Study Of Depression And Suicide In Veterans

The largest and most up-to-date study of suicides among depressed veterans provides important new data that may help guide screening and treatment for all veterans.



Published online yesterday (Oct. 30), the study finds that the predictors of suicide among veterans in depression treatment differ from those seen in the general American population, with younger, white, non-Hispanic men having the highest risk among the veterans.



Veterans with substance abuse issues, and those who had been hospitalized for psychiatric reasons in the year before their depression diagnosis, also had a higher suicide risk. Surprisingly, older veterans who had been diagnosed with post-traumatic stress disorder in addition to depression had a lower overall rate of suicide than those without a PTSD diagnosis, perhaps because they were more likely to receive care through Veterans Affairs PTSD programs.



Though the study did not directly compare populations of veterans and non-veterans receiving treatment for depression, the study does confirm that suicide rates were very high among depressed VA patients during the study period of 1999 to 2004, reinforcing the need for the VA's recent initiatives to prevent suicide.



The study, conducted by researchers from the VA Ann Arbor Healthcare System and the University of Michigan Health System and U-M Depression Center, will appear in the December American Journal of Public Health issue focused on veterans' issues.



The researchers analyzed comprehensive data from 807,694 veterans of all ages diagnosed with depression and treated at any Veterans Affairs facility nationwide between 1999 and 2004. The data are from the VA's National Registry for Depression, developed and maintained by the Serious Mental Illness Treatment Research and Evaluation Center at the VA Ann Arbor's Health Services Research and Development Center of Excellence.



In all, the researchers found that 1,683 of the depressed veterans committed suicide during the study period, representing 0.21 percent of the depressed veterans studied. They then analyzed the characteristics of all the depressed veterans who committed suicide, and calculated suicide hazard ratios and suicide rates per 100,000 person-years for each subgroup.



"Doctors learn about patient characteristics that might increase risk of suicide," says first author Kara Zivin, Ph.D., a VA investigator and assistant professor in the U-M Department of Psychiatry. "Typically, these are older age, male gender, and white race, as well as depression, and medical or substance abuse issues. But our study indicates that among veterans in depression treatment, the predictors of suicide may not be the same. We hope our findings will help guide physicians in understanding suicide risk among currently depressed veterans."
















Zivin and senior author Marcia Valenstein, M.D., an associate professor of psychiatry at U-M and leader of this study, note that these data are but the first of many findings that will likely emerge from analysis of the VA data.



"We are also examining whether there are specific periods during depression treatment when veterans are at higher risk and might need higher levels of monitoring," says Valenstein. "In addition, we are examining whether different types of depression treatments, such as different antidepressants or sleeping medications, are associated with different rates of suicide."



The study divided veterans into three age groups: 18 to 44 years, 45 to 64 years, and 65 years or older. It did not assess whether they had served in combat during a particular conflict, although the existence of a disability connected to military service was considered.



Interestingly, the depressed veterans who did not have a service-connected disability were more likely to commit suicide than those with a service-connected disability. This may be due to greater access to treatments among service-connected veterans, or more stable incomes due to compensation payments.



For their analysis, the researchers included all veterans who had received at least two diagnoses of depression during the study period, or had received both a diagnosis of depression and filled a prescription for an antidepressant. Veterans with bipolar disorder, schizophrenia or schizoaffective disorders were not included because of their different prognoses compared with people who have "unipolar" depression. In all, the analysis included data from 807,694 of the 1.5 million veterans diagnosed with depression since 1997.



When the researchers calculated suicide rates over the entire 5.5 year study period, they were much higher for men (89.5 per 100,000 person-years) than for women (28.9), and higher for whites (95 per 100,000 PY) than for African Americans (27) and veterans of other races (56.1). Veterans of Hispanic origin had a lower rate (46.28 per 100,000 PY) of suicide than those not of Hispanic origin (86.8). Adjusted hazard ratios also reflected these differences.



Difference in rates among depressed veterans of different age groups were striking, with 18-44-year-olds committing suicide at a rate of 94.98 suicides per 100,000 person years, compared with 77.93 for the middle age group and 90 for the oldest age group.



The initial findings revealed a suicide rate of 68.16 per 100,000 PY for depressed veterans who also had PTSD, compared with a rate of 90.66 for those who did not. This surprising finding led the researchers to dig deeper and look at whether specific subgroups of depressed veterans with PTSD had higher or lower suicide risk. Further examination demonstrated that the "protective" effect of having PTSD in addition to depression was strongest among veterans in the two older age groups.



The authors say their study does not reveal a reason for this "protective" effect, but they theorize that it may be due to the high level of attention to PTSD treatment in the VA system and the greater likelihood that patients with PTSD will receive psychotherapy. More study is necessary, they say.







