Burn Patients Need More Help Coping With Depression

A new study reveals the full extent of psychological problems among people who have spent years recovering from serious burns. About half of those surveyed showed signs of clinical depression, with women being most vulnerable.


While the study findings may not be surprising, specialists are calling them a valuable tool that could spur burn centers to devote more resources to mental healing.


"In addition to looking at whether we can fix this or alter that through plastic surgery, we also need to screen people for depression," said lead author Brett Thombs, who worked on the study at Johns Hopkins University. He now serves as an assistant professor of psychiatry at McGill University in Canada.


Thomas and colleagues surveyed 224 Johns Hopkins patients who were undergoing reconstruction surgery after being burned. On average, the patients suffered burns about seven years earlier.


The findings appear in the January/February issue of the journal General Hospital Psychiatry.


Forty-six percent of those surveyed showed signs of mild, moderate or serious depression. Women and those most concerned about their body images were most likely to be depressed.


It's normal for burn victims to have trouble adjusting to their condition, Thombs said. "I don't think anyone would go through a burn without being horribly sad. It's a very tough adjustment to make."


But some remain depressed and don't recover, failing to move "through a course of grief and be able to pick themselves up and find their way on their own," he said. "They need help of some kind."


There are effective ways to help burn victims who feel ostracized, said Leora Bowden, a clinical social worker who works with burn patients at the University of Michigan. With the help of treatments like cognitive therapy aimed at changing thought patterns patients can "improve their ability to function and their ability to feel better about themselves, both of which are equally important," she said.


It isn't possible to change society's reaction to disfigured people, said John Findley, psychiatrist for the burn and trauma unit at Massachusetts General Hospital. "But we can get (patients) to look at themselves differently, look beyond the skin and see the healthy person that was there before the thermal injury."


General Hospital Psychiatry is a peer-reviewed research journal published bimonthly by Elsevier Science. For information about the journal, contact Wayne Katon, M.D., at (206) 543-7177.


Thombs BD, et al. "Depression in Burn Reconstruction Patients: Symptom Prevalence and Association With Body Image Dissatisfaction and Physical Function. General Hospital Psychiatry 29(1) 2007.


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The Most Comprehensive And Accurate Scale For Assessing Depression Is Not The One That Is Most Used

In the current issue of Psychotherapy and Psychosomatics, investigators from the University of Bologna, Copenhagen and Cambridge present data that suggest that the most commonly used scale for assessing depression (the Hamilton Depression Rating Scale) may not be sufficient and another, more comprehensive and accurate, is available.


A comprehensive assessment of the wide spectrum of depressive symptomatology, particularly in its subclinical forms, is lacking in standard rating scales. There is also an emerging need for instruments that can detect small differences in therapeutic studies and have good sensitivity. The purpose of this paper is to review the clinimetric characteristics of Paykel's Clinical Interview for Depression (CID) and to examine the results of the studies in which the interview has been used. Published reports which involved the use of the CID were identified by searching the following electronic databases: Medline, PsychINFO, EMBASE, and Web of Science. A manual search of the literature was also performed. The initial strategies yielded 169 published reports for potential inclusion in the review: 98 are discussed here. The CID has been used extensively in a variety of studies, including descriptive studies, classification by means of factor analysis and cluster analysis, and predictor variables of response to treatment or relapse. The CID has also been used as an outcome measure in several controlled clinical trials and follow-up studies of pharmacotherapy and psychotherapy of affective disorders. It has been shown to be valid and reliable, to discriminate depressives from controls, or different subgroups of depressed patients, and to reflect changes during the course of treatment, particularly when individual symptoms are considered. Evidence from these studies highlights the utility of the CID in clinical research and practice. Its clinimetric characteristics, particularly the broad evaluation of affective symptomatology and the sensitivity to change, make it an instrument of choice in therapeutic trials.


Sources: Journal of Psychotherapy and Psychosomatics, AlphaGalileo Foundation.

Landmark Results From Depression Efficacy Study To Be Presented By CNS Response At U.S. Psychiatric And Mental Health Congress

CNS Response, Inc. (OTCBB: CNSO) announced that the company will present top-line results from its multi-site clinical trial next week at the U.S. Psychiatric and Mental Health Congress. "Referenced-EEG (rEEG®) Efficacy Compared to Star*D for Patients with Depression Treatment Failure: First Look at Final Results," will be presented by Charles DeBattista, M.D. on Monday, November 2nd, at 3:45 to 6:45 p.m. The conference is being held at the Mandalay Bay South Convention Center in Las Vegas, NV.


