A brain scan study suggests that a suspect gene may increase susceptibility to anxiety and depression* by weakening a
circuit for processing negative emotion. People with the depression-linked gene variant showed less gray matter and weaker
connections in the mood-regulating circuit. How well the circuit was connected accounted for nearly 30 percent of their
anxious temperament, researchers at the National Institute of Health's (NIH) National Institute of Mental Health (NIMH)
found. Dr. Daniel Weinberger and colleagues report on their brain imaging genetics study in the May 8, 2005 online edition of
Nature Neuroscience.
"We discovered the mood-regulating circuit by using the gene to interrogate the imaging data," explained Weinberger. "The
brain handles information much like an orchestra. So we asked questions akin to 'Are the violin and the clarinet playing the
same tune and to what extent might this gene account for it?'"
In this case, it turned out that the amygdala, a fear processing hub deep in the brain and the cingulate, an
emotion-dampening center located near the front of the brain, were playing a duet under the baton of the depression-linked
gene.
The gene codes for the serotonin transporter, the protein in brain cells that recycles the chemical messenger after it's been
secreted into the synapse, the gulf between cells. Since the most widely prescribed class of antidepressants act by blocking
this protein, researchers have focused on possible functional consequences of a slight variation in its DNA sequence across
individuals. Everyone inherits two copies of the gene, one from each parent, which comes in two common versions: short and
long. The short version makes less protein, resulting in less recycling, increased levels of serotonin in the synapse, and
more serotonin-triggered cellular activity. Previous NIMH-supported studies had shown that inheriting the short variant more
than doubles risk of depression following life stresses,** boosts amygdala activity while viewing scary faces,*** and has
been linked to anxious temperament. Yet, how it works at the level of brain circuitry remained a mystery.
The NIMH research team first scanned 114 healthy subjects using magnetic resonance imaging (MRI). Those with at least one
copy of the short variant had less gray matter, neurons and their connections, in the amygdala-cingulate circuit than those
with two copies of the long variant.
Next, using functional magnetic resonance imaging (fMRI), the researchers monitored the brain activity of 94 healthy
participants while they were looking at scary faces, which activates fear circuitry. Those with the short variant showed less
functional connectivity, in the same circuit.
Nearly 30 percent of subjects' scores on a standard scale of "harm avoidance," an inherited temperament trait associated with
depression and anxiety, was explained by how well the mood-regulating circuit was connected.
"Until now, it's been hard to relate amygdala activity to temperament and genetic risk for depression," said Dr. Andreas
Meyer-Lindenberg, a lead author. "This study suggests that the cingulate's ability to put the brakes on a runaway amygdala
fear response depends upon the degree of connectivity in this circuit, which is influenced by the serotonin transporter
gene."
Since serotonin activity plays a key role in wiring the brain's emotion processing circuitry during early development, the
researchers propose that the short variant leads to stunted coupling in the circuit, a poorly regulated amygdala response and
impaired emotional reactivity - resulting in increased vulnerability to persistent bad moods and eventually depression as
life's stresses take their toll.
Other members of the NIMH team were: Dr. Lukas Pezawas, Dr. Bhaskar Kolachana, Dr. Michael Egan, Dr. Venakata Mattay, Emily
Drabant, Beth Verchinski, and Karen Munoz. Dr. Ahmad Hariri, University of Pittsburgh, also participated in the study.
NIMH is part of the National Institutes of Health (NIH), the Federal Government's primary agency for biomedical and
behavioral research. NIH is a component of the U.S. Department of Health and Human Services.
* Information on Depression
nimh.nih/healthinformation/depressionmenu.cfm
** Gene More Than Doubles Risk of Depression Following Life Stresses
nimh.nih/Press/prgenestress.cfm
*** Gene May Bias Amygdala Response to Frightful Faces
nimh.nih/Press/pramygdala.cfm
Contact: Jules Asher
NIMHpressnih
301-443-4536
NIH/National Institute of Mental Health
nimh.nih
вторник, 31 мая 2011 г.
Detecting Depression In Caretakers Of Mentally Ill Adults
A diagnostic test of eight short questions designed by Jaclene Zauszniewski from the Frances Payne Bolton School of Nursing at Case Western Reserve University can be used to detect depressive thinking patterns that lead to clinical depression in women who care for an adult family member with a serious mental illness.
Issues in Mental Health Nursing recently published Zauszniewski's findings from the study, "Psychometric Assessment of the Depressive Cognition Scale in Women Family Members of Adults with Serious Mental Illness." Working with Zauszniewski on this study funded by the Frances Payne Bolton School of Nursing was co-investigator Jane Suresky, assistant professor of nursing at FPB.
Zauszniewski, a psychiatric nurse researcher, has tested the Depressive Cognition Scale (DCS) she developed on a number of different populations and groups to test whether the short questionnaire and scale can detect cognitive symptoms of early depression.
Each of the DCS's questions targets a symptom of depression and measures negative thinking.
Negative thoughts related to self-worth, power and hope can be precursors to the development of clinical depression. Thus, early detection of negative thinking patterns can lead to prevention of serious depressive illness.
The DCS tested for negative thinking patterns in the study's 60 women, who cared for an adult family member with a serious mental illness such as depression, schizophrenia or bipolar disorder. The average age of the participants was 46 years old and almost half lived in the same household as the adult with the mental illness.
The idea is if the caregiver - who is under stress and encounters the stigma of having a family member with a mental illness - becomes depressed, it can impact the quality of life for both the person being cared for who might go off their medications and miss doctor appointments, and quality of life for the caregiver.
"Detecting depression early can be helpful for everyone, "Zauszniewski said.
Zauszniewski designed the DCS in 1995 as a way to detect depressive thoughts in the elderly. It is based on Developmental Psychologist Erik Erikson's eight stages of human development that lead to building character strengths.
The successful completion of each stage of life identified by Erikson from birth through old age helps individuals develop and master characteristics that allow them to function and have healthy relationships with other people, Zauszniewski said. On the other hand, less than successful resolution of a developmental stage, can result in the evolution of unfavorable characteristics, such as depressive thought patterns.
Based on the ideas of those developmental stages, DCS has been found valid for diagnosing depressive thoughts through the responses to questions that look at an individual's sense of purposelessness, meaninglessness, emptiness, helplessness, hopelessness, powerlessness, loneliness and worthlessness.
Not only has the DCS test been found valid in a number of different groups from the elderly to young adults, it has been validated when used by people in cultures that speak Arabic, Portuguese, and Chinese languages.
Zauszniewski is the nursing school's Kate Hanna Harvey Professor of Community Health Nursing and associate dean for doctoral education.
Issues in Mental Health Nursing recently published Zauszniewski's findings from the study, "Psychometric Assessment of the Depressive Cognition Scale in Women Family Members of Adults with Serious Mental Illness." Working with Zauszniewski on this study funded by the Frances Payne Bolton School of Nursing was co-investigator Jane Suresky, assistant professor of nursing at FPB.
Zauszniewski, a psychiatric nurse researcher, has tested the Depressive Cognition Scale (DCS) she developed on a number of different populations and groups to test whether the short questionnaire and scale can detect cognitive symptoms of early depression.
Each of the DCS's questions targets a symptom of depression and measures negative thinking.
Negative thoughts related to self-worth, power and hope can be precursors to the development of clinical depression. Thus, early detection of negative thinking patterns can lead to prevention of serious depressive illness.
The DCS tested for negative thinking patterns in the study's 60 women, who cared for an adult family member with a serious mental illness such as depression, schizophrenia or bipolar disorder. The average age of the participants was 46 years old and almost half lived in the same household as the adult with the mental illness.
The idea is if the caregiver - who is under stress and encounters the stigma of having a family member with a mental illness - becomes depressed, it can impact the quality of life for both the person being cared for who might go off their medications and miss doctor appointments, and quality of life for the caregiver.
"Detecting depression early can be helpful for everyone, "Zauszniewski said.
Zauszniewski designed the DCS in 1995 as a way to detect depressive thoughts in the elderly. It is based on Developmental Psychologist Erik Erikson's eight stages of human development that lead to building character strengths.
The successful completion of each stage of life identified by Erikson from birth through old age helps individuals develop and master characteristics that allow them to function and have healthy relationships with other people, Zauszniewski said. On the other hand, less than successful resolution of a developmental stage, can result in the evolution of unfavorable characteristics, such as depressive thought patterns.
Based on the ideas of those developmental stages, DCS has been found valid for diagnosing depressive thoughts through the responses to questions that look at an individual's sense of purposelessness, meaninglessness, emptiness, helplessness, hopelessness, powerlessness, loneliness and worthlessness.
Not only has the DCS test been found valid in a number of different groups from the elderly to young adults, it has been validated when used by people in cultures that speak Arabic, Portuguese, and Chinese languages.
Zauszniewski is the nursing school's Kate Hanna Harvey Professor of Community Health Nursing and associate dean for doctoral education.
Middle-Aged Misery Spans The Globe, Researchers Find
Using data on 2 million people, from 80 nations, researchers from the University of Warwick and Dartmouth College in the US have found an extraordinarily consistent international pattern in depression and happiness levels that leaves us most miserable in middle age.
Their paper entitled "Is Well-being U-Shaped over the Life Cycle?" is to be published shortly in Social Science & Medicine, the world's most-cited social science journal. The researchers found happiness levels followed a U shaped curve, with happiness higher towards the start and end of our lives and leaving us most miserable in middle age. Many previous studies of the life-course had suggested that psychological well-being stayed relatively flat and consistent as we aged.
Using a sample of 1 million people from the UK, the researchers discovered that for both men and women the probability of depression peaks around 44 years of age. In the US they found a significant difference between men and women with unhappiness reaching a peak at around 40 years of age for women and 50 years of age for men.
They found the same U-shape in happiness levels and life satisfaction by age for 72 countries: Albania; Argentina; Australia; Azerbaijan; Belarus; Belgium; Bosnia; Brazil; Brunei; Bulgaria; Cambodia; Canada; Chile; China; Colombia; Costa Rica; Croatia; Czech Republic; Denmark; Dominican Republic; Ecuador; El Salvador; Estonia; Finland; France; Germany; Greece; Honduras; Hungary; Iceland; Iraq; Ireland; Israel; Italy; Japan; Kyrgyzstan; Laos; Latvia; Lithuania; Luxembourg; Macedonia; Malta; Mexico; Myanmar; Netherlands; Nicaragua; Nigeria; Norway; Paraguay; Peru; Philippines; Poland; Portugal; Puerto Rico; Romania; Russia; Serbia; Singapore; Slovakia; South Africa; South Korea; Spain; Sweden; Switzerland; Tanzania; Turkey; United Kingdom; Ukraine; Uruguay; USA; Uzbekistan; and Zimbabwe.
The authors, economists Professor Andrew Oswald from the University of Warwick and Professor David Blanchflower from Dartmouth College in the US, believe that the U-shaped effect stems from something inside human beings. They show that signs of mid-life depression are found in all kinds of people; it is not caused by having young children in the house, by divorce, or by changes in jobs or income.
University of Warwick Economist Professor Andrew Oswald said:
"Some people suffer more than others but in our data the average effect is large. It happens to men and women, to single and married people, to rich and poor, and to those with and without children. Nobody knows why we see this consistency."
"What causes this apparently U-shaped curve, and its similar shape in different parts of the developed and even often developing world, is unknown. However, one possibility is that individuals learn to adapt to their strengths and weaknesses, and in mid-life quell their infeasible aspirations. Another possibility is that cheerful people live systematically longer. A third possibility is that a kind of comparison process is at work in which people have seen similar-aged peers die and value more their own remaining years. Perhaps people somehow learn to count their blessings."
"It looks from the data like something happens deep inside humans. For the average person in the modern world, the dip in mental health and happiness comes on slowly, not suddenly in a single year. Only in their 50s do most people emerge from the low period. But encouragingly, by the time you are 70, if you are still physically fit then on average you are as happy and mentally healthy as a 20 year old. Perhaps realizing that such feelings are completely normal in midlife might even help individuals survive this phase better."
The research analysed information on 500,000 randomly sampled Americans and West Europeans from the General Social Surveys of the United States and the Eurobarometer Surveys. The authors also looked at the mental health levels of 16,000 Europeans, the depression and anxiety levels among a large sample of U.K. citizens, and data from the "The World Values Survey" which gives samples of people in 80 countries.
Their paper entitled "Is Well-being U-Shaped over the Life Cycle?" is to be published shortly in Social Science & Medicine, the world's most-cited social science journal. The researchers found happiness levels followed a U shaped curve, with happiness higher towards the start and end of our lives and leaving us most miserable in middle age. Many previous studies of the life-course had suggested that psychological well-being stayed relatively flat and consistent as we aged.
Using a sample of 1 million people from the UK, the researchers discovered that for both men and women the probability of depression peaks around 44 years of age. In the US they found a significant difference between men and women with unhappiness reaching a peak at around 40 years of age for women and 50 years of age for men.
They found the same U-shape in happiness levels and life satisfaction by age for 72 countries: Albania; Argentina; Australia; Azerbaijan; Belarus; Belgium; Bosnia; Brazil; Brunei; Bulgaria; Cambodia; Canada; Chile; China; Colombia; Costa Rica; Croatia; Czech Republic; Denmark; Dominican Republic; Ecuador; El Salvador; Estonia; Finland; France; Germany; Greece; Honduras; Hungary; Iceland; Iraq; Ireland; Israel; Italy; Japan; Kyrgyzstan; Laos; Latvia; Lithuania; Luxembourg; Macedonia; Malta; Mexico; Myanmar; Netherlands; Nicaragua; Nigeria; Norway; Paraguay; Peru; Philippines; Poland; Portugal; Puerto Rico; Romania; Russia; Serbia; Singapore; Slovakia; South Africa; South Korea; Spain; Sweden; Switzerland; Tanzania; Turkey; United Kingdom; Ukraine; Uruguay; USA; Uzbekistan; and Zimbabwe.
The authors, economists Professor Andrew Oswald from the University of Warwick and Professor David Blanchflower from Dartmouth College in the US, believe that the U-shaped effect stems from something inside human beings. They show that signs of mid-life depression are found in all kinds of people; it is not caused by having young children in the house, by divorce, or by changes in jobs or income.
University of Warwick Economist Professor Andrew Oswald said:
"Some people suffer more than others but in our data the average effect is large. It happens to men and women, to single and married people, to rich and poor, and to those with and without children. Nobody knows why we see this consistency."
"What causes this apparently U-shaped curve, and its similar shape in different parts of the developed and even often developing world, is unknown. However, one possibility is that individuals learn to adapt to their strengths and weaknesses, and in mid-life quell their infeasible aspirations. Another possibility is that cheerful people live systematically longer. A third possibility is that a kind of comparison process is at work in which people have seen similar-aged peers die and value more their own remaining years. Perhaps people somehow learn to count their blessings."
"It looks from the data like something happens deep inside humans. For the average person in the modern world, the dip in mental health and happiness comes on slowly, not suddenly in a single year. Only in their 50s do most people emerge from the low period. But encouragingly, by the time you are 70, if you are still physically fit then on average you are as happy and mentally healthy as a 20 year old. Perhaps realizing that such feelings are completely normal in midlife might even help individuals survive this phase better."
The research analysed information on 500,000 randomly sampled Americans and West Europeans from the General Social Surveys of the United States and the Eurobarometer Surveys. The authors also looked at the mental health levels of 16,000 Europeans, the depression and anxiety levels among a large sample of U.K. citizens, and data from the "The World Values Survey" which gives samples of people in 80 countries.
Depression And Back Pain
If you are depressed your disabling back-pain is twice as likely to come back.
A new study was carried out at the University of Alberta, Canada.
Despite earlier controversies regarding depression and back pain, it seems this study proves there is a clear relationship.
Linda J. Carroll, PhD, team leader said 'Our results provide evidence that depression is an important and independent risk factor for troublesome pain. Those with both back pain and depression use twice the sick days and incur twice the health care costs as those with either problem separately.'
You can read about this study in the journal Pain.
Researchers examined data on 790 patients who had had back pain but did not have it at the time of the study. The patients were randomly selected.
All the patients were then followed up 6 months and 12 months later to see if the pain had come back and also to see if they were depressed.
Researchers found that the chicken and egg question here works both ways. Patients with back pain can get depression because of it, and patients with depression can get back pain because of the depression.
Carroll said 'Both conditions can come and go and both are very common. In fact, only 20 percent of the population has not experienced any neck or low back pain in the past six months. So it's important to try to deal with these conditions before they become troublesome and lead to a vicious cycle.'
They found people react to back pain in two ways. They either react passively, avoid everything which can make them feel the pain. These people also seek medication. The other type attacks the pain actively by doing exercise or staying busy.
Carroll said 'We're wondering if depression leads people to cope passively when they experience the kinds of mild pain episodes that most of us are periodically subjected to. This in turn may increase the likelihood that pain will become a problem in someone's life.'
A new study was carried out at the University of Alberta, Canada.
Despite earlier controversies regarding depression and back pain, it seems this study proves there is a clear relationship.
Linda J. Carroll, PhD, team leader said 'Our results provide evidence that depression is an important and independent risk factor for troublesome pain. Those with both back pain and depression use twice the sick days and incur twice the health care costs as those with either problem separately.'
You can read about this study in the journal Pain.
Researchers examined data on 790 patients who had had back pain but did not have it at the time of the study. The patients were randomly selected.