In addition to Zivin and Valenstein, the study's authors are Myra Kim, Ph.D., John F. McCarthy, Ph.D., Karen Austin, MPH, Katherine Hoggatt, Ph.D., and Heather Walters, M.S., all of the VA, Ann Arbor, the U-M Medical School or the U-M School of Public Health. Zivin, Valenstein and McCarthy are members of the U-M Depression Center. The study was funded by the Department of Veterans Affairs.



Reference: American Journal of Public Health, Dec. 2007, Vol. 97, No. 12

New York Times Magazine Writer Profiles Personal Experiences With Estrogen Therapy

In Sunday's New York Times Magazine, Cynthia Gorney, a writer and journalism professor at the Graduate School of Journalism at the University of California-Berkeley, discusses both the controversy of hormone replacement and possible benefits related to memory and mood. She also discusses her own medical history, including depression and her personal struggle with "the estrogen question" -- whether individual benefits of estrogen therapy outweigh potential risks. Gorney's article examines perimenopausal mood issues -- such as depression, memory and attention -- as well as the prevention of Alzheimer's disease. According to Gorney, all of these conditions can be linked to estrogen deficiency, and she discusses the possibility that estrogen replacement could be the solution for some women.

Gorney writes that when she began using an estrogen patch for mental health-related issues in 2001, the "prevailing belief about hormone replacement ... was still, as it had been for a quarter century, the distillation of extensive medical and pharmaceutical-company instruction: that once women start losing estrogen, taking replacement hormones protects against heart disease, cures hot flashes, keeps the bones strong, has happy effects on the skin and sex life and carries a breast cancer risk that's worth considering but not worrying about too much, absent some personal history of breast cancer or a history of breast cancer in the immediate family." However, Gorney became concerned about potential risks after the 2002 release of the Women's Health Initiative, which uncovered possible negative health effects for women on hormone therapy. However, Gorney's article pokes many holes in the landmark study, in part because women in their late 40s and early 50s weren't included the study, and she suggests that hormone replacement may be what many women need. Nonetheless, there is still a lack of real data (Gorney, New York Times Magazine, 4/18).


Reprinted with kind permission from nationalpartnership. You can view the entire Daily Women's Health Policy Report, search the archives, or sign up for email delivery here. The Daily Women's Health Policy Report is a free service of the National Partnership for Women & Families, published by The Advisory Board Company.


© 2010 The Advisory Board Company. All rights reserved.

Searching For The Soul Of The Genome

The discovery that a "gene desert" on chromosome 9 was a hotspot for coronary artery disease (CAD) risk was among the highlights of findings produced recently by genome-wide association studies, which compare the genomes of many people for genetic variations and have been broadly used in the past few years to study hundreds of diseases and complex traits. Gene deserts are large genomic segments devoid of genes.



Now scientists at the University of California, San Diego School of Medicine and colleagues have developed a novel approach to detect long-distance chromosomal interactions and have applied this method to the chromosome 9 gene desert, revealing that the association results from an altered inflammatory signaling response in individuals with increased CAD risk.



The findings are published in the Feb. 10 issue of Nature.



The researchers followed up on results of the widely reported genome-wide association studies in 2007 and 2008, noting that the gene desert interval on chromosome 9 contained DNA variants (called single nucleotide polymorphisms or SNPs) associated with CAD and type 2 diabetes mellitus (T2D). Based on these findings, Francis Collins, director of the National Institutes of Health and a leader in the original Human Genome Project, publicly described the chromosome 9 interval as "like the seat of the soul of the genome."



The DNA variants associated with CAD and T2D are located close to one another on chromosome 9, but inherited independently so genetic risk for developing CAD is not associated with risk for the T2D.



In comparing the genomes of people with heart disease and people without, Frazer and colleagues found that those who carried the chromosome 9 DNA risk variants for CAD had a two-fold higher risk of early onset myocardial infarction (a heart attack) than non-carriers.



"The association of this interval with CAD was a surprise and not expected as it is a 'gene desert' and the flanking genes, which are far away, have little to do with lipid metabolism, one of the primary factors in heart disease," said one of the study's corresponding authors Kelly A. Frazer, PhD, professor in the Moores Cancer Center, UCSD Department of Pediatrics and Rady Children's Hospital San Diego, a research and teaching affiliate of the UCSD School of Medicine.



The research team took an even closer look at the relevant region of chromosome 9, called 9p21, and discovered that the 9p21 DNA sequence, which is devoid of protein-coding genes, is particularly rich in potential regulatory elements influencing disease risk. They identified 33 "enhancers" or regulatory elements responsible for activating or repressing genes. The researchers determined that the 9p21 interval is the second densest interval for predicted enhancers in the entire human genome, and six times denser than the genome on average.



The DNA variants associated with CAD appear to disrupt enhancer activity involved in cellular signaling and response to inflammation in vascular endothelial cells - the cells that form the inner lining of major blood vessels.