Dr. DeBattista is Professor of Psychiatry and Behavioral Health Sciences at Stanford University School of Medicine, and Director of the Depression and Psychopharmacology Clinic at Stanford Medical Center. Dr. DeBattista specializes in psychiatry with special expertise in clinical depression, disorders of excessive somnolence, electroconvulsive therapy, and fatigue.


CNS Response will be conducting an investor conference call and webcast discussing the top-line results on Tuesday, November 3rd, at 8:00 a.m. PST, 11:00 a.m. EST. Details of the conference call will be announced shortly.


Source

CNS Response

National Campaign Showcases The Importance Of Joining Forces With 'Man's Best Friend' In Overcoming Depression

While many people with depression turn to family and friends for support, research has shown that enlisting the help of an unexpected companion -- a dog -- may also have a positive effect on overall health and well-being(i). As part of her commitment to helping people with the illness, Emmy Award-winning actress, Linda Dano, is leading Support Partners: Canine Companions, a new program that offers practical tips on how to expand support networks by incorporating dogs into the recovery process. The program is sponsored by Eli Lilly and Company and the Psychiatric Service Dog Society.


"Depression is an illness often associated with strong social stigma, causing people to withdraw from their lives, intensifying the emotional symptoms of the illness, like sadness and feelings of worthlessness," said Rakesh Jain, M.D., M.P.H., director of psychiatric drug research, R/D Clinical Research Center, Lake Jackson, Texas. "While a doctor, family and friends should form the basis of any support network, dogs can play an important role by being a constant companion. They can help reduce these emotional symptoms, while possibly helping other symptoms, like fatigue or lack of energy, with daily walks."


Research has shown that there are many potential benefits to having a dog that correlate to areas health-care professionals believe can help people with depression.


-- The majority of pet owners feel their pets are extremely important when
they are sad, lonely or depressed.(ii)



-- Dogs can provide the desirable qualities of a best friend, like
listening, physical contact and empathy.(iii)



-- Half of people with a dog believe that their pet makes a major
difference to their lives, ranking increased exercise and companionship
as the two most important differences.(iv)



-- Talking to dogs is related to greater life satisfaction and better
physical and mental health.(v)


Linda Dano, Support Partners: Canine Companions spokesperson, has personally experienced the benefits a dog can have in helping to manage depression. "As someone who has always been a dog-owner, my Lhasa apsos, Mo and Charlie, became more important to me than ever when I was diagnosed with depression," says Dano. "I started getting help from my physician and support from my friends, and soon realized that my dogs also gave me a sense of comfort, purpose and companionship. Many days when all I wanted was to stay in bed, alone, I knew I had to get up to take care of Mo and Charlie and comfort them as they comforted me."


Support Partners: Canine Companions offers a brochure that provides information about the benefits of dogs, the different levels of support a dog can offer someone with depression and easy, practical ways pet owners can immediately work with their dogs to include them in their support network. The brochure also provides those who are unsure if they have depression information about the illness and how to take the first step of asking for help.















"There are many simple things you can do with your dog if you're depressed that may help you feel better," explains Joan Esnayra, Ph.D., president of the Psychiatric Service Dog Society, a nonprofit organization that works with mental-health consumers who wish to train their dogs to assist with the management of depression. "Taking your dog for a walk can help you get some exercise. Teaching your dog a new trick can give you a sense of accomplishment. Even petting your dog can help with your recovery by relieving stress and anxiety."


About the Support Partners Program


Support Partners: Canine Companions is the newest component of the Support Partners program, a national educational campaign dedicated to people with depression and to those who care about them. Co-sponsored by the National Women's Health Resource Center (NWHRC), the Support Partners program aims to open the lines of communication about the illness and encourages a support- team approach to overcoming depression. Support Partners offers three guidebooks that provide tips for people with depression, and those who care about them, on how to form a support network. Copies of the guidebooks can be obtained by visiting SupportPartnersProgram.


About Depression


Up to 19 million Americans per year are diagnosed with major depressive disorder.(vi),(vii) It can happen to anyone of any age, race or ethnic group(viii); however, women are nearly twice as likely to experience depression as men.(ix) Depression is a serious medical condition with a variety of symptoms, such as sadness, loss of interest, fatigue, changes in appetite or weight, or bodily aches and pains.(x) For some, depression can include thoughts of death or suicide.(xi)


The goal of treatment is to help people with depression feel more like themselves, so they can move forward with their lives. Depression symptoms that don't go away completely can prevent people with depression from getting fully well and may increase the risk of symptoms coming back. Nobody should settle for feeling only slightly better. With the right treatment and support, recovering from depression is possible.