All the patients were then followed up 6 months and 12 months later to see if the pain had come back and also to see if they were depressed.
Researchers found that the chicken and egg question here works both ways. Patients with back pain can get depression because of it, and patients with depression can get back pain because of the depression.
Carroll said 'Both conditions can come and go and both are very common. In fact, only 20 percent of the population has not experienced any neck or low back pain in the past six months. So it's important to try to deal with these conditions before they become troublesome and lead to a vicious cycle.'
They found people react to back pain in two ways. They either react passively, avoid everything which can make them feel the pain. These people also seek medication. The other type attacks the pain actively by doing exercise or staying busy.
Carroll said 'We're wondering if depression leads people to cope passively when they experience the kinds of mild pain episodes that most of us are periodically subjected to. This in turn may increase the likelihood that pain will become a problem in someone's life.'
Minister Jimmy Devins Addresses The National Office For Suicide Prevention's Third Annual Forum, Ireland
''We as policy makers working in the area of suicide prevention need to foster a culture where people in distress, at whatever stage in their lives, won't hesitate to seek help,'' - Devins
Dr Jimmy Devins TD, Minister for Disability and Mental Health, yesterday addressed the National Office for Suicide Prevention's third Annual Forum in the Royal Hospital, Kilmainham.
Speaking at the event Minister Devins said, ''this forum provides an opportunity to meet and exchange views and to look at practical ways of tackling the issue of suicide to prevent the further tragic loss of lives. I am particularly pleased that the theme of this year's Forum is "Young People's Perspectives on Youth Mental Health and Suicide Prevention" and listening to what our young people have to say on this issue.''
Minister Devins continued, ''there are many pressures facing our young people in today's Ireland - pressures such as bullying, emotional distress, addictions, peer pressure and exam pressure. It is only by taking on board what our young people have to say that we can gain true insights into how those pressures can be alleviated.''
The Minister congratulated the Young Social Innovators from St Joseph's Secondary School in Rochfortbridge, Co Westmeath who made a presentation to the Forum on 'Feeling Low, Let Someone Know'. In addition Headstrong, the National Youth Mental Health Centre, made a presentation on 'Youth Mental Health in a Changing Ireland' which helps inform the debate on mental health and suicide prevention.
Minister Devins concluded, ''we as policy makers working in the area of suicide prevention need to foster a culture where people in distress, at whatever stage in their lives, won't hesitate to seek help, a culture that recognises the signs and signals of distress and is willing to help, and that focuses early in life on developing good coping skills and avoiding harmful practices.''
Read the full text of the Minister's speech
Department of Health and Children
Dr Jimmy Devins TD, Minister for Disability and Mental Health, yesterday addressed the National Office for Suicide Prevention's third Annual Forum in the Royal Hospital, Kilmainham.
Speaking at the event Minister Devins said, ''this forum provides an opportunity to meet and exchange views and to look at practical ways of tackling the issue of suicide to prevent the further tragic loss of lives. I am particularly pleased that the theme of this year's Forum is "Young People's Perspectives on Youth Mental Health and Suicide Prevention" and listening to what our young people have to say on this issue.''
Minister Devins continued, ''there are many pressures facing our young people in today's Ireland - pressures such as bullying, emotional distress, addictions, peer pressure and exam pressure. It is only by taking on board what our young people have to say that we can gain true insights into how those pressures can be alleviated.''
The Minister congratulated the Young Social Innovators from St Joseph's Secondary School in Rochfortbridge, Co Westmeath who made a presentation to the Forum on 'Feeling Low, Let Someone Know'. In addition Headstrong, the National Youth Mental Health Centre, made a presentation on 'Youth Mental Health in a Changing Ireland' which helps inform the debate on mental health and suicide prevention.
Minister Devins concluded, ''we as policy makers working in the area of suicide prevention need to foster a culture where people in distress, at whatever stage in their lives, won't hesitate to seek help, a culture that recognises the signs and signals of distress and is willing to help, and that focuses early in life on developing good coping skills and avoiding harmful practices.''
Read the full text of the Minister's speech
Department of Health and Children
Penn Study Based On Abu Ghraib Suggests Military Veterans Highly Tolerant Of Detainee Abuse
In a study that appears in the current issue of Military Medicine, William C. Holmes, MD, MSCE, Assistant Professor of Medicine and Epidemiology, University of Pennsylvania School of Medicine, and lead author of the paper, assesses veterans' tolerance for detainee abuse and variables associated with it.
In the study, three scenarios of detainee abuse, taken directly from Abu Ghraib prison in Iraq, were presented to veterans. After each scenario, zero tolerance -- or the belief that abuse is "completely unacceptable" regardless of who the detainee is -- was assessed for the described abuse. Holmes, who is also an investigator at the Center for Health Equity Resesarch and Promotion at the Philadelphia VA Medical Center, found that:
* Only 16% of veterans indicated zero tolerance for detainee exposure and deprivation
* Only 31% indicated zero tolerance for detainee exposure and sexualized humiliation
* Not even half (48%) indicated zero tolerance for detainee rape
"The level of tolerance exhibited by these findings is surprising, but may not be true for all veterans and certainly cannot be said to be representative of active-duty military," says Holmes. He adds, "These findings do indicate, however, the value of assessing tolerance for abuse, and for using scenario-based assessment to do that; it provides an argument for similar work being done in active-duty military, particularly those who are heading to Iraq to become involved in sensitive, oversight positions."
The study was completed by administering paper questionnaires to 351veteran volunteers at the Philadelphia VA Medical Center's Mental Health Clinic, Primary Care Clinic, and Women's Health Center. Participants were asked a number of sociodemographic questions (e.g., age, sex) and other questions (e.g., period of service, service in a war zone). Symptoms of depression and post traumatic stress disorder (PTSD) were also assessed.
Although every questionnaire administered the three increasingly-severe abuse scenarios, there were three questionnaire versions used: all scenarios of one version ended by stating that the abusing soldier was not ordered by a superior to treat the detainee in this way; all scenarios of the second version ended by stating that the abusing soldier was ordered by a superior to treat the detainee in this way; and all scenarios of the third version ended by stating that a second soldier stated, "This treatment is wrong," and reported it.
In general, veterans' tolerance for abuse was least when soldier-initiated, and greatest when superior-ordered. Tolerance for abuse also was high when a whistleblower was involved.
The strongest, most consistently significant variable related to tolerance was depression and co-morbid depression/posttraumatic stress disorder (PTSD). Those with depression alone and those with comorbid depression/PTSD exhibited odds that were approximately two and three times more tolerant of abuse than those with neither depression or PTSD. Sex of the respondent also was related to tolerance. Men exhibited odds that were ~4 to 20 times more tolerant of abuse than women.
Holmes notes that future studies using scenario-based questionnaire methods are warranted in generalizable war zone samples. "If our results are replicated in active-duty soldiers," he challenges, "one could imagine the use of scenario-based questionnaires of this type to provide risk stratification of a soldiers' likelihood for abuse upon entry into a sensitive oversight position. The frequent development of depression and PTSD in soldiers in Afghanistan and Iraq would suggest that completion of the questionnaire occur intermittently during their tour of duty as well."
PENN Medicine is a $2.9 billion enterprise dedicated to the related missions of medical education, biomedical research, and high-quality patient care. PENN Medicine consists of the University of Pennsylvania School of Medicine (founded in 1765 as the nation's first medical school) and the University of Pennsylvania Health System.
Penn's School of Medicine is ranked #2 in the nation for receipt of NIH research funds; and ranked #3 in the nation in U.S. News & World Report's most recent ranking of top research-oriented medical schools. Supporting 1,400 fulltime faculty and 700 students, the School of Medicine is recognized worldwide for its superior education and training of the next generation of physician-scientists and leaders of academic medicine.
The University of Pennsylvania Health System includes three hospitals, all of which have received numerous national patient-care honors [Hospital of the University of Pennsylvania; Pennsylvania Hospital, the nation's first hospital; and Penn Presbyterian Medical Center]; a faculty practice plan; a primary-care provider network; two multispecialty satellite facilities; and home care and hospice.
Contact: Kate Olderman
University of Pennsylvania School of Medicine
In the study, three scenarios of detainee abuse, taken directly from Abu Ghraib prison in Iraq, were presented to veterans. After each scenario, zero tolerance -- or the belief that abuse is "completely unacceptable" regardless of who the detainee is -- was assessed for the described abuse. Holmes, who is also an investigator at the Center for Health Equity Resesarch and Promotion at the Philadelphia VA Medical Center, found that:
* Only 16% of veterans indicated zero tolerance for detainee exposure and deprivation
* Only 31% indicated zero tolerance for detainee exposure and sexualized humiliation
* Not even half (48%) indicated zero tolerance for detainee rape
"The level of tolerance exhibited by these findings is surprising, but may not be true for all veterans and certainly cannot be said to be representative of active-duty military," says Holmes. He adds, "These findings do indicate, however, the value of assessing tolerance for abuse, and for using scenario-based assessment to do that; it provides an argument for similar work being done in active-duty military, particularly those who are heading to Iraq to become involved in sensitive, oversight positions."
The study was completed by administering paper questionnaires to 351veteran volunteers at the Philadelphia VA Medical Center's Mental Health Clinic, Primary Care Clinic, and Women's Health Center. Participants were asked a number of sociodemographic questions (e.g., age, sex) and other questions (e.g., period of service, service in a war zone). Symptoms of depression and post traumatic stress disorder (PTSD) were also assessed.
Although every questionnaire administered the three increasingly-severe abuse scenarios, there were three questionnaire versions used: all scenarios of one version ended by stating that the abusing soldier was not ordered by a superior to treat the detainee in this way; all scenarios of the second version ended by stating that the abusing soldier was ordered by a superior to treat the detainee in this way; and all scenarios of the third version ended by stating that a second soldier stated, "This treatment is wrong," and reported it.
In general, veterans' tolerance for abuse was least when soldier-initiated, and greatest when superior-ordered. Tolerance for abuse also was high when a whistleblower was involved.
The strongest, most consistently significant variable related to tolerance was depression and co-morbid depression/posttraumatic stress disorder (PTSD). Those with depression alone and those with comorbid depression/PTSD exhibited odds that were approximately two and three times more tolerant of abuse than those with neither depression or PTSD. Sex of the respondent also was related to tolerance. Men exhibited odds that were ~4 to 20 times more tolerant of abuse than women.
Holmes notes that future studies using scenario-based questionnaire methods are warranted in generalizable war zone samples. "If our results are replicated in active-duty soldiers," he challenges, "one could imagine the use of scenario-based questionnaires of this type to provide risk stratification of a soldiers' likelihood for abuse upon entry into a sensitive oversight position. The frequent development of depression and PTSD in soldiers in Afghanistan and Iraq would suggest that completion of the questionnaire occur intermittently during their tour of duty as well."
PENN Medicine is a $2.9 billion enterprise dedicated to the related missions of medical education, biomedical research, and high-quality patient care. PENN Medicine consists of the University of Pennsylvania School of Medicine (founded in 1765 as the nation's first medical school) and the University of Pennsylvania Health System.
Penn's School of Medicine is ranked #2 in the nation for receipt of NIH research funds; and ranked #3 in the nation in U.S. News & World Report's most recent ranking of top research-oriented medical schools. Supporting 1,400 fulltime faculty and 700 students, the School of Medicine is recognized worldwide for its superior education and training of the next generation of physician-scientists and leaders of academic medicine.
The University of Pennsylvania Health System includes three hospitals, all of which have received numerous national patient-care honors [Hospital of the University of Pennsylvania; Pennsylvania Hospital, the nation's first hospital; and Penn Presbyterian Medical Center]; a faculty practice plan; a primary-care provider network; two multispecialty satellite facilities; and home care and hospice.
Contact: Kate Olderman
University of Pennsylvania School of Medicine
Violent Games Not To Blame For Youth Aggression
How depressed young people are strongly predicts how aggressive and violent they may be or may become. Contrary to popular belief, however, exposure to violence in video games or on television is not related to serious acts of youth aggression or violence among Hispanics in the US, according to new research by Dr. Christopher Ferguson from Texas A&M International University. His findings are published online in Springer's Journal of Youth and Adolescence.
The potential negative effects of violent video games on adolescent antisocial behavior, and youth violence in particular, is a highly debated issue, both in academic circles and among the general public and policy makers. However, to date, the research is inconclusive largely due to methodological problems.
Ferguson recruited 302 mainly Hispanic youth between the ages of 10 and 14 years, from a small Hispanic-majority city population on the border of Mexico, as part of a larger study of youth violence. They were interviewed twice once at the start of the study and again 12 months later.
Ferguson looked at their exposure to violence both in video games and on television as well as negative life events, including neighborhood problems, negative relationships with adults, antisocial personality, family attachment, and delinquent peers. He also assessed the styles of family interaction and communication, adolescents' exposure to domestic violence, depressive symptoms, serious aggression, bullying and delinquent behavior.
His analyses show that 75 percent of young people played video games within the past month on computers, consoles or other devices, and 40 percent played games with violent content. Boys were more likely than girls to play violent games. One year later, 7 percent reported engaging in at least one criminally violent act during the previous 12 months, the most common being physical assaults on other students or using physical force to take an object or money from another person. Nineteen percent reported engaging in at least one nonviolent crime during the same period, with shoplifting and thefts on school property at the top of the list.
In addition, Ferguson found that depressive symptoms were a strong predictor for youth aggression and rule breaking, and their influence was particularly severe for those who had preexisting antisocial personality traits. However, neither exposure to violence from video games or television at the start of the study predicted aggressive behavior in young people or rule-breaking at 12 months.
Ferguson concludes: "Depressive symptoms stand out as particularly strong predictors of youth violence and aggression, and therefore current levels of depression may be a key variable of interest in the prevention of serious aggression in youth. The current study finds no evidence to support a long-term relationship between video game violence use and subsequent aggression. Even though the debate over violent video games and youth violence will continue, it must do so with restraint."
Sources: Springer Science+Business Media, AlphaGalileo Foundation.
The potential negative effects of violent video games on adolescent antisocial behavior, and youth violence in particular, is a highly debated issue, both in academic circles and among the general public and policy makers. However, to date, the research is inconclusive largely due to methodological problems.
Ferguson recruited 302 mainly Hispanic youth between the ages of 10 and 14 years, from a small Hispanic-majority city population on the border of Mexico, as part of a larger study of youth violence. They were interviewed twice once at the start of the study and again 12 months later.
Ferguson looked at their exposure to violence both in video games and on television as well as negative life events, including neighborhood problems, negative relationships with adults, antisocial personality, family attachment, and delinquent peers. He also assessed the styles of family interaction and communication, adolescents' exposure to domestic violence, depressive symptoms, serious aggression, bullying and delinquent behavior.
His analyses show that 75 percent of young people played video games within the past month on computers, consoles or other devices, and 40 percent played games with violent content. Boys were more likely than girls to play violent games. One year later, 7 percent reported engaging in at least one criminally violent act during the previous 12 months, the most common being physical assaults on other students or using physical force to take an object or money from another person. Nineteen percent reported engaging in at least one nonviolent crime during the same period, with shoplifting and thefts on school property at the top of the list.
In addition, Ferguson found that depressive symptoms were a strong predictor for youth aggression and rule breaking, and their influence was particularly severe for those who had preexisting antisocial personality traits. However, neither exposure to violence from video games or television at the start of the study predicted aggressive behavior in young people or rule-breaking at 12 months.
Ferguson concludes: "Depressive symptoms stand out as particularly strong predictors of youth violence and aggression, and therefore current levels of depression may be a key variable of interest in the prevention of serious aggression in youth. The current study finds no evidence to support a long-term relationship between video game violence use and subsequent aggression. Even though the debate over violent video games and youth violence will continue, it must do so with restraint."
Sources: Springer Science+Business Media, AlphaGalileo Foundation.
Study Tests Depression Treatment For Diabetes Patients
In Appalachia, diabetes hits hard. Depression does, too. Together, they form a difficult pair to beat.
To help patients fight back, a team of Ohio University College of Osteopathic Medicine (OU-COM) and Ohio University researchers have put together a new approach to the double-edged problem. Program ACTIVE (Appalachians Coming Together to Increase Vital Exercise) is a two-year intervention feasibility study to test the effectiveness of a combination of exercise and talk therapy as a treatment for depression in patients with type 2 diabetes.
"Diabetes is a difficult disease," said Mary de Groot, Ph.D., assistant professor of psychology and lead author of a paper produced by the research team. "Add depression on top of that, and it makes it that much tougher."
Their paper, "Depression among type 2 Diabetes Rural Appalachian Clinic Attendees," is published in the June issue of Diabetes Care, the journal of the American Diabetes Association.
The researchers point out that previously published studies have shown that depressive symptoms in diabetics are "associated with worsened blood glucose levels, diabetes complications, increased functional disability, worsened adherence to diabetes regimen, higher ambulatory care costs, and increased mortality."
The study looked at type 2 diabetes patients attending family medicine and endocrinology appointments in rural Appalachian counties of Southeastern Ohio and West Virginia. Of those 201 patients, 31 percent reported co-morbid diabetes and depression through completion of the Beck Depression Inventory, a self-report questionnaire assessment.
That rate is similar to the national co-morbidity rate, somewhat surprisingly low considering the relatively high rate of poverty where the patients live. For instance, Meigs County, Ohio, has a poverty rate of 19.8 percent, compared to 10.6 percent for the state of Ohio.
