie Moffitt and Avshalom Caspi and colleagues from the United Kingdom and New Zealand used a long-term tracking study of more than 1,000 New Zealanders from birth to age 32 to reach the conclusion that people vastly underreport the amount of mental illness they've suffered when asked to recall their history years after the fact.
But such self-reporting from memory is the basis of much of what we know about the prevalence of anxiety, depression, alcohol dependence and marijuana dependence. Longitudinal studies like the Dunedin Study in New Zealand that track people over time are rare and expensive, Moffitt said.
"If you start with a group of children and follow them their whole lives, sooner or later almost everybody will experience one of these disorders," said Moffitt, the Knut Schmitt-Nielsen professor of psychology and neuroscience at Duke.
The Great Smoky Mountains Study, a similar effort based at Duke, has tracked 1,400 American children from age 9-13 into their late 20s and found similar patterns, said Jane Costello, a professor medical psychology at Duke who runs the study.
"I think we've got to get used to the idea that mental illness is actually very common," Costello said. "People are growing up impaired, untreated and not functioning to their full capacity because we've ignored it."
The prevalence of mental illness has been hotly debated by policy makers and mental health providers for many years. The pharmaceutical and health insurance industries also have a stake in the debate, Moffitt said.
The best retrospective studies, the US National Comorbidity Surveys (NCS) and the New Zealand Mental Health Survey, have found the incidence of depression from ages 18 to 32 at a rate of about 18 percent. But they have been roundly criticized by some for their rates being too high. The latest analysis from the Dunedin Study found 41 percent of that age range had experienced clinically significant depression.
Similarly, the survey studies have reported a 6 to 17 percent lifetime rate of alcohol dependence between ages 18-32, versus nearly 32 percent in the Dunedin Study.
Guidelines published by the American Psychiatric Association that set the bar for defining what is and isn't a treatable illness are currently being revised by a rewriting of the authoritative Diagnostic and Statistical Manual of Mental Disorders (DSM). But given the findings of these longitudinal studies, the stringency of the diagnostic criteria might need to be reconsidered, said Moffitt, who is on the committee writing the new DSM-Vstandards.
"Researchers might begin to ask why so many people experience a disorder at least once during their lifetimes and what this means for the way we define mental health, deliver services and count the economic burdens of mental illness," Moffitt said.
On the one hand, it could be argued that the diagnostic standards have been set too low if so many people can be considered mentally ill. On the other hand, perhaps these findings argue for more and better mental health care because the disorders are more common than anyone had realized.
"There are two opposing camps, and I'm agnostic about that," Moffitt said.
At the very least, maybe these findings can help reduce the stigma against mental illness and mental health care, Moffitt added. New Zealand, for example, has begun a new campaign of public service announcements featuring sports heroes saying they've experienced mental health issues.
"If we're serious about this problem, we need to get serious about preventing it," Costello added. "We do know a lot more about prevention now."
Moffitt and Caspi's findings from the Dunedin Study appear online in the journal Psychological Medicine. Their work was supported by the New Zealand Health Research Council, the US National Institutes of Health and the UK Medical Research Council.
It depends on how one goes about measuring.
Duke University psychologists Terrie Moffitt and Avshalom Caspi and colleagues from the United Kingdom and New Zealand used a long-term tracking study of more than 1,000 New Zealanders from birth to age 32 to reach the conclusion that people vastly underreport the amount of mental illness they've suffered when asked to recall their history years after the fact.
But such self-reporting from memory is the basis of much of what we know about the prevalence of anxiety, depression, alcohol dependence and marijuana dependence. Longitudinal studies like the Dunedin Study in New Zealand that track people over time are rare and expensive, Moffitt said.
"If you start with a group of children and follow them their whole lives, sooner or later almost everybody will experience one of these disorders," said Moffitt, the Knut Schmitt-Nielsen professor of psychology and neuroscience at Duke.
The Great Smoky Mountains Study, a similar effort based at Duke, has tracked 1,400 American children from age 9-13 into their late 20s and found similar patterns, said Jane Costello, a professor medical psychology at Duke who runs the study.
"I think we've got to get used to the idea that mental illness is actually very common," Costello said. "People are growing up impaired, untreated and not functioning to their full capacity because we've ignored it."
The prevalence of mental illness has been hotly debated by policy makers and mental health providers for many years. The pharmaceutical and health insurance industries also have a stake in the debate, Moffitt said.
The best retrospective studies, the US National Comorbidity Surveys (NCS) and the New Zealand Mental Health Survey, have found the incidence of depression from ages 18 to 32 at a rate of about 18 percent. But they have been roundly criticized by some for their rates being too high. The latest analysis from the Dunedin Study found 41 percent of that age range had experienced clinically significant depression.
Similarly, the survey studies have reported a 6 to 17 percent lifetime rate of alcohol dependence between ages 18-32, versus nearly 32 percent in the Dunedin Study.
Guidelines published by the American Psychiatric Association that set the bar for defining what is and isn't a treatable illness are currently being revised by a rewriting of the authoritative Diagnostic and Statistical Manual of Mental Disorders (DSM). But given the findings of these longitudinal studies, the stringency of the diagnostic criteria might need to be reconsidered, said Moffitt, who is on the committee writing the new DSM-Vstandards.