About the Psychiatric Service Dog Society


The Psychiatric Service Dog Society (PSDS) is a 501(c)(3) nonprofit organization dedicated to responsible Psychiatric Service Dog (PSD) education, advocacy, research and training facilitation. It provides essential information for persons disabled by severe mental illness who wish to train a service dog to assist with the management of symptoms. The PSDS consults regularly with mental health-care providers in their efforts to learn more about PSD. The organization also hosts an online community of veteran and new service-dog handlers. The PSDS does not provide or train dogs for individuals. It is an educational and capacity-building organization dedicated to responsible psychiatric service dog community stewardship. Please visit psychdog for more information.


About Lilly


Lilly, a leading innovation-driven corporation, is developing a growing portfolio of first-in-class and best-in-class pharmaceutical products by applying the latest research from its own worldwide laboratories and from collaborations with eminent scientific organizations. Headquartered in Indianapolis, Ind., Lilly provides answers -- through medicines and information -- for some of the world's most urgent medical needs. Additional information about Lilly is available at lilly. O-LLY


References


(i) Serpell, J.A. Evidence for long term effects of pet ownership on human health. Pets, Benefits and Practice. Waltham Symposium 20. April 19, 1990.


(ii) The Delta Society. "The Healthy Pleasure of Their Company: Companion Animals and Human Health" by Karen Allen, School of Medicine, State University of New York at Buffalo. Available at deltasociety/TextOnly/AnimalsHealthCompanionComp3.htm. Accessed April 17, 2007.


(iii) Allen, Karen. "Coping with Life Changes & Transitions: The Role of Pet."


(iv) Serpell, J.A. Evidence for long term effects of pet ownership on human health. Pets, Benefits and Practice. Waltham Symposium 20. April 19, 1990.


(v) Allen, Karen. "Coping with Life Changes & Transitions: The Role of Pet."


(vi) Kessler, Ronald et al. "Prevalence, Severity, and Comorbidity of 12- Month DSM-IV Disorders in the National Comorbidity Survey Replication." Arch Gen Psychiatry. June 2005. 62: 617-709.


(vii) United States Census 2000, Population as of April 1, 2000. Available at census/main/www/cen2000.html. Accessed May 10, 2007.


(viii) Depression and Bipolar Support Alliance. About Mood Disorders. Available at: dbsalliance/site/PageServer?pagename=about_MDOverview. Accessed April 24, 2007.


(ix) National Institute of Mental Health. Depression Research at the National Institute of Mental Health: Fact Sheet. Available at nimh.nih/publicat/depression.cfm#ptdep1. Accessed April 4, 2007.


(x) American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 4th ed., Text Revision. Washington DC: American Psychiatric Association; 2000:345-428.


(xi) American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 4th ed., Text Revision. Washington DC: American Psychiatric Association; 2000:345-428.

Mental Disorders Make Up 14% Of Global Disease Burden

Neuropsychiatric disorders (NPDs) make up 14% of the global disease burden, according to The Lancet "Series on Global Mental Health". NPDs contribute more to the total global burden than heart disease, stroke or cancer, because NPDs are so disabling. NPDs include depression, substance and alcohol use disorders, and psychoses.


According to Professor Martin Prince, Institute of Psychiatry, King's College, London, mental illnesses raise the probability of developing and exacerbating a wide range of physical illnesses. Prof. Prince is one of the writers of "No health without mental health", part of a series of six reviews.


Prof. Prince explained that NPDs are common accompaniments of other communicable and non-communicable diseases (NCDs) - they complicate their treatment, are usually linked to poorer outcomes, including a higher death rate for patients. Prince says we need to carry out more research on these links; especially on the potential for mental health interventions to improve patients' physical outcomes.


Not much research has been carried out on the impact of NPDs on physical illnesses in low and middle income countries. 80% of all NCD deaths and 99% of HIV/AIDS deaths happen in low and middle income countries. As mental healthcare budgets in these countries are low, we need to find some way of measuring the impact of neuropsychiatric disorders.


Prof Prince said "Mental health awareness needs to be integrated into all elements of health and social policy, health-system planning, and delivery of primary and secondary general health care."