"My vision of it is that people in Appalachia have sort of a higher tolerance for bad things," said Frank Schwartz, M.D., assistant professor of endocrinology at OU-COM and director of the Appalachian Rural Health Institute (ARHI) Diabetes Center.
"What is compelling is the length of episodes of depression," said de Groot, the principal investigator. A follow-up study of the patients involved showed that 88 percent of those who had initially identified themselves as suffering from depression also did so 18 months later. Depression severity was associated with younger age, unemployment and a greater number of prescribed medications. These findings are consistent with those observed in urban samples.
"Part of the significance of the paper is that it helps put rural Appalachia on the map in terms of depression and diabetes," de Groot said.
According to Schwartz, in research conducted by the ARHI Diabetes Center, Appalachia has a diabetes prevalence rate of 11.3 percent well above the 7.6 percent national rate.
De Groot and her colleagues encourage doctors to screen their diabetic patients for depression. People with diabetes are twice as likely to have an experience with depression as those without diabetes.
For patients, de Groot said, it is vital to share feelings and mood symptoms with their doctors. It's important, too, to know that talk therapy has been shown to be effective in treating depression in type 2 diabetes, she said, and that antidepressant medications have been effective in treating depression in people with type 1 and type 2 diabetes.
Program ACTIVE is the researchers' way of doing something about the situation.
To meet the depression criterion for Program ACTIVE, patients must have felt consistently depressed or down for most of the day nearly every day for two weeks or longer. Associated symptoms people experience are:
-- a significant decrease in interest in activities they would ordinarily enjoy;
-- changes in sleep;
-- changes in appetite;
-- weight loss or gain;
-- difficulty with concentration;
-- feelings of worthlessness;
-- and significantly decreased energy.
Program ACTIVE, which is funded by the National Institute of Diabetes & Digestive & Kidney Diseases (NIDDK), combines 12 weeks of exercise with 10 sessions of talk therapy for patients with type 2 diabetes and depression for two weeks or longer. The aim is to assess improvements made during the program in depression, diabetes and cardiovascular risk factors.
Participants have free access to the workout facilities at the Athens Community Center, which is one of the program's community partners, as are University Medical Associates, Family Health Care Inc. and Holzer Clinic in Athens. Talk therapy, or cognitive behavioral therapy, sessions are conducted in Athens.
"If we can show effective intervention, this will become a program that is implemented in many high-risk environments," Schwartz said.
Schwartz and his colleague at the Cornwell Center for Cardiovascular and Diabetes Care in Athens, Jay Shubrook, D.O., assistant professor of family medicine at OU-COM, are co-investigators in Program ACTIVE, as is Michael Kushnick, Ph.D., exercise physiologist with Ohio University's Department of Recreation and Sports Sciences.
The team received funding for its initial study from the Ohio University Diabetes Research Initiative (DRI), and the NIDDK. Ohio University's DRI funded the 18-month follow-up study.
In addition to de Groot, Schwartz and Shubrook, co-authors of the paper are Robert Gotfried, D.O.; Brenda Pinkerman, Ph.D., who earned a doctorate in clinical psychology from Ohio University; and graduate students Todd Doyle, Erin Hockman and Charles Wheeler.
The mission of Ohio University College of Osteopathic Medicine is innovative learning, focused research and compassionate care for Ohio and beyond. Each year more than 100 osteopathic physicians graduate from OU-COM, Ohio's only college of osteopathic medicine. Fifty-four percent of OU-COM alumni practice in primary care fields, and more than 60 percent of its graduates remain in Ohio, where they are more likely to practice in rural and other physician-shortage areas.
Ohio University College of Osteopathic Medicine
330 TEB, The Ridges
Athens, OH 45701
United States
oucom.ohiou
To help patients fight back, a team of Ohio University College of Osteopathic Medicine (OU-COM) and Ohio University researchers have put together a new approach to the double-edged problem. Program ACTIVE (Appalachians Coming Together to Increase Vital Exercise) is a two-year intervention feasibility study to test the effectiveness of a combination of exercise and talk therapy as a treatment for depression in patients with type 2 diabetes.
"Diabetes is a difficult disease," said Mary de Groot, Ph.D., assistant professor of psychology and lead author of a paper produced by the research team. "Add depression on top of that, and it makes it that much tougher."
Their paper, "Depression among type 2 Diabetes Rural Appalachian Clinic Attendees," is published in the June issue of Diabetes Care, the journal of the American Diabetes Association.
The researchers point out that previously published studies have shown that depressive symptoms in diabetics are "associated with worsened blood glucose levels, diabetes complications, increased functional disability, worsened adherence to diabetes regimen, higher ambulatory care costs, and increased mortality."
The study looked at type 2 diabetes patients attending family medicine and endocrinology appointments in rural Appalachian counties of Southeastern Ohio and West Virginia. Of those 201 patients, 31 percent reported co-morbid diabetes and depression through completion of the Beck Depression Inventory, a self-report questionnaire assessment.
That rate is similar to the national co-morbidity rate, somewhat surprisingly low considering the relatively high rate of poverty where the patients live. For instance, Meigs County, Ohio, has a poverty rate of 19.8 percent, compared to 10.6 percent for the state of Ohio.
"My vision of it is that people in Appalachia have sort of a higher tolerance for bad things," said Frank Schwartz, M.D., assistant professor of endocrinology at OU-COM and director of the Appalachian Rural Health Institute (ARHI) Diabetes Center.
"What is compelling is the length of episodes of depression," said de Groot, the principal investigator. A follow-up study of the patients involved showed that 88 percent of those who had initially identified themselves as suffering from depression also did so 18 months later. Depression severity was associated with younger age, unemployment and a greater number of prescribed medications. These findings are consistent with those observed in urban samples.
"Part of the significance of the paper is that it helps put rural Appalachia on the map in terms of depression and diabetes," de Groot said.
According to Schwartz, in research conducted by the ARHI Diabetes Center, Appalachia has a diabetes prevalence rate of 11.3 percent well above the 7.6 percent national rate.
De Groot and her colleagues encourage doctors to screen their diabetic patients for depression. People with diabetes are twice as likely to have an experience with depression as those without diabetes.
For patients, de Groot said, it is vital to share feelings and mood symptoms with their doctors. It's important, too, to know that talk therapy has been shown to be effective in treating depression in type 2 diabetes, she said, and that antidepressant medications have been effective in treating depression in people with type 1 and type 2 diabetes.
Program ACTIVE is the researchers' way of doing something about the situation.
To meet the depression criterion for Program ACTIVE, patients must have felt consistently depressed or down for most of the day nearly every day for two weeks or longer. Associated symptoms people experience are:
-- a significant decrease in interest in activities they would ordinarily enjoy;
-- changes in sleep;
-- changes in appetite;
-- weight loss or gain;
-- difficulty with concentration;
-- feelings of worthlessness;
-- and significantly decreased energy.
Program ACTIVE, which is funded by the National Institute of Diabetes & Digestive & Kidney Diseases (NIDDK), combines 12 weeks of exercise with 10 sessions of talk therapy for patients with type 2 diabetes and depression for two weeks or longer. The aim is to assess improvements made during the program in depression, diabetes and cardiovascular risk factors.
Participants have free access to the workout facilities at the Athens Community Center, which is one of the program's community partners, as are University Medical Associates, Family Health Care Inc. and Holzer Clinic in Athens. Talk therapy, or cognitive behavioral therapy, sessions are conducted in Athens.
"If we can show effective intervention, this will become a program that is implemented in many high-risk environments," Schwartz said.
Schwartz and his colleague at the Cornwell Center for Cardiovascular and Diabetes Care in Athens, Jay Shubrook, D.O., assistant professor of family medicine at OU-COM, are co-investigators in Program ACTIVE, as is Michael Kushnick, Ph.D., exercise physiologist with Ohio University's Department of Recreation and Sports Sciences.
The team received funding for its initial study from the Ohio University Diabetes Research Initiative (DRI), and the NIDDK. Ohio University's DRI funded the 18-month follow-up study.
In addition to de Groot, Schwartz and Shubrook, co-authors of the paper are Robert Gotfried, D.O.; Brenda Pinkerman, Ph.D., who earned a doctorate in clinical psychology from Ohio University; and graduate students Todd Doyle, Erin Hockman and Charles Wheeler.
The mission of Ohio University College of Osteopathic Medicine is innovative learning, focused research and compassionate care for Ohio and beyond. Each year more than 100 osteopathic physicians graduate from OU-COM, Ohio's only college of osteopathic medicine. Fifty-four percent of OU-COM alumni practice in primary care fields, and more than 60 percent of its graduates remain in Ohio, where they are more likely to practice in rural and other physician-shortage areas.
Ohio University College of Osteopathic Medicine
330 TEB, The Ridges
Athens, OH 45701
United States
oucom.ohiou
Lack Of Light And Seasonal Depression - What's The Link? From The Harvard Health Letter
People troubled by
depression usually experience their dark moods in an on-again, off-again
fashion. In that respect, seasonal affective disorder (SAD) differs only in
that the oscillations follow a seasonal schedule, with the depression
usually starting in the fall and lasting through the spring. Lack of light
is often blamed for SAD, but just how darker days cause depression in SAD
sufferers is still in question, reports the January 2008 issue of the
Harvard Health Letter.
Experts debate whether it has been proved that lack of sunlight in
winter triggers SAD, but there's certainly circumstantial evidence to
support the connection. How might lack of light cause depression? The
Harvard Health Letter discusses three theories:
1. The root cause may be insensitivity to light. Most of us go
through winter on a relatively even keel because exposure to
indoor lighting helps offset the lack of natural light, but
indoor light may be too weak for SAD sufferers.
2. There are neural pathways from the eyes' retinas to parts of
the brain that help put many of our physiological processes
on a 24-hour cycle. Lack of light may put people with SAD out
of phase with their biological clocks: awake and active when
their internal timers want them snug in bed.
3. A lack of light, or insensitivity to it, may disrupt
brain processes influenced by serotonin and dopamine, brain
chemicals that play a role in mood.
Light therapy, which involves sitting in front of a bright light for a
short time each day, helps some people who suffer from SAD. But
antidepressant medications may work just as well, says the Harvard Health
Letter.
Harvard Health Letter
health.harvard
depression usually experience their dark moods in an on-again, off-again
fashion. In that respect, seasonal affective disorder (SAD) differs only in
that the oscillations follow a seasonal schedule, with the depression
usually starting in the fall and lasting through the spring. Lack of light
is often blamed for SAD, but just how darker days cause depression in SAD
sufferers is still in question, reports the January 2008 issue of the
Harvard Health Letter.
Experts debate whether it has been proved that lack of sunlight in
winter triggers SAD, but there's certainly circumstantial evidence to
support the connection. How might lack of light cause depression? The
Harvard Health Letter discusses three theories:
1. The root cause may be insensitivity to light. Most of us go
through winter on a relatively even keel because exposure to
indoor lighting helps offset the lack of natural light, but
indoor light may be too weak for SAD sufferers.
2. There are neural pathways from the eyes' retinas to parts of
the brain that help put many of our physiological processes
on a 24-hour cycle. Lack of light may put people with SAD out
of phase with their biological clocks: awake and active when
their internal timers want them snug in bed.
3. A lack of light, or insensitivity to it, may disrupt
brain processes influenced by serotonin and dopamine, brain
chemicals that play a role in mood.
Light therapy, which involves sitting in front of a bright light for a
short time each day, helps some people who suffer from SAD. But
antidepressant medications may work just as well, says the Harvard Health
Letter.
Harvard Health Letter
health.harvard
Napolitano Speaks To National Hispanic Medical Association - Plenary Session To Address The Effect Of Depression On The Latino Community
Congresswoman Grace F. Napolitano (D-Norwalk) addressed a plenary session of the 12th Annual Conference of the National Hispanic Medical Association's (NHMA) today. She spoke at a session titled "Recognition and Management of Depression and Co-Morbidities in the Hispanic Population." The session will be held from 11 am - 3 pm in Room HC-7 of the U.S. Capitol. It will be the first meeting of the newly elected Board of Directors who will serve from 2008-2012.
The NHMA is a non-profit association representing 36,000 licensed Latino physicians in the United States. The organization's mission is to improve the health of Latinos and other underserved populations.
Napolitano recognized the members of the NHMA for the important work they do, while also recognizing the need to do more - not just doctors, but also family, friends and neighbors - to recognize and seek assistance when someone is suffering from depression, especially now with the epidemic of Post Traumatic Stress Disorder (PTSD) among soldiers who served in the Iraq War.
"Too many people who struggle with depression and PTSD also struggle with the stigma of mental illness," Rep. Napolitano told the group of medical professionals. "It is a tragedy that so many should suffer with these feelings of shame when what they need is understanding, hope and care."
Rep. Napolitano is co-chair of the bi-partisan Congressional Mental Health Caucus and has been a leader on issues of mental health, especially those affecting adolescent Latinas and veterans.
Grace F. Napolitano - 38th Congressional District of California
napolitano.house
The NHMA is a non-profit association representing 36,000 licensed Latino physicians in the United States. The organization's mission is to improve the health of Latinos and other underserved populations.
Napolitano recognized the members of the NHMA for the important work they do, while also recognizing the need to do more - not just doctors, but also family, friends and neighbors - to recognize and seek assistance when someone is suffering from depression, especially now with the epidemic of Post Traumatic Stress Disorder (PTSD) among soldiers who served in the Iraq War.
"Too many people who struggle with depression and PTSD also struggle with the stigma of mental illness," Rep. Napolitano told the group of medical professionals. "It is a tragedy that so many should suffer with these feelings of shame when what they need is understanding, hope and care."
Rep. Napolitano is co-chair of the bi-partisan Congressional Mental Health Caucus and has been a leader on issues of mental health, especially those affecting adolescent Latinas and veterans.
Grace F. Napolitano - 38th Congressional District of California
napolitano.house
Multiple Sclerosis Activity May Be Affected By Prozac
A new study published in the Journal of
Neurology Neurosurgery and Psychiatry finds that Prozac, a
commonly prescribed antidepressant, may be an agent in slowing
down the disease process of the relapsing remitting form of multiple
sclerosis (MS).
Multiple sclerosis is an autoimmune disease where the immune system
attacks the central nervous system. In the relapsing remitting form,
new symptoms occur in discrete attacks.
A team of researchers led by J P Mostert (Department of Neurology,
University Medical Center Groningen, University of Groningen,
Groningen, The Netherlands) conducted a double-blind,
placebo-controlled, exploratory analysis of 40 patients
with the relapsing
remitting form of MS. For a period of 24 weeks, half of the sample was
treated with 20 mg daily of fluoxetine
(Prozac) while the other half received a placebo. To measure the
activity of MS, detailed magnetic resonance images (MRI) of the
participants' brains were completed every four weeks. The researchers
focused on areas of neurological inflammation that would indicate
active disease.
Of the 40 initial patients, 19 participants in each group finished the
study. The main finding was that the patients who were treated with
Prozac had fewer new areas of inflammation than those treated with
placebo. The researchers were able to detect the effects just after
eight weeks - the same amount of time that it takes for selective
serotonin reuptake inhibitor
(SSRI) drugs such as Prozac to begin relieving depression.
Specifically, the group given placebo had an average of over five new
areas affected with inflammation compared to just less than two areas
in the Prozac group. Twenty-five percent of scans from Prozac-treated
patients and forty percent of placebo-treated patients depicted new
areas of inflammation. Almost two out of three patients in the Prozac
group had no new inflammation areas during the last 16 weeks of
treatment, whereas only about 25% of patients in the placebo group had
no new areas.
Although this was a small-scale study and a larger sample size is
required to increase the robustness of results, the authors conclude
that, "Results of our exploratory trial are sufficiently encouraging to
justify further studies with fluoxetine in patients with MS. Higher
doses of fluoxetine and combination treatment with immunomodulatory
drugs should be considered."
Effects of fluoxetine on disease activity in relapsing
multiple sclerosis: a double-blind, placebo-controlled, exploratory
study
J P Mostert, F Admiraal-Behloul, J M Hoogduin, J Luyendijk, D J
Heersema, M A van Buchem, J De Keyser
Journal of Neurology
Neurosurgery and Psychiatry. (2008)
doi: 10.1136/jnnp.2007.139345
Click
Here to See Article Online
Written by: Peter M Crosta
View drug information on Prozac Weekly.
Neurology Neurosurgery and Psychiatry finds that Prozac, a
commonly prescribed antidepressant, may be an agent in slowing
down the disease process of the relapsing remitting form of multiple
sclerosis (MS).
Multiple sclerosis is an autoimmune disease where the immune system
attacks the central nervous system. In the relapsing remitting form,
new symptoms occur in discrete attacks.
A team of researchers led by J P Mostert (Department of Neurology,
University Medical Center Groningen, University of Groningen,
Groningen, The Netherlands) conducted a double-blind,
placebo-controlled, exploratory analysis of 40 patients
with the relapsing
remitting form of MS. For a period of 24 weeks, half of the sample was
treated with 20 mg daily of fluoxetine
(Prozac) while the other half received a placebo. To measure the
activity of MS, detailed magnetic resonance images (MRI) of the
participants' brains were completed every four weeks. The researchers
focused on areas of neurological inflammation that would indicate
active disease.
Of the 40 initial patients, 19 participants in each group finished the
study. The main finding was that the patients who were treated with
Prozac had fewer new areas of inflammation than those treated with
placebo. The researchers were able to detect the effects just after
eight weeks - the same amount of time that it takes for selective
serotonin reuptake inhibitor
(SSRI) drugs such as Prozac to begin relieving depression.