"Our work highlights the new approach we developed for analyzing long-range chromosomal interactions and the utility of such methods for deciphering the functions of non-coding DNA variants associated with disease risk," said Michael G. Rosenfeld, MD, a professor in the UCSD Department of Medicine, Howard Hughes Medical Institute investigator and a corresponding author of the study.



The UCSD researchers plan to scale up the new approach and use other methods to annotate additional non-coding DNA variants identified through GWAS studies as being linked to human disease.



"There are thousands of DNA regulatory variants that incur increased risk for disease that we can functionally characterize for their effect on long-range interactions," said Olivier Harismendy, PhD, first author of the study and an assistant project scientist in the UCSD Department of Pediatrics and Moores Cancer Center.



Notes:



Co-authors of the study include Dimple Notani, Xiaoyuan Song and Bogdan Tanasa of the UCSD Department of Medicine, Howard Hughes Medical Institute; Xiang-Dong Fu of the UCSD Department of Cellular and Molecular Medicine; Nathaniel Heintzman and Bing Ren of the Ludwig Institute for Cancer Research; and Nazli G. Rahim and Eric J. Topol of Scripps Genomic Medicine, Scripps Translational Science Institute and The Scripps Research Institute.



Source:

Scott LaFee

University of California - San Diego

Someone To Complain With Isn't Necessarily A Good Thing, Especially For Teenage Girls

Friendships that lend themselves to ruminating about problems may actually contribute to emotional difficulties in girls, according to new research. A study in the July issue of the journal Developmental Psychology, published by the American Psychological Association, finds that girls are more likely than boys of the same age group to develop anxiety and depression as a result of extensive conversations with friends about their problems.


Co-rumination, or excessively talking with another person about problems, including rehashing them and dwelling on the negative feelings associated with them, is thought to have both costs and benefits for people experiencing unpleasant situations. This six-month longitudinal study involved 813 third-, fifth-, seventh- and ninth-grade girls and boys, and tested whether co-rumination is associated with depression and anxiety while simultaneously benefiting girls and boys by strengthening friendships.


For girls, co-rumination predicted increased positive friendship quality, including feelings of closeness between friends. However, the study also found that girls who co-ruminate had increased depressive and anxiety symptoms, which in turn, contributed to greater co-rumination.


"Having anxiety symptoms (and presumably, associated heightened levels of worries and concerns) and a high-quality friend to talk to may provide a uniquely reinforcing context for co-rumination," stated Amanda J. Rose, Ph.D, lead author and Associate Professor of Psychology at the University of Missouri - Columbia.


Rose and her colleagues speculated that co-rumination may lead girls to think about problems in a way that is different from boys, and that is more closely linked to emotional problems. For example, girls may be more likely than boys to take personal responsibility for failures, according to the study's authors.


For boys, co-rumination predicted only greater positive friendship quality and not increased depression and anxiety. "These findings are interesting because girls' intentions when discussing problems may be to give and seek positive support. However, these conversations appear to contribute to increased depression," said Rose.



The research cautions parents and adults against being lulled into a false sense of security about youth, especially girls, with seemingly supportive friendships. While other studies indicate that adults should worry about socially isolated youth, this research raises the issue that youth in seemingly supportive friendships may also be at risk for depression and anxiety if the friendship is based on a pattern of co-rumination.


Article: Prospective Associations of Co-Rumination with Friendship and Emotional Adjustment Considering the Socioemotional Trade-Offs of Co-Rumination. Amanda J. Rose, Wendy Carlson, and Erika M. Waller, University of Missouri - Columbia. Developmental Psychology, Vol. 43, No. 4


Click here to see the article.


The American Psychological Association (APA), in Washington, DC, is the largest scientific and professional organization representing psychology in the United States and is the world's largest association of psychologists. APA's membership includes more than 148,000 researchers, educators, clinicians, consultants and students. Through its divisions in 54 subfields of psychology and affiliations with 60 state, territorial and Canadian provincial associations, APA works to advance psychology as a science, as a profession and as a means of promoting human welfare.


American Psychological Association

Award In Excellence For Clinical Pharmacology Honours Bryan Roth

Bryan L. Roth, PhD, the Michael J. Hooker Distinguished Professor of Pharmacology in the University of North Carolina at Chapel Hill School of Medicine, has received the PhRMA Foundation Award in Excellence in Pharmacology/Toxicology.



Roth is also professor in the departments of pharmacology, medicinal chemistry and natural products and he holds the Michael Hooker Chair of Protein Therapeutics and Translational Proteomics.



His work in pharmacology and drug discovery has earned him numerous patents and he has published nearly 300 articles in, among many other publications, Science, Nature, Cell and the New England Journal of Medicine. He has also trained dozens of doctoral and post-doctoral students who have also become leaders in their field.