The following are NPDs:


-- Schizophrenia

-- Depression

-- Anxiety

-- Bipolar Disorder

-- Attention Deficit Hyperactivity Disorder

-- Alzheimer's Disease

-- Obsessive Compulsive Disorder

-- Eating disorders


Neuropsychiatry is a branch of medicine. It deals with mental disorders attributable to diseases of the nervous system.


The Lancet "Series on Global Mental Health"

FDA Strengthens Warning For Pregnant Women Using Paxil After Two Studies Link Use To Fetal Heart Defects

FDA on Thursday issued a public health advisory warning pregnant women and physicians about an increased risk of fetal heart defects from taking GlaxoSmithKline's antidepressant Paxil -- known generically as paroxetine -- during the first three months of pregnancy, the Washington Post reports (Kaufman/Vedantam, Washington Post, 12/9). The warning moves Paxil to Category D, FDA's second-highest category for risk of birth defects. Category D means that either "controlled or observational" studies of pregnant women "have demonstrated a risk to the fetus" (FDA release, 12/8). The advisory is based on preliminary results from two studies, which found that women taking Paxil during the first three months of pregnancy were 1.5 to two times as likely to give birth to an infant with a heart defect as women who took other antidepressants or none at all (Washington Post, 12/9).

Studies, Recommendations
The first study, an evaluation of U.S. health insurer data, found that about 2% of women who took Paxil early in pregnancy gave birth to infants with heart defects, compared to about 1% of all women. The other study, which examined data from about 6,900 infants in Sweden, found that 1.5% of women taking Paxil in their first trimester gave birth to infants with heart defects, compared to 1% of women who took other antidepressants (Richwine, Reuters, 12/8). Most of the heart defects reported in the studies were atrial and ventricular septal defects, or holes in the heart walls, which sometimes can require surgery and sometimes can resolve with no treatment (AP/South Florida Sun-Sentinel, 12/9). For women taking Paxil who plan to become pregnant or are three months pregnant or less, "[h]ealth care professionals should consider discontinuing [the drug] -- and switching to another antidepressant if indicated," FDA said in a release, adding, "In some patients, the benefits of continuing Paxil may be greater than the potential risk to the fetus. FDA is advising health care professionals not to prescribe Paxil in women who are in the first three months of pregnancy or are planning pregnancy, unless other treatment options are not appropriate" (FDA release, 12/8). Before Thursday's advisory, Paxil had been classified as a Category C drug for pregnant women, which means comprehensive studies of its effects during pregnancy have not been performed (Kaiser Daily Women's Health Policy Report, 9/28).

Reaction
GSK spokesperson Gaile Renegar said that the studies are examinations of databases and not clinical trials (Reuters, 12/8). She added that the company is studying to see how and why Paxil might be causing any birth defects (Washington Post, 12/9). GSK has worked with FDA to make the labeling changes and to communicate the updated findings for Paxil so physicians and patients can make well-informed treatment decisions," Jack Modell, GSK vice president of clinical psychiatry, said (GSK release, 12/8). Kimberly Yonkers, a psychiatrist at Yale University School of Medicine, also noted the limitations of the two studies, adding, "Depression is still undertreated. Pregnant women in particular are immensely undertreated, and you worry about people being unduly frightened." Robert Temple, FDA's director of medical policy, said, "If you're on Paxil and pregnant, our advice is to talk to your physician and consider switching to a different drug," adding, "Abrupt withdrawal of Paxil has its own problems, but the clear suggestion here is that you might want to think about a change" (Washington Post, 12/9).

NBC's "Nightly News" on Thursday reported on the advisory. The segment includes comments from Lee Cohen, director of the perinatal and reproductive psychiatry clinical research program at Massachusetts General Hospital (Bazell, "Nightly News," NBC, 12/8). The complete segment is available online in Windows Media.


"Reprinted with permission from kaisernetwork. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at kaisernetwork/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork, a free service of The Henry J. Kaiser Family Foundation . © 2005 Advisory Board Company and Kaiser Family Foundation. All rights reserved.


View drug information on Paxil CR.

Suicide Prevention Group Delivers Much Needed Message To Pennsylvania's Elderly

This month, in recognition of
National Mental Health Month and Older Pennsylvanians Month, Feeling Blue
Suicide Prevention Council (SPC) will offer an important message to senior
citizens through a public service announcement. The public service
announcement developed by Feeling Blue SPC is intended to bring awareness
to the public health problem of depression and to offer hope to older
Pennsylvanians who may be feeling suicidal: You are not alone in your
feelings of depression. There's hope and there's help.