Specifically, the group given placebo had an average of over five new
areas affected with inflammation compared to just less than two areas
in the Prozac group. Twenty-five percent of scans from Prozac-treated
patients and forty percent of placebo-treated patients depicted new
areas of inflammation. Almost two out of three patients in the Prozac
group had no new inflammation areas during the last 16 weeks of
treatment, whereas only about 25% of patients in the placebo group had
no new areas.
Although this was a small-scale study and a larger sample size is
required to increase the robustness of results, the authors conclude
that, "Results of our exploratory trial are sufficiently encouraging to
justify further studies with fluoxetine in patients with MS. Higher
doses of fluoxetine and combination treatment with immunomodulatory
drugs should be considered."
Effects of fluoxetine on disease activity in relapsing
multiple sclerosis: a double-blind, placebo-controlled, exploratory
study
J P Mostert, F Admiraal-Behloul, J M Hoogduin, J Luyendijk, D J
Heersema, M A van Buchem, J De Keyser
Journal of Neurology
Neurosurgery and Psychiatry. (2008)
doi: 10.1136/jnnp.2007.139345
Click
Here to See Article Online
Written by: Peter M Crosta
View drug information on Prozac Weekly.
Internet Use Cuts Depression Among Senior Citizens
Spending time online reduces depression by 20 percent for senior citizens, the Phoenix Center reports in a new Policy Paper released today. In addition to the quality of life benefits, the Policy Paper said reducing the incidence of depression by widespread Internet use among older Americans could trim the nation's health care bill.
"Maintaining relationships with friends and family at a time in life when mobility becomes increasingly limited is challenging for the elderly," says Phoenix Center Visiting Scholar and study co-author Dr. Sherry G. Ford, an Associate Professor of Communications Studies at University of Montevallo in Alabama. "Increased Internet access and use by senior citizens enables them to connect with sources of social support when face-to-face interaction becomes more difficult."
The Policy Paper, Internet Use and Depression Among the Elderly, examines survey responses of 7,000 retired Americans 55 years or older. The data was provided by the Health and Retirement Study of the University of Michigan and screened to exclude respondents who were still working and also those living in nursing homes in order to limit possible variations that might skew the findings. These limitations reduced the size of the sample from the initial 22,000 to 7,000, but that is still far larger than all previous efforts to consider the effect of Internet use on psychological well-being of the elderly population. Age 55 is the common age cut off for studies of the elderly. Unlike many existing studies on the benefits of broadband, the statistical methodologies used in the analysis aim to determine causal effects and not simply measure correlations.
Phoenix Center President Lawrence W. Spiwak says, "This is the most advanced statistical analysis on the social impacts of broadband to date, and the most believable. If policymakers want better data analysis, they now have it. The study raises the bar for credible statistical analysis when formulating broadband policy."
The implications of the findings are significant because depression affects millions Americans age 55 or older and costs the United States about $100 million annually in direct medical costs, suicide and mortality, and workplace costs. The Pew Internet & American Life Project estimates that only about 42 percent of Americans aged 65 or more use the Internet, far below the adoption rate of other age groups. Given the relatively low adoption rates by seniors, the study concludes that the opportunity for better health outcomes from expanded Internet adoption is substantial. Further, with billions spent annually on depression-related health care costs, the potential economic savings also are impressive. "Efforts to expand broadband use in the U.S. must eventually tackle the problem of low adoption in the elderly population," says study Phoenix Center Chief Economist and study co-author Dr. George S. Ford. "The positive mental health consequences of Internet demonstrate, in part, the value of demand stimulus programs aimed at older Americans."
The Phoenix Center is a non-profit 501(c)(3) organization that studies broad public-policy issues related to governance, social and economic conditions, with a particular emphasis on the law and economics of telecommunications and high-tech industries.
"Maintaining relationships with friends and family at a time in life when mobility becomes increasingly limited is challenging for the elderly," says Phoenix Center Visiting Scholar and study co-author Dr. Sherry G. Ford, an Associate Professor of Communications Studies at University of Montevallo in Alabama. "Increased Internet access and use by senior citizens enables them to connect with sources of social support when face-to-face interaction becomes more difficult."
The Policy Paper, Internet Use and Depression Among the Elderly, examines survey responses of 7,000 retired Americans 55 years or older. The data was provided by the Health and Retirement Study of the University of Michigan and screened to exclude respondents who were still working and also those living in nursing homes in order to limit possible variations that might skew the findings. These limitations reduced the size of the sample from the initial 22,000 to 7,000, but that is still far larger than all previous efforts to consider the effect of Internet use on psychological well-being of the elderly population. Age 55 is the common age cut off for studies of the elderly. Unlike many existing studies on the benefits of broadband, the statistical methodologies used in the analysis aim to determine causal effects and not simply measure correlations.
Phoenix Center President Lawrence W. Spiwak says, "This is the most advanced statistical analysis on the social impacts of broadband to date, and the most believable. If policymakers want better data analysis, they now have it. The study raises the bar for credible statistical analysis when formulating broadband policy."
The implications of the findings are significant because depression affects millions Americans age 55 or older and costs the United States about $100 million annually in direct medical costs, suicide and mortality, and workplace costs. The Pew Internet & American Life Project estimates that only about 42 percent of Americans aged 65 or more use the Internet, far below the adoption rate of other age groups. Given the relatively low adoption rates by seniors, the study concludes that the opportunity for better health outcomes from expanded Internet adoption is substantial. Further, with billions spent annually on depression-related health care costs, the potential economic savings also are impressive. "Efforts to expand broadband use in the U.S. must eventually tackle the problem of low adoption in the elderly population," says study Phoenix Center Chief Economist and study co-author Dr. George S. Ford. "The positive mental health consequences of Internet demonstrate, in part, the value of demand stimulus programs aimed at older Americans."
The Phoenix Center is a non-profit 501(c)(3) organization that studies broad public-policy issues related to governance, social and economic conditions, with a particular emphasis on the law and economics of telecommunications and high-tech industries.
Detection Of Depression Hindered By Patient Personality
Patient personality affects the accuracy of reports by friends and family members of mood history and symptoms and can cause missed diagnoses of depression, according to research published online by the journal International Psychogeriatrics.
Friends and family members of a person who is highly outgoing and fun-loving and who is likely to experience happiness and excitement, for example, often miss the signs that indicate the person is depressed.
"When a person who has enjoyed socializing and whose mood normally is positive becomes depressed, friends and family often don't recognize it. Depression is inconsistent with the expectations that people have," said Paul R. Duberstein, Ph.D., professor of Psychiatry at the University of Rochester Medical Center and corresponding author of the journal article.
Missed diagnoses and "false negatives" can have grave consequences for patients with depression or mood disorders, the researchers stated.
Understanding and improving the ability of friends and family to identify depression could enhance the appropriate use of services for depressed older adults and improve the quality of treatment monitoring, the researchers concluded.
The research is based on the study of 191 primary care patients aged 60 or older from the Rochester, N.Y., area and their friends and family members.
Older patients tend to discuss their health concerns with friends and family members, who often accompany them on visits to physicians. Information provided by friends and family members can help identify at-risk individuals.
When the research began, researchers hypothesized that friends and family would miss depression in a person who is introverted.
"But our research showed the opposite to be true," Duberstein said. "We found the signs of depression were more likely to be missed in people with an outgoing, extraverted personality."
The researchers also found that friends and family missed signs of depression in a person characterized as "agreeable," someone who is more trusting and more altruistic or who might be considered a conformist.
"It is important for people to understand that people who are highly extraverted and highly agreeable can become depressed and that the signs of depression for these people are more likely to be missed or detected by friends and family," Duberstein said "Don't assume that because someone is outgoing or agreeable that they are not vulnerable to becoming depressed."
Physicians should be particularly vigilant when interpreting reports from friends and family members of their extraverted or agreeable patients, the researchers stated.
The study was funded by the National Institute of Mental Health.
In addition to Duberstein, the article's authors include: Benjamin P. Chapman, Ph.D., Yeates Conwell, M.D., Joanne McGriff, M.D., M.P.H., Nathan Franus, M.S., Silvia Sorensen, Ph.D., Xin M. Tu, Ph.D., Jeffrey M. Lyness, M.D., and Kimberly A. Kaukeinen of the University of Rochester Medical Center; Marnin J. Heisel, Ph.D., of University of Western Ontario, Yan Ma, Ph.D., of the Weill Cornell Medical College, and James C. Coyne, Ph.D., of the University of Pennsylvania.
Friends and family members of a person who is highly outgoing and fun-loving and who is likely to experience happiness and excitement, for example, often miss the signs that indicate the person is depressed.
"When a person who has enjoyed socializing and whose mood normally is positive becomes depressed, friends and family often don't recognize it. Depression is inconsistent with the expectations that people have," said Paul R. Duberstein, Ph.D., professor of Psychiatry at the University of Rochester Medical Center and corresponding author of the journal article.
Missed diagnoses and "false negatives" can have grave consequences for patients with depression or mood disorders, the researchers stated.
Understanding and improving the ability of friends and family to identify depression could enhance the appropriate use of services for depressed older adults and improve the quality of treatment monitoring, the researchers concluded.
The research is based on the study of 191 primary care patients aged 60 or older from the Rochester, N.Y., area and their friends and family members.
Older patients tend to discuss their health concerns with friends and family members, who often accompany them on visits to physicians. Information provided by friends and family members can help identify at-risk individuals.
When the research began, researchers hypothesized that friends and family would miss depression in a person who is introverted.
"But our research showed the opposite to be true," Duberstein said. "We found the signs of depression were more likely to be missed in people with an outgoing, extraverted personality."
The researchers also found that friends and family missed signs of depression in a person characterized as "agreeable," someone who is more trusting and more altruistic or who might be considered a conformist.
"It is important for people to understand that people who are highly extraverted and highly agreeable can become depressed and that the signs of depression for these people are more likely to be missed or detected by friends and family," Duberstein said "Don't assume that because someone is outgoing or agreeable that they are not vulnerable to becoming depressed."
Physicians should be particularly vigilant when interpreting reports from friends and family members of their extraverted or agreeable patients, the researchers stated.
The study was funded by the National Institute of Mental Health.
In addition to Duberstein, the article's authors include: Benjamin P. Chapman, Ph.D., Yeates Conwell, M.D., Joanne McGriff, M.D., M.P.H., Nathan Franus, M.S., Silvia Sorensen, Ph.D., Xin M. Tu, Ph.D., Jeffrey M. Lyness, M.D., and Kimberly A. Kaukeinen of the University of Rochester Medical Center; Marnin J. Heisel, Ph.D., of University of Western Ontario, Yan Ma, Ph.D., of the Weill Cornell Medical College, and James C. Coyne, Ph.D., of the University of Pennsylvania.
NICE guidelines for treatment and care of people with depression and anxiety
The National Institute for Clinical Excellence (NICE) has today issued guidelines for the NHS on the treatment and care
of people with depression and anxiety. The guidelines take account of today's announcement by the Medicines and Healthcare
products Regulatory Agency (MHRA) on the safety of anti-depressant drug treatments and will support health professionals when
implementing the MHRA's advice. The guidelines also recommend effective psychological treatments for people with depression
and anxiety and will set national standards for care across England and Wales.
Depression is characterised by a low mood and loss of interest, usually accompanied by one or more of the following - low
energy; change in appetite, weight or sleep pattern; poor concentration; feelings of guilt or worthlessness and suicidal
ideas. The guideline on depression recommends that for mild and moderate depression, psychological treatments specifically
focused on depression (such as problem-solving therapy, cognitive behaviour therapy (CBT) and counselling) can be as
effective as drug treatments and should be offered as treatment options.
The guideline also recommends that:
-- Antidepressants should not be used for the initial treatment of mild depression, because the risk-benefit ratio is poor.
-- Where antidepressants are prescribed for moderate or severe depression it should be a selective serotonin reuptake
inhibitor (SSRI), because SSRIs are as effective as tricyclic antidepressants and their use is less likely to be discontinued
because of side-effects
-- All patients prescribed antidepressants should be informed that, although the drugs are not associated with tolerance and
craving, discontinuation/withdrawal symptoms may occur on stopping or missing doses or, occasionally, on reducing the dose of
the drug.
-- Screening for all high risk groups - for example, those with a past history of depression, significant physical illnesses
causing disability, or other mental health problems such as dementia.
-- For severe depression, psychological treatment (CBT) should be used in combination with anti-depressant medication.
Anxiety is characterised by feelings of apprehension and worry, spontaneous panic attacks, irritability, poor sleeping,
avoidance and poor concentration. The guideline on anxiety recommends that patients should be offered any of the following
three types of intervention, taking into account patient preference. In descending order of long term effectiveness, these
interventions are:
-- Psychological therapy, such as CBT.
-- Medication, such as an SSRI licensed for generalised anxiety disorder.
-- Self help, such as bibliotherapy (the use of written materials) based on CBT principles.
The guideline also recommends that:
-- Involving individuals in an effective partnership with healthcare professionals, with all decision making being shared,
improves outcomes.
-- Access to information, including support groups, is a valuable part of any package of care.
-- There are positive advantages of services for people with anxiety being based in primary care rather than in a hospital
setting.
Andrew Dillon, Chief Executive of NICE and Executive Lead for both guidelines said:
"These guidelines provide an important step forward in improving the diagnosis, treatment and care of people with depression
and anxiety. The guidelines recognise that whilst medication has an important role to play in treating these conditions,
there are also many effective alternatives."
Stephen Pilling, Consultant Clinical Psychologist and Co-Director of the National Collaborating Centre for Mental
Health which developed the guideline on depression said: "There is a solid base of evidence to show that psychological
therapies can work as well as drug treatments for treating depression and that they have fewer side effects. The guideline
reflects this fact. I hope this guideline will lead to better awareness of the problems faced by people with depression and
help health professionals to offer the right assessment, treatment and follow up."
Dr Alan Cohen, General Practitioner and Chair of the anxiety guideline development group said: "Anxiety is a common
condition which can have a severe impact on a person's quality of life. Fortunately there are effective treatments available,
both pharmacological and psychological, and the decision as to which treatments to use should be a decision made in
partnership between the health professional and their patient."
Lilian Owens Chair of "No Panic" patient support group and member of the anxiety guideline development group said:
"Ensuring that people with anxiety and depression are fully informed about their treatment options and understand what is
happening to them whilst in NHS care is essential. The guideline clearly highlights the importance of providing full
information about treatment options available and making all efforts necessary to ensure that someone who has anxiety or
depression is jointly and actively involved in decision making about their treatment."
Ends
For more information call Fraser Woodward on 020 7067 5905 or 07879 846 787
Notes to Editors
About clinical guidelines
1. Clinical guidelines are recommendations on the appropriate treatment and care of patients with specific diseases and
conditions within the NHS in England and Wales. They sit alongside, but do not replace, the knowledge and skills of
experienced health professionals.
2. The guideline on depression was developed for NICE by the National Collaborating Centre for Mental Health, a
professionally-led group with the experience and resources to develop guidance for the NHS on behalf of NICE. The National
Collaborating Centre for Mental Health is led jointly by the British Psychological Society and the Royal College of
Psychiatrists.
3. The guideline on anxiety was developed for NICE by the National Collaborating Centre for Primary Care, a
professionally-led group with the experience and resources to develop guidance for the NHS on behalf of NICE. The National
Collaborating Centre for Primary Care is led by the Royal College of General Practitioners.
4. The Collaborating Centres follow international standards of guideline development. They establish an independent group to
develop each guideline consisting of representatives of people with the condition, health professionals working in the NHS
and health service researchers. The group reviews the published clinical research alongside current clinical practice and the
experience of people with the condition. Professional and patient/carer groups whose members are likely to be affected by the
guideline were able to submit information and comment on the recommendations before they were finalised.
About NICE
5. NICE is part of the NHS. It is the independent organisation responsible for providing national guidance on treatments and
care for those using the NHS in England and Wales. Its guidance is for healthcare professionals and patients and their carers
to help them make decisions about treatment and healthcare. For further information about NICE you can visit nice.uk.
6. NICE produces guidance in three areas of health:
-- the use of new and existing medicines and treatments within the NHS in England and Wales - technology appraisals.
-- the appropriate treatment and care of patients with specific diseases and conditions within the NHS in England and Wales -
clinical guidelines.
-- whether interventional procedures used for diagnosis or treatment are safe enough and work well enough for routine use-
interventional procedures.
NICE also funds three enquiries that undertake research into the way patients are treated to identify ways of improving the
quality of care (the investigations are known as confidential enquiries).
7. NICE guidance and recommendations are prepared by independent groups that include professionals working in the NHS and
people who are familiar with the issues affecting patients and carers.
Obtaining copies of the guidelines
8. Electronic copies of the quick reference guide to the depression guideline can be found on the NICE website at nice.uk/CG023quickrefguide and electronic copies
of the information for the public leaflet that accompanies the guideline can be found at nice.uk/CG023publicinfo.
9. Electronic copies of the quick reference guide to the anxiety guideline can be found on the NICE website at nice.uk/CG022quickrefguide and electronic
copies of the information for the public leaflet that accompanies the guideline can be found at nice.uk/CG022publicinfo.