"Researchers might begin to ask why so many people experience a disorder at least once during their lifetimes and what this means for the way we define mental health, deliver services and count the economic burdens of mental illness," Moffitt said.
On the one hand, it could be argued that the diagnostic standards have been set too low if so many people can be considered mentally ill. On the other hand, perhaps these findings argue for more and better mental health care because the disorders are more common than anyone had realized.
"There are two opposing camps, and I'm agnostic about that," Moffitt said.
At the very least, maybe these findings can help reduce the stigma against mental illness and mental health care, Moffitt added. New Zealand, for example, has begun a new campaign of public service announcements featuring sports heroes saying they've experienced mental health issues.
"If we're serious about this problem, we need to get serious about preventing it," Costello added. "We do know a lot more about prevention now."
Moffitt and Caspi's findings from the Dunedin Study appear online in the journal Psychological Medicine. Their work was supported by the New Zealand Health Research Council, the US National Institutes of Health and the UK Medical Research Council.
CQ's Carey Discusses SCHIP, Mental Health Parity, Postpartum Depression Bills
Mary Agnes Carey, associate editor of CQ HealthBeat, discusses House Democrats' failure to override President Bush's veto of SCHIP legislation, a House mental health parity bill and legislation that would expand postpartum depression research in this week's "Health on the Hill from kaisernetwork and CQ."
House Democrats fell 13 votes short of the two-thirds majority needed to override the veto of legislation that would have reauthorized and expanded SCHIP. According to Carey, Democrats plan to send another SCHIP proposal to Bush within the next two weeks, but they have said that they will not compromise on the number of children who would be covered under an expansion of the program or on funding SCHIP with a 61-cent-per-pack increase in the federal cigarette tax. Democrats also intend to continue seeking more Republican votes to gain the two-thirds majority, Carey says. She adds that House and Senate Republicans have offered an alternative SCHIP measure that would increase funding for the program by $11 billion over five years. Under the measure, states would be required to prove that they have covered 90% of eligible children in families earning up to 200% of the federal poverty level before expanding coverage to children in families with incomes up to 250% of the poverty level. Bush administration officials said they plan to meet with Democrats to discuss an SCHIP compromise, according to Carey.
Carey also discusses the House Energy and Commerce Committee's recent approval of mental health parity legislation. The bill now will head to the House floor, where it is expected to pass. According to Carey, the House version of the bill would require insurers to cover more mental health services than the Senate bill, which likely will create difficulties when it comes to reconciling the two bills. The Bush administration, business groups and many in the mental health community oppose the House's expansion of coverage.
In addition, Carey discusses legislation passed by the House that would direct NIH to expand research initiatives and increase public awareness of postpartum depression. The bill would require basic research into the causes of the condition and the development of improved screening and diagnostic techniques, as well as information and education programs for health care professionals and the public. The measure also calls for a study that would explore the mental health consequences of pregnancy outcomes, including abortion, Carey says (Carey, "Health on the Hill from kaisernetwork and CQ," 10/22).
The complete audio version of "Health on the Hill," transcript and resources for further research are available online at kaisernetwork.
Reprinted with kind permission from kaisernetwork. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at kaisernetwork/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork, a free service of The Henry J. Kaiser Family Foundation© 2005 Advisory Board Company and Kaiser Family Foundation. All rights reserved.
House Democrats fell 13 votes short of the two-thirds majority needed to override the veto of legislation that would have reauthorized and expanded SCHIP. According to Carey, Democrats plan to send another SCHIP proposal to Bush within the next two weeks, but they have said that they will not compromise on the number of children who would be covered under an expansion of the program or on funding SCHIP with a 61-cent-per-pack increase in the federal cigarette tax. Democrats also intend to continue seeking more Republican votes to gain the two-thirds majority, Carey says. She adds that House and Senate Republicans have offered an alternative SCHIP measure that would increase funding for the program by $11 billion over five years. Under the measure, states would be required to prove that they have covered 90% of eligible children in families earning up to 200% of the federal poverty level before expanding coverage to children in families with incomes up to 250% of the poverty level. Bush administration officials said they plan to meet with Democrats to discuss an SCHIP compromise, according to Carey.
Carey also discusses the House Energy and Commerce Committee's recent approval of mental health parity legislation. The bill now will head to the House floor, where it is expected to pass. According to Carey, the House version of the bill would require insurers to cover more mental health services than the Senate bill, which likely will create difficulties when it comes to reconciling the two bills. The Bush administration, business groups and many in the mental health community oppose the House's expansion of coverage.
In addition, Carey discusses legislation passed by the House that would direct NIH to expand research initiatives and increase public awareness of postpartum depression. The bill would require basic research into the causes of the condition and the development of improved screening and diagnostic techniques, as well as information and education programs for health care professionals and the public. The measure also calls for a study that would explore the mental health consequences of pregnancy outcomes, including abortion, Carey says (Carey, "Health on the Hill from kaisernetwork and CQ," 10/22).
The complete audio version of "Health on the Hill," transcript and resources for further research are available online at kaisernetwork.
Reprinted with kind permission from kaisernetwork. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at kaisernetwork/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork, a free service of The Henry J. Kaiser Family Foundation© 2005 Advisory Board Company and Kaiser Family Foundation. All rights reserved.
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