Older adults are the highest risk population in the country, but few
suicide prevention programs target them. Through a grant provided by the
Pennsylvania Department of Health, Feeling Blue SPC has been able to make
this objective possible.



"As a responsible society, we must ensure the mental health and
well-being of our older population," said Department of Health Secretary
Dr. Calvin B. Johnson. "We hope this announcement can help spread the
message that depression is not a 'normal' part of aging and that suicide
can be prevented."



The statistics surrounding elderly suicide are alarming. According to
the National Strategy for Suicide Prevention, a division of the U.S.
Department of Health & Human Services, risk factors for suicide among older
persons differ from those among the young. Elderly people are also more
socially isolated. Additionally, approximately three quarters of the older
adults who die by suicide have visited a physician within one month of
taking their life.



Feeling Blue Suicide Prevention Council (SPC) is a nonprofit
organization dedicated to preventing suicide, reducing the stigma
associated with suicide, and supporting those people affected by depression
or by the loss of a loved one to suicide. They do this through education,
training and linking people with a variety of resources.


Feeling Blue Suicide Prevention Council

feelingblue

UAB Researchers Assess Psychopathological Symptoms In Pre-School Children

The Unit of Child and Adolescent Psychopathology, part of the UAB Department of Clinical and Health Psychology, is undertaking pioneer research in Catalonia on the prevention and detection of emotional and behavioural disorders among children between the ages of three and six. The results show a high percentage of children in this age group with some kind of psychopathological symptom. According to the researchers, detecting these is vital since at this age children can be treated to prevent psychopathological symptoms appearing at a later stage.



The objective of the research carried out by the Unit is to generate awareness of psychopathologies in pre-school children, particularly in schools and in educational psychologists. The aim is that these not only focus on children with language disorders, developmental delay, etc, but also on the whole of this population, based on the idea that improving prevention is much easier with children of this age group.



This age group is crucial for the future, since 99% of children who do not suffer from any kind of disruptive behaviour do not develop these disorders in later life. By contrast, those who do suffer from disruptive behaviour continue to have the same problem five years later or develop some other kind of disorder.



The concern and the studies focused on this age group are very recent. The researchers have found that many of the problems and disorders found at later stages in life begin during this period of childhood. This is the first time anyone has studied the problem in Catalonia. The geographical location is a very important factor for this kind of study, which is why the data from studies carried out in other countries can only be used as a guide and it is vital to carry out fieldwork at the same location.



The study consists of various field studies that look into the psychopathological disorders in pre-school children from different perspectives: the different ways in which these disorders develop in children living in an urban environment and those living in a rural environment, the appearance of physical symptoms, the development of eating disorders due to psychosocial factors, the difference between parents and teachers in the detection of symptoms of depression, etc.





Contact: Lucas Santos


Universitat Autonoma de Barcelona

Controversial Electroconvulsive Therapy Helps Severe Depression, From The Harvard Mental Health Letter

Passing an electric current
through the brain to induce a seizure is not everyone's idea of a
therapeutic procedure. So it's no surprise that electroconvulsive therapy
(ECT) has been controversial. Fears of misuse are common, and efforts to
restrict or abolish the practice have had some success. Yet ECT persists
because it can be a uniquely effective treatment for severe depression and
other mental illnesses, reports the February 2007 issue of the Harvard
Mental Health Letter.


The treatment affects many brain pathways, nerve receptors,
neurotransmitters, and endocrine systems. Before the advent of ECT, drugs
were used for the same purpose, but were less effective and had more
serious side effects.



The most common side effect of ECT is memory loss. Tests show that
memory- both the ability to recall earlier events and the ability to absorb
new knowledge-declines with ECT. Memory usually returns to normal within a
few weeks, but not necessarily for all patients and in all respects. The
way the treatment is done may make a difference. For instance, research
suggests that placing both electrodes on the same side of the head, using
intermittent pulses instead of continuous stimulation, and lowering the
dose of electricity can greatly reduce the risk of memory loss.



"ECT continues to restore the health and sometimes save the lives of
people with the potentially lethal disorders of severe depression, mania,
and acute psychosis. For the patients who suffer most with mood symptoms,
nothing better than ECT has been devised," says Dr. Michael Miller, editor
in chief of the Harvard Mental Health Letter. "That is the most important
reason for its survival through doubts, fears, and political controversy."


Harvard Health Publications

health.harvard