10. Hard copies of both guidelines will be distributed to the NHS on 15th December and will be available to order from the
NHS response line on 0870 1555 455 from that date, by quoting the following reference numbers :
-- NO763 - anxiety quick reference guide
-- NO764 - anxiety information for the public (English)
-- NO765 - anxiety information for the public (English and Welsh bilingual)
-- NO766 - depression quick reference guide
-- NO767 - depression information for the public (English)
-- NO768 - depression information for the public (English and Welsh bilingual)
About the Medicines and Healthcare products Regulatory Agency (MHRA)
11. The MHRA is the executive arm of the UK's Drug Licensing Authority and is responsible for all aspects of the regulation
of medicines in the UK. The MHRA is advised by the Committee for the Safety of Medicines (CSM) - an independent Committee of
scientific experts that advise Government on the safety, quality and effectiveness of medicines, including vaccines. The CSM
is also responsible for promoting the collection and investigation of reports on suspected adverse reactions to medicines
already on the market. In April 2003, the CSM established an Expert Working Group to consider the safety of Selective
Serotonin Reuptake Inhibitors (SSRIs), used for the treatment of depressive illness and anxiety disorders since the late
1980s. The Group incorporates specialist experts in the clinical management of depressive illness in childhood and
adolescence. The findings of the CSM's Expert Working Group have been accepted by the MHRA and regulatory action to amend the
marketing authorisations for all the products affected has been initiated by the MHRA and will be carried through as a matter
of urgency. More information on the MHRA, CSM and their advice, can be found on mhra.uk.
About No Panic
12. No Panic is an International Self Help Charity offering a range of information and services for those people who suffer
with anxiety disorders. No Panic is 95% user led and service provision is driven by experts who have experienced an anxiety
disorder. for further information please contact nopanic.uk
National Institute for Clinical Excellence
(NICE)
Mid City Place
71 High Holborn
London
WC1V 6NA
Tel: 020 7067 5800
Fax: 020 7067 5801
nicenice.nhs.uk
nice.uk
of people with depression and anxiety. The guidelines take account of today's announcement by the Medicines and Healthcare
products Regulatory Agency (MHRA) on the safety of anti-depressant drug treatments and will support health professionals when
implementing the MHRA's advice. The guidelines also recommend effective psychological treatments for people with depression
and anxiety and will set national standards for care across England and Wales.
Depression is characterised by a low mood and loss of interest, usually accompanied by one or more of the following - low
energy; change in appetite, weight or sleep pattern; poor concentration; feelings of guilt or worthlessness and suicidal
ideas. The guideline on depression recommends that for mild and moderate depression, psychological treatments specifically
focused on depression (such as problem-solving therapy, cognitive behaviour therapy (CBT) and counselling) can be as
effective as drug treatments and should be offered as treatment options.
The guideline also recommends that:
-- Antidepressants should not be used for the initial treatment of mild depression, because the risk-benefit ratio is poor.
-- Where antidepressants are prescribed for moderate or severe depression it should be a selective serotonin reuptake
inhibitor (SSRI), because SSRIs are as effective as tricyclic antidepressants and their use is less likely to be discontinued
because of side-effects
-- All patients prescribed antidepressants should be informed that, although the drugs are not associated with tolerance and
craving, discontinuation/withdrawal symptoms may occur on stopping or missing doses or, occasionally, on reducing the dose of
the drug.
-- Screening for all high risk groups - for example, those with a past history of depression, significant physical illnesses
causing disability, or other mental health problems such as dementia.
-- For severe depression, psychological treatment (CBT) should be used in combination with anti-depressant medication.
Anxiety is characterised by feelings of apprehension and worry, spontaneous panic attacks, irritability, poor sleeping,
avoidance and poor concentration. The guideline on anxiety recommends that patients should be offered any of the following
three types of intervention, taking into account patient preference. In descending order of long term effectiveness, these
interventions are:
-- Psychological therapy, such as CBT.
-- Medication, such as an SSRI licensed for generalised anxiety disorder.
-- Self help, such as bibliotherapy (the use of written materials) based on CBT principles.
The guideline also recommends that:
-- Involving individuals in an effective partnership with healthcare professionals, with all decision making being shared,
improves outcomes.
-- Access to information, including support groups, is a valuable part of any package of care.
-- There are positive advantages of services for people with anxiety being based in primary care rather than in a hospital
setting.
Andrew Dillon, Chief Executive of NICE and Executive Lead for both guidelines said:
"These guidelines provide an important step forward in improving the diagnosis, treatment and care of people with depression
and anxiety. The guidelines recognise that whilst medication has an important role to play in treating these conditions,
there are also many effective alternatives."
Stephen Pilling, Consultant Clinical Psychologist and Co-Director of the National Collaborating Centre for Mental
Health which developed the guideline on depression said: "There is a solid base of evidence to show that psychological
therapies can work as well as drug treatments for treating depression and that they have fewer side effects. The guideline
reflects this fact. I hope this guideline will lead to better awareness of the problems faced by people with depression and
help health professionals to offer the right assessment, treatment and follow up."
Dr Alan Cohen, General Practitioner and Chair of the anxiety guideline development group said: "Anxiety is a common
condition which can have a severe impact on a person's quality of life. Fortunately there are effective treatments available,
both pharmacological and psychological, and the decision as to which treatments to use should be a decision made in
partnership between the health professional and their patient."
Lilian Owens Chair of "No Panic" patient support group and member of the anxiety guideline development group said:
"Ensuring that people with anxiety and depression are fully informed about their treatment options and understand what is
happening to them whilst in NHS care is essential. The guideline clearly highlights the importance of providing full
information about treatment options available and making all efforts necessary to ensure that someone who has anxiety or
depression is jointly and actively involved in decision making about their treatment."
Ends
For more information call Fraser Woodward on 020 7067 5905 or 07879 846 787
Notes to Editors
About clinical guidelines
1. Clinical guidelines are recommendations on the appropriate treatment and care of patients with specific diseases and
conditions within the NHS in England and Wales. They sit alongside, but do not replace, the knowledge and skills of
experienced health professionals.
2. The guideline on depression was developed for NICE by the National Collaborating Centre for Mental Health, a
professionally-led group with the experience and resources to develop guidance for the NHS on behalf of NICE. The National
Collaborating Centre for Mental Health is led jointly by the British Psychological Society and the Royal College of
Psychiatrists.
3. The guideline on anxiety was developed for NICE by the National Collaborating Centre for Primary Care, a
professionally-led group with the experience and resources to develop guidance for the NHS on behalf of NICE. The National
Collaborating Centre for Primary Care is led by the Royal College of General Practitioners.
4. The Collaborating Centres follow international standards of guideline development. They establish an independent group to
develop each guideline consisting of representatives of people with the condition, health professionals working in the NHS
and health service researchers. The group reviews the published clinical research alongside current clinical practice and the
experience of people with the condition. Professional and patient/carer groups whose members are likely to be affected by the
guideline were able to submit information and comment on the recommendations before they were finalised.
About NICE
5. NICE is part of the NHS. It is the independent organisation responsible for providing national guidance on treatments and
care for those using the NHS in England and Wales. Its guidance is for healthcare professionals and patients and their carers
to help them make decisions about treatment and healthcare. For further information about NICE you can visit nice.uk.
6. NICE produces guidance in three areas of health:
-- the use of new and existing medicines and treatments within the NHS in England and Wales - technology appraisals.
-- the appropriate treatment and care of patients with specific diseases and conditions within the NHS in England and Wales -
clinical guidelines.
-- whether interventional procedures used for diagnosis or treatment are safe enough and work well enough for routine use-
interventional procedures.
NICE also funds three enquiries that undertake research into the way patients are treated to identify ways of improving the
quality of care (the investigations are known as confidential enquiries).
7. NICE guidance and recommendations are prepared by independent groups that include professionals working in the NHS and
people who are familiar with the issues affecting patients and carers.
Obtaining copies of the guidelines
8. Electronic copies of the quick reference guide to the depression guideline can be found on the NICE website at nice.uk/CG023quickrefguide and electronic copies
of the information for the public leaflet that accompanies the guideline can be found at nice.uk/CG023publicinfo.
9. Electronic copies of the quick reference guide to the anxiety guideline can be found on the NICE website at nice.uk/CG022quickrefguide and electronic
copies of the information for the public leaflet that accompanies the guideline can be found at nice.uk/CG022publicinfo.
10. Hard copies of both guidelines will be distributed to the NHS on 15th December and will be available to order from the
NHS response line on 0870 1555 455 from that date, by quoting the following reference numbers :
-- NO763 - anxiety quick reference guide
-- NO764 - anxiety information for the public (English)
-- NO765 - anxiety information for the public (English and Welsh bilingual)
-- NO766 - depression quick reference guide
-- NO767 - depression information for the public (English)
-- NO768 - depression information for the public (English and Welsh bilingual)
About the Medicines and Healthcare products Regulatory Agency (MHRA)
11. The MHRA is the executive arm of the UK's Drug Licensing Authority and is responsible for all aspects of the regulation
of medicines in the UK. The MHRA is advised by the Committee for the Safety of Medicines (CSM) - an independent Committee of
scientific experts that advise Government on the safety, quality and effectiveness of medicines, including vaccines. The CSM
is also responsible for promoting the collection and investigation of reports on suspected adverse reactions to medicines
already on the market. In April 2003, the CSM established an Expert Working Group to consider the safety of Selective
Serotonin Reuptake Inhibitors (SSRIs), used for the treatment of depressive illness and anxiety disorders since the late
1980s. The Group incorporates specialist experts in the clinical management of depressive illness in childhood and
adolescence. The findings of the CSM's Expert Working Group have been accepted by the MHRA and regulatory action to amend the
marketing authorisations for all the products affected has been initiated by the MHRA and will be carried through as a matter
of urgency. More information on the MHRA, CSM and their advice, can be found on mhra.uk.
About No Panic
12. No Panic is an International Self Help Charity offering a range of information and services for those people who suffer
with anxiety disorders. No Panic is 95% user led and service provision is driven by experts who have experienced an anxiety
disorder. for further information please contact nopanic.uk
National Institute for Clinical Excellence
(NICE)
Mid City Place
71 High Holborn
London
WC1V 6NA
Tel: 020 7067 5800
Fax: 020 7067 5801
nicenice.nhs.uk
nice.uk
New Direction For Development Of Psychotropic Drugs Suggested By Researchers
Leading brain and behavior researchers have called for a new direction to develop innovative psychotropic drugs to treat mental illness at the annual meeting of the American College of Neuropsychopharmacology. The panel of academic, industry and government representatives concluded that several factors have impeded the development of novel treatments for mental illness including: incomplete understanding of the impact of mental illness on the brain; continued skepticism of results from animal models for certain disorders; an outdated paradigm of treatment and the industry preference toward so-called "me-too" drugs.
"We need to do better when treating major mental illness, and right now that means we need groundbreaking new research that will result in new medications that are both more effective and have fewer side effects than drugs currently on the market," noted Dennis Charney, MD, Dean of Academic and Scientific Affairs for Mount Sinai School of Medicine and Professor, Department of Psychiatry, Neuroscience and Pharmacology & Biochemistry.
The findings come in the wake of considerable debate in the academic and clinical communities as to whether newer drugs (particularly anti-psychotic medications) represent significant improvement over treatments that have been available for nearly half a century, as well as a greater recognition of the disease burden resulting from mental illness. Currently, mental disorders cause more disability than any class of illness in Americans 15 - 44 years, and the suicide rate in that age group is higher than annual mortality from homicide, AIDS and most cancers.
"There is near universal agreement that we've had only modest progress in developing drugs for schizophrenia and affective disorders in the past several decades. This panel discussion is part of a broader effort to determine why new drug development has been such a historically inefficient process," explained Dr. Bryan Roth, Professor of Pharmacology at UNC Chapel Hill and Director of the NIMH Psychoactive Drug Screening Program at the National Institutes of Health. Affective disorders include bipolar, depressive and anxiety disorders.
The group, reviewing over a decade of psychotropic drug-development research from industry, government and academia, identified several factors that have contributed to the slow progress in developing new treatments.
Review of past clinical research highlighted that a "single disease model" of schizophrenia and mood disorders has prevailed. Increasingly, clinicians and researchers have begun to understand that a combination of several key symptom modalities may need to be addressed separately. "Some early studies are suggesting that we are looking at the wrong targets for mood disorders. Until we have treatments that make it into the clinical setting, we won't fully know the usefulness of single target treatments," added Husseini Manji, MD, FRCPC, Chief, NIMH Laboratory of Molecular Pathophysiology.
The most promising new direction for CNS (central nervous system) drug development appears to be focusing on treatments that act on more than one molecular target. "We typically have used the 'silver bullet' approach (currently the prevailing practice in industry) designed to hit one molecular target at a time. This analysis shows that drugs with more complex action (or utilizing more than one drug at a time) have a greater potential for positive treatment outcomes," concluded Roth.
This shift may be most noticeable when addressing schizophrenia, a disease in which psychosis has long prevailed as the dominant symptom. Now, notes Carpenter, additional attention is being paid to other important symptoms that may have a greater impact on long-term functionality, including cognitive impairment and depression in people with schizophrenia.
Because of limitations in animal models of complex psychiatric disorders like schizophrenia, investigators were often not discouraged by negative results in key tests, particularly if other data seemed encouraging. Roth was surprised by his own findings: "When reviewing this data, we found that animal models were actually quite good at predicting results in human subjects."
However, the overall effectiveness of animal models for mood disorders is still unknown. "Some of these novel molecular targets may be much better than existing ones, but we won't know anything for sure until we have large scale clinical trials," said Manji.
Evaluating decades of research that failed to yield its intended results has provided investigators with insights on how to do better, the researchers believe. Several panel participants expressed the belief that past theories and practices that have been standard practice in new drug development for several decades must change, and new paradigms of mental illness should be embraced to guide future medication development and treatment practice.
"One of the primary reasons we have encountered such difficulty in developing treatments for schizophrenia and mood disorders is a lack of understanding of the diseases themselves," explained William Carpenter, MD, Director of the Maryland Psychiatric Research Center and Professor of Psychiatry at the University of Maryland School of Medicine. "We now have a better understanding of the complex nature of these illnesses, which affect multiple targets in the brain."
"What is different now is that we have the power of molecular biology combined with improved animal models to identify targets for the development of novel treatments for mood disorders and schizophrenia," noted Charney.
ACNP held its Annual Meeting December 3 - 7, 2006, in Hollywood, FL.
ACNP, founded in 1961, is a professional organization of more than 700 leading scientists, including three Nobel Laureates. The mission of ACNP is to further research and education in neuropsychopharmacology and related fields in the following ways: promoting the interaction of a broad range of scientific disciplines of brain and behavior in order to advance the understanding of prevention and treatment of disease of the nervous system including psychiatric, neurological, behavioral and addictive disorders; encouraging scientists to enter research careers in fields related to these disorders and their treatment; and ensuring the dissemination of relevant scientific advances. A non-profit organization, ACNP receives revenues from a variety of sources including membership dues, publication sales, registration fees, and pharmaceutical industry grants.
Contact: Sharon Reis
GYMR
"We need to do better when treating major mental illness, and right now that means we need groundbreaking new research that will result in new medications that are both more effective and have fewer side effects than drugs currently on the market," noted Dennis Charney, MD, Dean of Academic and Scientific Affairs for Mount Sinai School of Medicine and Professor, Department of Psychiatry, Neuroscience and Pharmacology & Biochemistry.
The findings come in the wake of considerable debate in the academic and clinical communities as to whether newer drugs (particularly anti-psychotic medications) represent significant improvement over treatments that have been available for nearly half a century, as well as a greater recognition of the disease burden resulting from mental illness. Currently, mental disorders cause more disability than any class of illness in Americans 15 - 44 years, and the suicide rate in that age group is higher than annual mortality from homicide, AIDS and most cancers.
"There is near universal agreement that we've had only modest progress in developing drugs for schizophrenia and affective disorders in the past several decades. This panel discussion is part of a broader effort to determine why new drug development has been such a historically inefficient process," explained Dr. Bryan Roth, Professor of Pharmacology at UNC Chapel Hill and Director of the NIMH Psychoactive Drug Screening Program at the National Institutes of Health. Affective disorders include bipolar, depressive and anxiety disorders.
The group, reviewing over a decade of psychotropic drug-development research from industry, government and academia, identified several factors that have contributed to the slow progress in developing new treatments.
Review of past clinical research highlighted that a "single disease model" of schizophrenia and mood disorders has prevailed. Increasingly, clinicians and researchers have begun to understand that a combination of several key symptom modalities may need to be addressed separately. "Some early studies are suggesting that we are looking at the wrong targets for mood disorders. Until we have treatments that make it into the clinical setting, we won't fully know the usefulness of single target treatments," added Husseini Manji, MD, FRCPC, Chief, NIMH Laboratory of Molecular Pathophysiology.
The most promising new direction for CNS (central nervous system) drug development appears to be focusing on treatments that act on more than one molecular target. "We typically have used the 'silver bullet' approach (currently the prevailing practice in industry) designed to hit one molecular target at a time. This analysis shows that drugs with more complex action (or utilizing more than one drug at a time) have a greater potential for positive treatment outcomes," concluded Roth.
This shift may be most noticeable when addressing schizophrenia, a disease in which psychosis has long prevailed as the dominant symptom. Now, notes Carpenter, additional attention is being paid to other important symptoms that may have a greater impact on long-term functionality, including cognitive impairment and depression in people with schizophrenia.
Because of limitations in animal models of complex psychiatric disorders like schizophrenia, investigators were often not discouraged by negative results in key tests, particularly if other data seemed encouraging. Roth was surprised by his own findings: "When reviewing this data, we found that animal models were actually quite good at predicting results in human subjects."
However, the overall effectiveness of animal models for mood disorders is still unknown. "Some of these novel molecular targets may be much better than existing ones, but we won't know anything for sure until we have large scale clinical trials," said Manji.
Evaluating decades of research that failed to yield its intended results has provided investigators with insights on how to do better, the researchers believe. Several panel participants expressed the belief that past theories and practices that have been standard practice in new drug development for several decades must change, and new paradigms of mental illness should be embraced to guide future medication development and treatment practice.
"One of the primary reasons we have encountered such difficulty in developing treatments for schizophrenia and mood disorders is a lack of understanding of the diseases themselves," explained William Carpenter, MD, Director of the Maryland Psychiatric Research Center and Professor of Psychiatry at the University of Maryland School of Medicine. "We now have a better understanding of the complex nature of these illnesses, which affect multiple targets in the brain."
"What is different now is that we have the power of molecular biology combined with improved animal models to identify targets for the development of novel treatments for mood disorders and schizophrenia," noted Charney.
ACNP held its Annual Meeting December 3 - 7, 2006, in Hollywood, FL.
ACNP, founded in 1961, is a professional organization of more than 700 leading scientists, including three Nobel Laureates. The mission of ACNP is to further research and education in neuropsychopharmacology and related fields in the following ways: promoting the interaction of a broad range of scientific disciplines of brain and behavior in order to advance the understanding of prevention and treatment of disease of the nervous system including psychiatric, neurological, behavioral and addictive disorders; encouraging scientists to enter research careers in fields related to these disorders and their treatment; and ensuring the dissemination of relevant scientific advances. A non-profit organization, ACNP receives revenues from a variety of sources including membership dues, publication sales, registration fees, and pharmaceutical industry grants.
Contact: Sharon Reis
GYMR
DOV Pharmaceutical, Inc. Initiates Phase II Clinical Trial In Patients With Major Depressive Disorder
DOV Pharmaceutical, Inc. (OTCBB: DOVP) announced that it has initiated a Phase II clinical trial of DOV 21,947 in patients diagnosed with major depressive disorder. DOV 21,947 is DOV's lead triple reuptake inhibitor, or "TRIP," for the treatment of depression and obesity. The clinical trial, which will randomize approximately 200 patients, is a double-blind, placebo-controlled, multi-center study assessing the efficacy and safety of DOV 21,947 over a six-week period. The primary endpoint of the study is the change in the Montgomery-Asberg Depression Rating Scale from baseline to end of treatment in evaluable patients. DOV expects to announce study results as early as the fourth quarter of 2008.
"After obtaining encouraging results in our recently completed eight-week safety study of DOV 21,947, which demonstrated both weight loss and lowered plasma triglyceride levels in drug-compliant subjects, we amended the design of this study to ensure that we are capturing the potential effects of DOV 21,947 on body weight and appropriately capturing drug-compliance data in our analyses," said Dr. Phil Skolnick, president and chief scientific officer. "Both preclinical and clinical evidence to date support our belief that as a TRIP, DOV 21,947 may provide efficacy greater than SSRIs and SNRIs currently prescribed for the treatment of depression. In addition to efficacy in animal models of depression, the clinical data for DOV 21,947 suggests an improved side-effect profile, including potential stabilization or reduction in body weight."
About DOV 21,947
Clinical and preclinical research indicates that drug combinations, which inhibit reuptake of all three neurotransmitters most closely linked to depression, serotonin, norepinephrine and dopamine, can produce greater overall efficacy than currently marketed antidepressants. A single antidepressant that could produce such triple reuptake inhibition would represent a breakthrough in the treatment of depression. DOV 21,947, a TRIP, is structurally related to DOV 216,303. In a previously reported Phase II clinical trial, DOV 216,303 was administered to patients suffering from major depressive disorder. After two weeks of treatment, patients treated with DOV 216,303 demonstrated reductions (p < 0.0001) in the total HAM-D scores comparable to control patients treated with citalopram. In both groups, the reductions from baseline in the HAM-D scores were greater than 40%.
In seven Phase I studies, DOV 21,947 was observed to be safe and well tolerated. In addition, the dosages for this clinical study are comparable to those used in the most recent eight-week study in which statistically significant weight loss was observed in drug-complaint subjects.
About DOV
DOV is a biopharmaceutical company focused on the acquisition and development of novel drug candidates for central nervous system disorders. The Company's product candidates address some of the largest pharmaceutical markets in the world including depression, pain and insomnia.
Cautionary Note
Statements in this press release that are not historical facts constitute forward-looking statements within the meaning of Section 27A of the Securities Act of 1933 and Section 21E of the Securities Exchange Act of 1934, each as amended. You can also identify forward-looking statements by the following words: may, will, should, expect, intend, plan, anticipate, believe, estimate, predict, potential, continue or the negative of these terms or other comparable terminology. We caution you that forward-looking statements are inherently uncertain and are simply point-in-time estimates based on a combination of facts and factors currently known by us about which we cannot be certain or even relatively confident. Actual results or events will surely differ and may differ materially from our forward-looking statements as a result of many factors, some of which we may not be able to predict or may not be within our control. Such factors may also materially adversely affect our ability to achieve our objectives and to successfully develop and commercialize our product candidates, including our ability to:
-- raise substantial additional capital in order to fund operations;
-- obtain and maintain all necessary patents, licenses and other
intellectual property rights;
-- demonstrate the safety and efficacy of product candidates at each
stage of development;
-- meet our development schedule for our product candidates, including
with respect to clinical trial initiation, enrollment and completion;
-- meet applicable regulatory standards and receive required regulatory
approvals on our anticipated time schedule or at all;
-- meet or require our partners to meet obligations and achieve
milestones under our license and other agreements;
-- obtain and maintain collaborations as required with pharmaceutical
partners; and
-- produce drug candidates in commercial quantities at reasonable costs
and compete successfully against other products and companies.
You should also refer to the risks discussed in our filings with the Securities and Exchange Commission including those contained in our annual report on Form 10-K for the fiscal year ended December 31, 2006 that was filed on March 30, 2007 and our quarterly reports on Form 10-Q that were filed on May 15, 2007, August 8, 2007 and November 7, 2007. We qualify all our forward-looking statements by these cautionary statements. Readers should not place undue reliance on our forward-looking statements. We do not undertake any obligation and do not intend to update any forward-looking statement.
DOV Pharmaceutical
"After obtaining encouraging results in our recently completed eight-week safety study of DOV 21,947, which demonstrated both weight loss and lowered plasma triglyceride levels in drug-compliant subjects, we amended the design of this study to ensure that we are capturing the potential effects of DOV 21,947 on body weight and appropriately capturing drug-compliance data in our analyses," said Dr. Phil Skolnick, president and chief scientific officer. "Both preclinical and clinical evidence to date support our belief that as a TRIP, DOV 21,947 may provide efficacy greater than SSRIs and SNRIs currently prescribed for the treatment of depression. In addition to efficacy in animal models of depression, the clinical data for DOV 21,947 suggests an improved side-effect profile, including potential stabilization or reduction in body weight."
About DOV 21,947
Clinical and preclinical research indicates that drug combinations, which inhibit reuptake of all three neurotransmitters most closely linked to depression, serotonin, norepinephrine and dopamine, can produce greater overall efficacy than currently marketed antidepressants. A single antidepressant that could produce such triple reuptake inhibition would represent a breakthrough in the treatment of depression. DOV 21,947, a TRIP, is structurally related to DOV 216,303. In a previously reported Phase II clinical trial, DOV 216,303 was administered to patients suffering from major depressive disorder. After two weeks of treatment, patients treated with DOV 216,303 demonstrated reductions (p < 0.0001) in the total HAM-D scores comparable to control patients treated with citalopram. In both groups, the reductions from baseline in the HAM-D scores were greater than 40%.
In seven Phase I studies, DOV 21,947 was observed to be safe and well tolerated. In addition, the dosages for this clinical study are comparable to those used in the most recent eight-week study in which statistically significant weight loss was observed in drug-complaint subjects.
About DOV
DOV is a biopharmaceutical company focused on the acquisition and development of novel drug candidates for central nervous system disorders. The Company's product candidates address some of the largest pharmaceutical markets in the world including depression, pain and insomnia.
Cautionary Note
Statements in this press release that are not historical facts constitute forward-looking statements within the meaning of Section 27A of the Securities Act of 1933 and Section 21E of the Securities Exchange Act of 1934, each as amended. You can also identify forward-looking statements by the following words: may, will, should, expect, intend, plan, anticipate, believe, estimate, predict, potential, continue or the negative of these terms or other comparable terminology. We caution you that forward-looking statements are inherently uncertain and are simply point-in-time estimates based on a combination of facts and factors currently known by us about which we cannot be certain or even relatively confident. Actual results or events will surely differ and may differ materially from our forward-looking statements as a result of many factors, some of which we may not be able to predict or may not be within our control. Such factors may also materially adversely affect our ability to achieve our objectives and to successfully develop and commercialize our product candidates, including our ability to:
-- raise substantial additional capital in order to fund operations;
-- obtain and maintain all necessary patents, licenses and other
intellectual property rights;
-- demonstrate the safety and efficacy of product candidates at each
stage of development;
-- meet our development schedule for our product candidates, including
with respect to clinical trial initiation, enrollment and completion;
-- meet applicable regulatory standards and receive required regulatory
approvals on our anticipated time schedule or at all;
-- meet or require our partners to meet obligations and achieve
milestones under our license and other agreements;
-- obtain and maintain collaborations as required with pharmaceutical
partners; and
-- produce drug candidates in commercial quantities at reasonable costs
and compete successfully against other products and companies.
You should also refer to the risks discussed in our filings with the Securities and Exchange Commission including those contained in our annual report on Form 10-K for the fiscal year ended December 31, 2006 that was filed on March 30, 2007 and our quarterly reports on Form 10-Q that were filed on May 15, 2007, August 8, 2007 and November 7, 2007. We qualify all our forward-looking statements by these cautionary statements. Readers should not place undue reliance on our forward-looking statements. We do not undertake any obligation and do not intend to update any forward-looking statement.
DOV Pharmaceutical
One In Three Women Suffer Post-Sex Blues, Australia
Post-sex blues is not a sexual behaviour commonly discussed, but a Queensland University of Technology (QUT) study of more than 200 young women has found one in three (32.9 per cent) had experienced the phenomenon at some point.
QUT Associate Professor Robert Schweitzer's research, published in the latest International Journal of Sexual Health, looked at the prevalence of postcoital dysphoria or the experience of negative feelings following otherwise satisfactory intercourse.
"While 32.9 per cent of women reported experiencing symptoms of postcoital dysphoria at least a little of the time in their life, what was even more surprising was that 10 per cent reported experiencing the symptoms some of the time or most of the time," said Professor Schweitzer from QUT's School of Psychology & Counselling.
"Under normal circumstances the resolution phase of sexual activity, or period just after sex, elicits sensations of well-being, along with psychological and physical relaxation.
"However, individuals who experience postcoital dysphoria may express their immediate feelings after sexual intercourse in terms of melancholy, tearfulness, anxiety, irritability or feeling of restlessness."
Professor Schweitzer said one woman described feeling "melancholy" after sex.
"I did not associate the feeling with an absence of love or affection for my sexual partner nor with an absence of love or affection from them towards me, because it seemed so unconnected with them," she said.
Professor Schweitzer said the cause of such negative feelings was virtually unknown.
"Research on the prevalence and causes of postcoital dysphroia has been virtually silent but internet searches reveal information on the subject is widely sought," he said.
"It has generally been thought that women who have experienced sexual abuse associate later sexual encounters with the trauma of the abuse along with sensations of shame, guilt, punishment and loss.
"This association is then purported to lead to sexual problems and the avoidance of sex."
But Professor Schweitzer said his study had instead found only limited correlation between sexual abuse and postcoital dysphoria.
"Psychological distress was also found to be only modestly associated with postcoital dysphoria," he said.
"This suggests other factors such as biological predisposition may be more important in understanding the phenomenon and identifying women at risk of experiencing postcoital dysphoria."
Professor Schweitzer's next stage of research will look at emotional characteristics of women who experience postcoital dysphoria.
"I want to look at how women view their 'sense of self'. Whether they are fragile or whether they are strong women, and investigate whether this leads to their postcoital dysphoria," he said.
The study titled The Prevalence and Correlates of Postcoital Dysphoria in Women was also authored by post graduate psychology researcher Brian Bird and the University of Utah's Professor Donald Strassberg.
QUT Associate Professor Robert Schweitzer's research, published in the latest International Journal of Sexual Health, looked at the prevalence of postcoital dysphoria or the experience of negative feelings following otherwise satisfactory intercourse.
"While 32.9 per cent of women reported experiencing symptoms of postcoital dysphoria at least a little of the time in their life, what was even more surprising was that 10 per cent reported experiencing the symptoms some of the time or most of the time," said Professor Schweitzer from QUT's School of Psychology & Counselling.
"Under normal circumstances the resolution phase of sexual activity, or period just after sex, elicits sensations of well-being, along with psychological and physical relaxation.
"However, individuals who experience postcoital dysphoria may express their immediate feelings after sexual intercourse in terms of melancholy, tearfulness, anxiety, irritability or feeling of restlessness."
Professor Schweitzer said one woman described feeling "melancholy" after sex.
"I did not associate the feeling with an absence of love or affection for my sexual partner nor with an absence of love or affection from them towards me, because it seemed so unconnected with them," she said.
Professor Schweitzer said the cause of such negative feelings was virtually unknown.
"Research on the prevalence and causes of postcoital dysphroia has been virtually silent but internet searches reveal information on the subject is widely sought," he said.
"It has generally been thought that women who have experienced sexual abuse associate later sexual encounters with the trauma of the abuse along with sensations of shame, guilt, punishment and loss.
"This association is then purported to lead to sexual problems and the avoidance of sex."
But Professor Schweitzer said his study had instead found only limited correlation between sexual abuse and postcoital dysphoria.
"Psychological distress was also found to be only modestly associated with postcoital dysphoria," he said.
"This suggests other factors such as biological predisposition may be more important in understanding the phenomenon and identifying women at risk of experiencing postcoital dysphoria."
Professor Schweitzer's next stage of research will look at emotional characteristics of women who experience postcoital dysphoria.
"I want to look at how women view their 'sense of self'. Whether they are fragile or whether they are strong women, and investigate whether this leads to their postcoital dysphoria," he said.
The study titled The Prevalence and Correlates of Postcoital Dysphoria in Women was also authored by post graduate psychology researcher Brian Bird and the University of Utah's Professor Donald Strassberg.
Suicide Rates Lowest On Record, England
The number of suicides in England are at an all-time low, Care Services Minister Phil Hope announced as he published the latest annual report on suicide prevention.
The new figures out today show:
- The suicide rate for 2007, the most recent available, was the lowest recorded at 7.5 deaths per 100,000 population.
- There continues to be a sustained fall in the rate of suicide among young men under the age of 35.
- There has also been a further reduction in suicides amongst mental health in-patients, from 216 in 1997 to 136 in 2006 (latest data).
- There has been a fall in suicides in prisons, from 65 in 1997 to 60 in 2008. The 2008 figure is down from 88 in 2007, although trend has fluctuated.
Care Services Minister Phil Hope said:
"The fact that suicide rates continue to fall is encouraging. We will continue to work with the NHS, local authorities and other agencies to try to prevent suicides as far as possible.
"Investment in good mental health services, including early intervention when people have mental health problems is very important. Our new strategy for mental health, called New Horizons, which will be published shortly, will focus on promoting positive mental health and wellbeing."
Professor Louis Appleby, clinical director for mental health at the Department for Health said:
"It is excellent that the suicide rate is at a new low, but front-line agencies need to re-double their efforts if we are going to bring it down further at a time of recession."
Source
Department of Health, UK
The new figures out today show:
- The suicide rate for 2007, the most recent available, was the lowest recorded at 7.5 deaths per 100,000 population.
- There continues to be a sustained fall in the rate of suicide among young men under the age of 35.
- There has also been a further reduction in suicides amongst mental health in-patients, from 216 in 1997 to 136 in 2006 (latest data).
- There has been a fall in suicides in prisons, from 65 in 1997 to 60 in 2008. The 2008 figure is down from 88 in 2007, although trend has fluctuated.
Care Services Minister Phil Hope said:
"The fact that suicide rates continue to fall is encouraging. We will continue to work with the NHS, local authorities and other agencies to try to prevent suicides as far as possible.
"Investment in good mental health services, including early intervention when people have mental health problems is very important. Our new strategy for mental health, called New Horizons, which will be published shortly, will focus on promoting positive mental health and wellbeing."
Professor Louis Appleby, clinical director for mental health at the Department for Health said:
"It is excellent that the suicide rate is at a new low, but front-line agencies need to re-double their efforts if we are going to bring it down further at a time of recession."
Source
Department of Health, UK
Researchers Find Early Childhood Education Program Yields High Economic Returns
For every $1 invested in a Chicago early childhood education program, nearly $11 is projected to return to society over the children's lifetimes - equivalent to an 18 percent annual return on program investment, according to a study led by University of Minnesota professor of child development Arthur Reynolds in the College of Education and Human Development.
For the analysis, Reynolds and other researchers evaluated the effectiveness of the Chicago Public Schools' federally funded Child Parent Centers (CPCs) established in 1967. Their work represents the first long-term economic analysis of an existing, large-scale early education program. Researchers surveyed study participants and their parents, and analyzed education, employment, public aid, criminal justice, substance use and child welfare records for the participants through to age 26.
"Our findings provide strong evidence that sustained high-quality early childhood programs can contribute to well-being for individuals and society," said Reynolds, director of the Chicago Longitudinal Study and co-director of the Human Capital Research Collaborative at the University of Minnesota. "The large-scale CPC program has one of the highest economic returns of any social program for young people. As public institutions are being pressed to cut costs, our findings suggest that increasing access to high-quality programs starting in preschool and continuing into the early grades is an efficient use of public resources."
The CPC program in the project provided services for low-income families beginning at age three in 20 school sites. Kindergarten and school-age services are provided up to age nine (third grade). Funded by Title I of the Elementary and Secondary Education Act, CPC is the second oldest (after Head Start) federally funded preschool program. The analysis appears in the January/February issue of Child Development, the journal of the Society for Research in Child Development. Co-authoring researchers included Judy Temple, Barry White and Suh-Ruu Ou at the University of Minnesota and Dylan Robertson from the Chicago Public Schools.
Reynolds and his colleagues did the cost-benefit analysis of the CPC using information collected on about 900 children enrolled in the 20 centers starting when they were three and first enrolled in a preschool program. The study continued until the children were nine and taking part in a school-age program that featured smaller classes, teacher aides, and instructional and family support. Follow-up interviews were done in early adulthood and information was collected from many sources until age 26. These children were compared to a group of about 500 comparable children who didn't take part in the CPC but participated in the usual educational interventions for disadvantaged youths in Chicago schools.
The CPC resulted in significantly higher rates of attendance at 4-year colleges and employment in higher-skilled jobs and significantly lower rates of felony arrests and symptoms of depression in young adulthood.
The program's economic benefits in 2007 dollars exceeded costs, including increased earnings and tax revenues, averted costs related to crime and savings for child welfare, special education and grade retention. The preschool part showed the strongest economic benefits providing a total return to society of $10.83 per dollar invested - equivalent to an 18 percent annual return on program investment. Gains varied by child, program and family group.
When the researchers included the benefits from reductions in smoking, total returns rose to more than $12 per dollar invested. The school-age program yielded a return of about $4 per dollar invested (annual rate of return of 10 percent) and the combined preschool and school-age program (preschool to third grade) yielded returns of $8.24 per dollar invested (annual rate of return of 18 percent), based on average net benefits per child of $38,000 above and beyond less extensive intervention.
Children at higher levels of risk experienced the highest economic benefits, including males ($17.88 per dollar invested; a 22% annual return), children who had taken part in preschool for a year ($13.58 per dollar invested; a 21% annual return) and children from higher-risk families, including those whose parents had not graduated from high school ($15.88 per dollar invested; a 20% annual return).
The researchers identified five key principles of the CPC that they say led to its effectiveness, including providing services that are of sufficient length or duration, are high in intensity and enrichment, feature small class sizes and teacher-student ratios, are comprehensive in scope and are implemented by well-trained and well-compensated staff. A further unique feature of the research is that the origin of the economic returns can be empirically traced through a chain of early educational advantages to cumulate in long-term effects.
The findings from this analysis can be useful to policymakers and school superintendents across the nation as they make funding decisions. A lot of states are thinking of scaling back on early childhood investments, but this analysis suggests the opposite, Reynolds said.
"Access to effective programs like CPC should be increased," Reynolds said. "In scarce times, policymakers should divest in programs that aren't working and reserve the scarce resources for the most effective."
The Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), which is part of the National Institute of Health, funded this study.
For the analysis, Reynolds and other researchers evaluated the effectiveness of the Chicago Public Schools' federally funded Child Parent Centers (CPCs) established in 1967. Their work represents the first long-term economic analysis of an existing, large-scale early education program. Researchers surveyed study participants and their parents, and analyzed education, employment, public aid, criminal justice, substance use and child welfare records for the participants through to age 26.
"Our findings provide strong evidence that sustained high-quality early childhood programs can contribute to well-being for individuals and society," said Reynolds, director of the Chicago Longitudinal Study and co-director of the Human Capital Research Collaborative at the University of Minnesota. "The large-scale CPC program has one of the highest economic returns of any social program for young people. As public institutions are being pressed to cut costs, our findings suggest that increasing access to high-quality programs starting in preschool and continuing into the early grades is an efficient use of public resources."
The CPC program in the project provided services for low-income families beginning at age three in 20 school sites. Kindergarten and school-age services are provided up to age nine (third grade). Funded by Title I of the Elementary and Secondary Education Act, CPC is the second oldest (after Head Start) federally funded preschool program. The analysis appears in the January/February issue of Child Development, the journal of the Society for Research in Child Development. Co-authoring researchers included Judy Temple, Barry White and Suh-Ruu Ou at the University of Minnesota and Dylan Robertson from the Chicago Public Schools.
Reynolds and his colleagues did the cost-benefit analysis of the CPC using information collected on about 900 children enrolled in the 20 centers starting when they were three and first enrolled in a preschool program. The study continued until the children were nine and taking part in a school-age program that featured smaller classes, teacher aides, and instructional and family support. Follow-up interviews were done in early adulthood and information was collected from many sources until age 26. These children were compared to a group of about 500 comparable children who didn't take part in the CPC but participated in the usual educational interventions for disadvantaged youths in Chicago schools.
The CPC resulted in significantly higher rates of attendance at 4-year colleges and employment in higher-skilled jobs and significantly lower rates of felony arrests and symptoms of depression in young adulthood.
The program's economic benefits in 2007 dollars exceeded costs, including increased earnings and tax revenues, averted costs related to crime and savings for child welfare, special education and grade retention. The preschool part showed the strongest economic benefits providing a total return to society of $10.83 per dollar invested - equivalent to an 18 percent annual return on program investment. Gains varied by child, program and family group.
When the researchers included the benefits from reductions in smoking, total returns rose to more than $12 per dollar invested. The school-age program yielded a return of about $4 per dollar invested (annual rate of return of 10 percent) and the combined preschool and school-age program (preschool to third grade) yielded returns of $8.24 per dollar invested (annual rate of return of 18 percent), based on average net benefits per child of $38,000 above and beyond less extensive intervention.
Children at higher levels of risk experienced the highest economic benefits, including males ($17.88 per dollar invested; a 22% annual return), children who had taken part in preschool for a year ($13.58 per dollar invested; a 21% annual return) and children from higher-risk families, including those whose parents had not graduated from high school ($15.88 per dollar invested; a 20% annual return).
The researchers identified five key principles of the CPC that they say led to its effectiveness, including providing services that are of sufficient length or duration, are high in intensity and enrichment, feature small class sizes and teacher-student ratios, are comprehensive in scope and are implemented by well-trained and well-compensated staff. A further unique feature of the research is that the origin of the economic returns can be empirically traced through a chain of early educational advantages to cumulate in long-term effects.
The findings from this analysis can be useful to policymakers and school superintendents across the nation as they make funding decisions. A lot of states are thinking of scaling back on early childhood investments, but this analysis suggests the opposite, Reynolds said.
"Access to effective programs like CPC should be increased," Reynolds said. "In scarce times, policymakers should divest in programs that aren't working and reserve the scarce resources for the most effective."
The Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), which is part of the National Institute of Health, funded this study.
When Antidepressant Drugs Are Not Enough. A New Study On Their Combination With Psychotherapy
A group of Dutch investigators has reported on a new study on the combination of antidepressant drugs and psychotherapy in the September issue of Psychotherapy and Psychosomatics.
Although several forms of effective therapy exist for outpatients suffering from major depressive disorder, many patients do not profit from treatment. Combining psychotherapy and medication may be an effective strategy. However, earlier studies have rarely found a clear advantage for the combination. Where an advantage was found, a possible placebo effect of adding 2 types of treatment could not be ruled out as cause for the superior effect of the combination. A total of 353 patients were screened, of whom 193 were randomized over 4 conditions: nefazodone plus clinical management, interpersonal psychotherapy (IPT), the combination of the two or the combination of IPT and pill-placebo. All patients suffered from major depressive disorder and had a score of at least 14 on the 17-item Hamilton Rating Scale (HAMD).
The patients were treated for 12-16 weeks. At baseline, at 6 weeks and on completion of treatment, ratings were performed by independent raters. The primary outcome measure was the HAMD, and the Montgomery-Asberg Depression Rating Scale (MADRS) the secondary outcome measure. Of the 193 patients included, 138 completed the trial. All treatments were effective. Using a random regression model, no differences between treatments were found on the HAMD. On the MADRS, however, the combination of medication with psychotherapy was more effective in reducing depressive symptoms compared to medication alone, but not to psychotherapy alone or IPT with pill-placebo. The results of this study yield support for the use of combining medication with psychotherapy instead of using medication only in the treatment of depressed outpatients. Combination treatment does not have an advantage over psychotherapy alone in the present study.
PSYCHOTHERAPY AND PSYCHOSOMATICS
PSYCHOTHERAPY AND PSYCHOSOMATICS
Although several forms of effective therapy exist for outpatients suffering from major depressive disorder, many patients do not profit from treatment. Combining psychotherapy and medication may be an effective strategy. However, earlier studies have rarely found a clear advantage for the combination. Where an advantage was found, a possible placebo effect of adding 2 types of treatment could not be ruled out as cause for the superior effect of the combination. A total of 353 patients were screened, of whom 193 were randomized over 4 conditions: nefazodone plus clinical management, interpersonal psychotherapy (IPT), the combination of the two or the combination of IPT and pill-placebo. All patients suffered from major depressive disorder and had a score of at least 14 on the 17-item Hamilton Rating Scale (HAMD).
The patients were treated for 12-16 weeks. At baseline, at 6 weeks and on completion of treatment, ratings were performed by independent raters. The primary outcome measure was the HAMD, and the Montgomery-Asberg Depression Rating Scale (MADRS) the secondary outcome measure. Of the 193 patients included, 138 completed the trial. All treatments were effective. Using a random regression model, no differences between treatments were found on the HAMD. On the MADRS, however, the combination of medication with psychotherapy was more effective in reducing depressive symptoms compared to medication alone, but not to psychotherapy alone or IPT with pill-placebo. The results of this study yield support for the use of combining medication with psychotherapy instead of using medication only in the treatment of depressed outpatients. Combination treatment does not have an advantage over psychotherapy alone in the present study.
PSYCHOTHERAPY AND PSYCHOSOMATICS
PSYCHOTHERAPY AND PSYCHOSOMATICS
Depressed? Sleep Therapy May Help
Patients who experience symptoms, such as sleepiness, fatigue, poor motivation, irritability, and difficulty concentrating, are often diagnosed with depression and are treated with antidepressants.
A new study suggests that many of these patients have obstructive sleep apnea (OSA), and their symptoms may be reduced with continuous positive airway pressure (CPAP) therapy.
Researchers from The Sleep Center at University Community Hospital, Tampa, FL, found that 38 percent of patients were receiving antidepressant medication, and, after using CPAP therapy consistently for 4 to 6 weeks, 98 percent of patients showed improvements in depression and sleep scores.
Researchers speculate that these patients were misdiagnosed with depression and actually had OSA or patients had related OSA events and subsequent sleep fragmentation that possibly affected the brain and caused depression.
It is also possible that OSA and depression share an underlying mechanism. Researchers suggest that physicians test patients presenting with symptoms of depression for OSA and, if necessary, offer CPAP treatment. The study appears in the September issue of CHEST, the peer-reviewed journal of the American College of Chest Physicians.
Jennifer Stawarz
American College of Chest Physicians
News briefs from the journal Chest, September 2005
chestnet
A new study suggests that many of these patients have obstructive sleep apnea (OSA), and their symptoms may be reduced with continuous positive airway pressure (CPAP) therapy.
Researchers from The Sleep Center at University Community Hospital, Tampa, FL, found that 38 percent of patients were receiving antidepressant medication, and, after using CPAP therapy consistently for 4 to 6 weeks, 98 percent of patients showed improvements in depression and sleep scores.
Researchers speculate that these patients were misdiagnosed with depression and actually had OSA or patients had related OSA events and subsequent sleep fragmentation that possibly affected the brain and caused depression.
It is also possible that OSA and depression share an underlying mechanism. Researchers suggest that physicians test patients presenting with symptoms of depression for OSA and, if necessary, offer CPAP treatment. The study appears in the September issue of CHEST, the peer-reviewed journal of the American College of Chest Physicians.
Jennifer Stawarz
American College of Chest Physicians
News briefs from the journal Chest, September 2005
chestnet
Brain Waves That Distinguish False Memories From Real Ones Pinpointed
For the first time, researchers at the University of Pennsylvania are able to pinpoint brain waves that distinguish true from false memories, providing a better understanding of how memory works and creating a new strategy to help epilepsy patients retain cognitive function.
The study, the first to show that brain waves predict the veracity of human memories, is available online in the journal Psychological Science and in the November 2007 print edition.
To test whether distinct patterns of electrophysiological activity prior to a response can distinguish true from false memories, psychologists at Penn recorded brain activity from 52 neurosurgical patients being treated for drug-resistant epilepsy. Patients were asked to perform a verbal free-recall task while researchers used an array of implanted electrodes and intracranial electroencephalographic recordings to locate where in their brains the patients' seizures originated. Patients volunteered to study lists of words which they were then asked to recall at a later time. When asked to recall the studied words, participants recalled some number of correct items and also made a small number of errors, recalling words that had not appeared on the target list.
While patients performed the memory game, scientists observed electrical activity in their brains to determine whether specific brain waves were associated with successfully storing and retrieving memories. Researchers found that a fast brain wave, known as the gamma rhythm, increased when participants studied a word that they would later recall. The same gamma waves, whose voltage rises and fall between 50 and 100 times per second, also increased in the half-second prior to participant's correctly recalling an item.
"These analyses revealed that the same pattern of gamma band oscillatory activity in the hippocampus, prefrontal cortex and left temporal lobe that predicts successful memory formation also re-emerged at retrieval, distinguishing correct from incorrect responses," said Per B. Sederberg, lead author and former Penn neuroscientist now performing post-doctoral research at Princeton University. The timing of these oscillatory effects suggests that self-cued memory retrieval initiates in the hippocampus and then spreads to the cortex. Thus, retrieval of true as compared with false memories induces a distinct pattern of gamma oscillations, possibly reflecting recollection of contextual information associated with past experience.
"Gamma waves actually predicted whether or not an item that was about to be recalled was previously studied," said Michael Kahana, a professor of psychology in Penn's School of Arts and Sciences and lead investigator. "In other words, one could see a difference in brain activity just prior to remembering something that had and had not actually happened."
In addition to providing a better understanding of how memory works, the findings may also provide a clearer picture of how to assist those suffering with epilepsy. In epilepsy's 2.6 million American sufferers, brain oscillations become so strong that they sweep across the brain, producing seizures. Although seizures are controlled with medication in two-thirds of people with epilepsy, the remainder may be candidates for surgery to remove the brain regions where seizures originate.
"Identifying the neural signatures of successful memory storage and retrieval can help neurosurgeons reduce the cognitive deficits that might result from epilepsy surgery," said Brian Litt, associate professor of neurology and bioengineering at Penn, and a co-author of the study.
In addition, these techniques for mapping cognitive networks could give rise to better ways of mapping functional networks in brain, which may help in treating a number of neurological disorders, including depression, schizophrenia, head trauma and affective disorders, Litt said.
A collaboration of psychologists, neurologists and neurosurgeons from the University of Pennsylvania, Princeton University, the University of Freiburg and Harvard Medical School participated in this research, which was funded by the National Institutes of Health, the Swartz Foundation, the Klingenstein Foundation and the Dana Foundation.
The study, the first to show that brain waves predict the veracity of human memories, is available online in the journal Psychological Science and in the November 2007 print edition.
To test whether distinct patterns of electrophysiological activity prior to a response can distinguish true from false memories, psychologists at Penn recorded brain activity from 52 neurosurgical patients being treated for drug-resistant epilepsy. Patients were asked to perform a verbal free-recall task while researchers used an array of implanted electrodes and intracranial electroencephalographic recordings to locate where in their brains the patients' seizures originated. Patients volunteered to study lists of words which they were then asked to recall at a later time. When asked to recall the studied words, participants recalled some number of correct items and also made a small number of errors, recalling words that had not appeared on the target list.
While patients performed the memory game, scientists observed electrical activity in their brains to determine whether specific brain waves were associated with successfully storing and retrieving memories. Researchers found that a fast brain wave, known as the gamma rhythm, increased when participants studied a word that they would later recall. The same gamma waves, whose voltage rises and fall between 50 and 100 times per second, also increased in the half-second prior to participant's correctly recalling an item.
"These analyses revealed that the same pattern of gamma band oscillatory activity in the hippocampus, prefrontal cortex and left temporal lobe that predicts successful memory formation also re-emerged at retrieval, distinguishing correct from incorrect responses," said Per B. Sederberg, lead author and former Penn neuroscientist now performing post-doctoral research at Princeton University. The timing of these oscillatory effects suggests that self-cued memory retrieval initiates in the hippocampus and then spreads to the cortex. Thus, retrieval of true as compared with false memories induces a distinct pattern of gamma oscillations, possibly reflecting recollection of contextual information associated with past experience.
"Gamma waves actually predicted whether or not an item that was about to be recalled was previously studied," said Michael Kahana, a professor of psychology in Penn's School of Arts and Sciences and lead investigator. "In other words, one could see a difference in brain activity just prior to remembering something that had and had not actually happened."
In addition to providing a better understanding of how memory works, the findings may also provide a clearer picture of how to assist those suffering with epilepsy. In epilepsy's 2.6 million American sufferers, brain oscillations become so strong that they sweep across the brain, producing seizures. Although seizures are controlled with medication in two-thirds of people with epilepsy, the remainder may be candidates for surgery to remove the brain regions where seizures originate.
"Identifying the neural signatures of successful memory storage and retrieval can help neurosurgeons reduce the cognitive deficits that might result from epilepsy surgery," said Brian Litt, associate professor of neurology and bioengineering at Penn, and a co-author of the study.
In addition, these techniques for mapping cognitive networks could give rise to better ways of mapping functional networks in brain, which may help in treating a number of neurological disorders, including depression, schizophrenia, head trauma and affective disorders, Litt said.
A collaboration of psychologists, neurologists and neurosurgeons from the University of Pennsylvania, Princeton University, the University of Freiburg and Harvard Medical School participated in this research, which was funded by the National Institutes of Health, the Swartz Foundation, the Klingenstein Foundation and the Dana Foundation.
Suicide Prevention And Antidepressants
Depression is the most important single factor predisposing to suicide, and more than half of all subjects completing suicide are known to have suffered from depression. Unfortunately, depression is still often untreated or undertreated, even after a suicide attempt. Antidepressive drugs represent the cornerstone of treatment of depressive patients. However, their role has become somewhat controversial over the last few years due to reports suggesting that antidepressants might, in a small subgroup of younger patients (recently estimated at 0.7% in clinical trials) actually worsen suicidal tendencies instead of alleviating them.
As a consequence, regulatory authorities in many countries have reconsidered their cost-benefit ratio. On the other hand, in many western countries, increasing use of antidepressants on the national and regional level correlates, as expected with declining suicide mortality, and in no country has an increase in suicides due to antidepressants been reported.
While there is no doubt that potential side effects of antidepressive medication concerning suicidal behaviour are a very serious issue, it is important to obtain a balanced view of all the clinical and epidemiological facts pertaining to the effect of antidepressive therapy in relation to suicidal behaviour.
Professor Erkki Isomets?¤, a renowned expert in psychiatric suicide research, will present the state of evidence and critically comment on the current discussion concerning this topic with regard to the role of antidepressive treatment in real-life clinical practice.
Press conference on 29 August 2008 in Barcelona, Spain.
SPEAKER: Professor Erkki T. Isomets?¤, Institute of Clinical Medicine, Department of Psychiatry, University of Helsinki, Finland
As a consequence, regulatory authorities in many countries have reconsidered their cost-benefit ratio. On the other hand, in many western countries, increasing use of antidepressants on the national and regional level correlates, as expected with declining suicide mortality, and in no country has an increase in suicides due to antidepressants been reported.
While there is no doubt that potential side effects of antidepressive medication concerning suicidal behaviour are a very serious issue, it is important to obtain a balanced view of all the clinical and epidemiological facts pertaining to the effect of antidepressive therapy in relation to suicidal behaviour.
Professor Erkki Isomets?¤, a renowned expert in psychiatric suicide research, will present the state of evidence and critically comment on the current discussion concerning this topic with regard to the role of antidepressive treatment in real-life clinical practice.
Press conference on 29 August 2008 in Barcelona, Spain.
SPEAKER: Professor Erkki T. Isomets?¤, Institute of Clinical Medicine, Department of Psychiatry, University of Helsinki, Finland
Depression Among Retired NFL Players: Pain Compounds Symptoms
As the sports world prepares for this weekend's National Football League draft and the excitement of promising young players entering the league, a new study from the University of Michigan Health System highlights the issues faced at the other end of the career spectrum, after players retire.
The study for the first time quantifies the pain and depression experienced by retired NFL players, and assesses other health issues that are impacted by pain and depression.
"We found that retired professional football players experience levels of depressive symptoms similar to those of the general population, but the impact of these symptoms is compounded by high levels of chronic pain," says lead author Thomas L. Schwenk, M.D., the George A. Dean, M.D. Chair and Professor of Family Medicine at the U-M Health System and associate director of the U-M Depression Center.
The study appears in the current issue of Medicine & Science in Sports & Exercise, the journal of the American College of Sports Medicine.
To obtain the data, researchers sent surveys to 3,377 members of the NFL Players Association, Retired Players Section. Of the 1,594 people who responded, the prevalence of moderate to severe depression was nearly 15 percent, very similar to the prevalence in the general public. But the frequency with which the retired players reported problems with pain nearly half the people in the study puts them at significant additional risk for depression and associated difficulties, Schwenk says.
More than half had high scores in pain, depression or both. About 11 percent had high scores in both areas, 37 percent had high pain scores and low depression scores, and 4 percent had low depression scores and high pain scores. The remaining 48 percent had low scores in both categories.
In addition to the strong link between depression and pain, the relationship between these conditions and other issues also was notable, says co-author Eric Hipple, a retired Detroit Lions quarterback who now is outreach coordinator for the U-M Depression Center.
For example, those responding to the survey whose scores indicated moderate to severe depression were 11 times more likely to report trouble sleeping than those rated as not depressed or mildly depressed.
Similarly, those in the moderate-to-severe depression category were nearly eight times more likely to report a loss of fitness and lack of exercise, and seven times more likely to report financial difficulties. Retired players who scored high in the pain categories also tended to have more problems in these areas. And respondents who rated as moderately to severely depressed were much more likely to have problems with a lack of social support or friendships, the use of prescribed medication, alcohol or other drugs, and trouble with the transition to life after football.
Participants in the survey also reported barriers to seeking help for their problems, including a preference to deal with their issues using spiritual means or through family and friends, lack of insurance coverage, and a lack of recognition that these problems were important. Many said they would feel weak or embarrassed if they sought help.
"What our research tells us is that this population of retired professional athletes would benefit from a proactive educational and clinical outreach program, possibly beginning even before retirement, as a way to help improve the likelihood that retired NFL players will achieve a high quality of life after football," Hipple says.
Researchers collected data about the most common problems experienced during the players' retirement, with nearly half (48 percent) reporting that difficulty with pain was quite common or very common. Other problems included loss of fitness and lack of exercise (29 percent), weight gain (28 percent), trouble sleeping (28 percent), difficulty with aging (27 percent), and trouble with the transition to life after professional football (27 percent).
Schwenk notes that, because of these factors and others, the shift from being a professional athlete to retirement can be challenging. For players at the elite level in their sport, he says, their lives are fully organized around their performance, and they are given a great deal of support.
"On retirement, athletes have reported jarring transitions to a life in which the focus of such intense commitment is unclear, the resources and personnel that organized and managed their lives away from the competition venue are lost, and the rewards, both emotional and financial, are diminished," Schwenk says.
Future studies should explore the hypothesis that the physical disabilities and chronic pain experienced by retired players cause significant difficulty with maintaining their fitness levels, making them more at risk for depression, the authors say.
The study was supported in part by a grant from the National Football League Players Association. The survey measured depression symptoms using the PHQ-9 questionnaire, which is based on standard diagnostic criteria. Participants also were asked about pain, nutrition, exercise, alcohol use and smoking, as well as other health issues.
In addition to Schwenk and Hipple, authors of the study were Daniel W. Gorenflo, Ph.D., research investigator in the Department of Family Medicine; and Richard R. Dopp, M.D., research fellow in the U-M Department of Psychiatry and a member of the Depression Center.
Reference: Medicine & Science in Sports & Exercise, April 2007, Vol. 39, Issue 4, pp. 599-605.
University of Michigan Health System
2901 Hubbard St., Ste. 2400
Ann Arbor, MI 48109-2435
United States
med.umich
The study for the first time quantifies the pain and depression experienced by retired NFL players, and assesses other health issues that are impacted by pain and depression.
"We found that retired professional football players experience levels of depressive symptoms similar to those of the general population, but the impact of these symptoms is compounded by high levels of chronic pain," says lead author Thomas L. Schwenk, M.D., the George A. Dean, M.D. Chair and Professor of Family Medicine at the U-M Health System and associate director of the U-M Depression Center.
The study appears in the current issue of Medicine & Science in Sports & Exercise, the journal of the American College of Sports Medicine.
To obtain the data, researchers sent surveys to 3,377 members of the NFL Players Association, Retired Players Section. Of the 1,594 people who responded, the prevalence of moderate to severe depression was nearly 15 percent, very similar to the prevalence in the general public. But the frequency with which the retired players reported problems with pain nearly half the people in the study puts them at significant additional risk for depression and associated difficulties, Schwenk says.
More than half had high scores in pain, depression or both. About 11 percent had high scores in both areas, 37 percent had high pain scores and low depression scores, and 4 percent had low depression scores and high pain scores. The remaining 48 percent had low scores in both categories.
In addition to the strong link between depression and pain, the relationship between these conditions and other issues also was notable, says co-author Eric Hipple, a retired Detroit Lions quarterback who now is outreach coordinator for the U-M Depression Center.
For example, those responding to the survey whose scores indicated moderate to severe depression were 11 times more likely to report trouble sleeping than those rated as not depressed or mildly depressed.
Similarly, those in the moderate-to-severe depression category were nearly eight times more likely to report a loss of fitness and lack of exercise, and seven times more likely to report financial difficulties. Retired players who scored high in the pain categories also tended to have more problems in these areas. And respondents who rated as moderately to severely depressed were much more likely to have problems with a lack of social support or friendships, the use of prescribed medication, alcohol or other drugs, and trouble with the transition to life after football.
Participants in the survey also reported barriers to seeking help for their problems, including a preference to deal with their issues using spiritual means or through family and friends, lack of insurance coverage, and a lack of recognition that these problems were important. Many said they would feel weak or embarrassed if they sought help.
"What our research tells us is that this population of retired professional athletes would benefit from a proactive educational and clinical outreach program, possibly beginning even before retirement, as a way to help improve the likelihood that retired NFL players will achieve a high quality of life after football," Hipple says.
Researchers collected data about the most common problems experienced during the players' retirement, with nearly half (48 percent) reporting that difficulty with pain was quite common or very common. Other problems included loss of fitness and lack of exercise (29 percent), weight gain (28 percent), trouble sleeping (28 percent), difficulty with aging (27 percent), and trouble with the transition to life after professional football (27 percent).
Schwenk notes that, because of these factors and others, the shift from being a professional athlete to retirement can be challenging. For players at the elite level in their sport, he says, their lives are fully organized around their performance, and they are given a great deal of support.
"On retirement, athletes have reported jarring transitions to a life in which the focus of such intense commitment is unclear, the resources and personnel that organized and managed their lives away from the competition venue are lost, and the rewards, both emotional and financial, are diminished," Schwenk says.
Future studies should explore the hypothesis that the physical disabilities and chronic pain experienced by retired players cause significant difficulty with maintaining their fitness levels, making them more at risk for depression, the authors say.
The study was supported in part by a grant from the National Football League Players Association. The survey measured depression symptoms using the PHQ-9 questionnaire, which is based on standard diagnostic criteria. Participants also were asked about pain, nutrition, exercise, alcohol use and smoking, as well as other health issues.
In addition to Schwenk and Hipple, authors of the study were Daniel W. Gorenflo, Ph.D., research investigator in the Department of Family Medicine; and Richard R. Dopp, M.D., research fellow in the U-M Department of Psychiatry and a member of the Depression Center.
Reference: Medicine & Science in Sports & Exercise, April 2007, Vol. 39, Issue 4, pp. 599-605.
University of Michigan Health System
2901 Hubbard St., Ste. 2400
Ann Arbor, MI 48109-2435
United States
med.umich
Study Supports The Long-Term Benefits Of TMS For Depression
In a study to determine the durability and long-term effects of transcranial magnetic stimulation (TMS), psychiatric researchers at Rush University Medical Center have found the non-invasive, non-drug therapy to be an effective, long-term treatment for major depression. Results of the study were published in the October 2010 issue of Brain Stimulation, a journal published by Elsevier.
TMS therapy is a non-invasive technique that delivers highly focused magnetic field pulses to a specific portion of the brain, the left prefrontal cortex, in order to stimulate the areas of the brain linked to depression. These pulses are of a similar intensity to the magnetic field produced during an MRI imaging scan. The repeated short bursts of magnetic energy introduced through the scalp excite neurons locally and in connected areas in the brain.
TMS received clearance from the U.S. Food and Drug Administration (FDA) in October 2008. This novel treatment option is a safe and effective, acute antidepressant therapy, but there is limited information on its long-term benefits.
"This is the only prospective, maintenance, follow-up study which assesses the durability of acute TMS benefit in patients with major depression," said Dr. Philip G. Janicak, study principal investigator and professor of psychiatry at Rush University Medical Center.
In the study, 301 patients suffering from major depression were randomly assigned to receive active or sham TMS in an acute, six-week, controlled trial. Patients who responded then underwent a three-week, transition period where they were tapered off of active or sham TMS treatment and started on a standard antidepressant for maintenance. After any successful acute treatment for depression such as TMS, antidepressant medications or electroconvulsive (ECT) therapy, it is usual practice to introduce maintenance medication to lessen the chance of relapsing.
In the acute, randomized trial, 142 patients who received active TMS therapy responded and entered the three-week, transition phase. One hundred twenty-one patients completed this phase without relapse. Of those patients, 99 (81.8 percent) then agreed to be followed for an additional 24-week period during which only 10 patients relapsed.
In addition, TMS was successfully used as an intermittent rescue strategy to preclude impending relapse in 32 of 38 (84 percent) patients. This indicated that the therapeutic effects of TMS are durable in the majority of acute responders and that reintroduction of TMS as an adjunct to medication was effective and safe in preventing relapse.
"The results of the follow-up study further support TMS as a viable treatment option for patients with major depression who have not responded to conventional antidepressant medications," said Janicak. "After acute response to TMS, a standardized regimen of antidepressant medication maintained the acute benefit in the majority of patients over a six-month period."
The FDA-approved TMS device was developed by Neuronetics, Inc. Patients treated with TMS therapy do not require anesthesia or sedation and remain awake and alert. It is a 40-minute outpatient procedure that is prescribed by a psychiatrist and performed in an outpatient setting. The treatment is typically administered daily for four-to-six-weeks.
Depression affects at least 14 million American adults each year. Researchers estimate that by the year 2020, depression will be the second leading cause of disability worldwide. About two-thirds of those who experience an episode of depression will have at least one other episode in their lives. Depression is a debilitating illness, and existing treatment options are frequently ineffective or intolerable due to side effects. Current antidepressant therapies are not beneficial for at least a third of depressed individuals, leaving many with a lack of adequate treatment options.
TMS therapy is a non-invasive technique that delivers highly focused magnetic field pulses to a specific portion of the brain, the left prefrontal cortex, in order to stimulate the areas of the brain linked to depression. These pulses are of a similar intensity to the magnetic field produced during an MRI imaging scan. The repeated short bursts of magnetic energy introduced through the scalp excite neurons locally and in connected areas in the brain.
TMS received clearance from the U.S. Food and Drug Administration (FDA) in October 2008. This novel treatment option is a safe and effective, acute antidepressant therapy, but there is limited information on its long-term benefits.
"This is the only prospective, maintenance, follow-up study which assesses the durability of acute TMS benefit in patients with major depression," said Dr. Philip G. Janicak, study principal investigator and professor of psychiatry at Rush University Medical Center.
In the study, 301 patients suffering from major depression were randomly assigned to receive active or sham TMS in an acute, six-week, controlled trial. Patients who responded then underwent a three-week, transition period where they were tapered off of active or sham TMS treatment and started on a standard antidepressant for maintenance. After any successful acute treatment for depression such as TMS, antidepressant medications or electroconvulsive (ECT) therapy, it is usual practice to introduce maintenance medication to lessen the chance of relapsing.
In the acute, randomized trial, 142 patients who received active TMS therapy responded and entered the three-week, transition phase. One hundred twenty-one patients completed this phase without relapse. Of those patients, 99 (81.8 percent) then agreed to be followed for an additional 24-week period during which only 10 patients relapsed.
In addition, TMS was successfully used as an intermittent rescue strategy to preclude impending relapse in 32 of 38 (84 percent) patients. This indicated that the therapeutic effects of TMS are durable in the majority of acute responders and that reintroduction of TMS as an adjunct to medication was effective and safe in preventing relapse.
"The results of the follow-up study further support TMS as a viable treatment option for patients with major depression who have not responded to conventional antidepressant medications," said Janicak. "After acute response to TMS, a standardized regimen of antidepressant medication maintained the acute benefit in the majority of patients over a six-month period."
The FDA-approved TMS device was developed by Neuronetics, Inc. Patients treated with TMS therapy do not require anesthesia or sedation and remain awake and alert. It is a 40-minute outpatient procedure that is prescribed by a psychiatrist and performed in an outpatient setting. The treatment is typically administered daily for four-to-six-weeks.
Depression affects at least 14 million American adults each year. Researchers estimate that by the year 2020, depression will be the second leading cause of disability worldwide. About two-thirds of those who experience an episode of depression will have at least one other episode in their lives. Depression is a debilitating illness, and existing treatment options are frequently ineffective or intolerable due to side effects. Current antidepressant therapies are not beneficial for at least a third of depressed individuals, leaving many with a lack of adequate treatment options.
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