Much of Roth's research focuses on trying to understand how central nervous system drugs affect the brain's neurons. The goal is to investigate existing treatments in order to find new treatments and mitigate side effects, particularly for such problems as schizophrenia, depression, bipolar disorder and eating disorders.



"We really don't understand how most drugs currently used in brain disorders work," he explained. "If we can uncover how they exert their therapeutic actions, we hope to find drugs that are more effective. Additionally, if we can understand the side effects of current drugs, we'll know what molecular targets we have to avoid in making new drugs so they don't have the side effects."



Essentially, the work identifies both good targets for drug development, and bad targets to be avoided. In one application of the technique, Roth's lab identified potentially safe and effective compounds for treating obesity. Those compounds have been out-licensed to biotech companies for commercial development.



And In one of his most important research projects, Dr. Roth and his team at UNC, along with scientists at the University of California, San Francisco, developed and validated a computer model that can allow researchers to predict likely side effects before a drug is even put into clinical testing. The method compares the structures of all known drugs for various disease targets to their naturally-occurring binding partners. That comparison has revealed interactions between drugs and their targets that could not be predicted simply by studying their chemical structures.



A native of Butte, Montana, Roth graduated from Carroll College in Helena in 1977 with a degree in biology and chemistry. He subsequently earned his combined MD/PhD in Biochemistry in 1983 from St. Louis University School of Medicine.



He completed an internship in psychiatry at the National Naval Medical Center in Bethesda, Md. in 1984, and from 1983-1986 worked at the National Institute of Mental Health. During much of that period, he also worked at the Naval Medical Research Institute in Bethesda, first as a principal investigator and later as assistant division head of the institute's surgical research division.



In 1991 Dr. Roth concluded his residency in psychiatry at Stanford University Medical School, where he was also a Dana Foundation Fellow in Neurosciences in the Nancy Pritzker Laboratory of Molecular and Developmental Neurobiology. That year, he also received his first PhRMA Foundation grant.



After completing his studies at Stanford he held appointments at Case Western Reserve University School of Medicine for more than a decade in Departments of Psychiatry, and Biochemistry, ultimately becoming a Full Professor of Biochemistry in 2003. During much of that time he was on the faculty of Case Western Reserve University, where he specialized in the treatment of schizophrenia and, for a time, directed the Schizophrenia Research Ward at University Hospitals of Cleveland.



The annual Award in Excellence honors researchers who received PhRMA Foundation grants early in their careers and then distinguished themselves through outstanding scientific and/or academic achievements.



"This award is wonderful for me and for my lab. Essentially, the PhRMA Foundation makes a bet on young investigators, and no one knows for years whether it was a good bet or not. I am happy I was able to find success and, hopefully, will continue to find it for many years."



The Award in Excellence will be presented April 9 at a meeting of the American Society for Pharmacology and Experimental Therapeutics.

UGA Study Finds That Violence Costs Nation $70 Billion Annually

The most comprehensive study of its kind has found that violence costs the United States $70 billion annually, a figure that rivals federal education spending and the damage caused by hurricane Katrina.



Phaedra Corso, lead author of study and associate professor of health policy at the University of Georgia College of Public Health and health economist at the Centers for Disease Control and Prevention, said the study illustrates how much money can be saved by investing in programs that decrease interpersonal violence and self-inflicted violence such as suicide. For comparison, the federal Department of Education has an annual budget of $67.2 billion and hurricane Katrina caused an estimated $80 billion in damage.



"Violence can be prevented, and this study highlights the benefits of prevention," said Corso, whose study appears in the June issue of the American Journal of Preventive Medicine.



Corso and her colleagues at the CDC analyzed eight national data sets compiled by the federal government and calculated medical costs as well as productivity losses. The study also examines the costs of violence in different sub-populations and categories of violence, revealing specific targets for cost effective interventions.



The researchers found that most of the costs of violence stem from males and young adults. Sixty-eight percent of the costs from assaults and 63 percent of the costs from self-inflicted injuries were in males aged 15 to 44.



"The most burdensome category is among young males who are victims of assaults with firearms," Corso said. "So if you want to prevent those costs from occurring, you need to focus on prevention in that particular population."



Other findings from the study include:



* Most of the $70 billion in costs associated with violence were from lost productivity ($64.4 billion), with the remaining $5.6 billion spent on medical care.


* Americans suffer 2.2 million medically treated injuries due to interpersonal violence annually, at a cost of $37 billion ($33 billion in productivity losses, $4 billion in medical treatment).


* The cost of self-inflicted injuries (suicide and attempted suicide) is $33 billion annually ($32 billion in productivity losses, $1 billion in medical costs).


* People aged 15 to 44 years comprise 44 percent of the population, but account for nearly 75 percent of injuries and 83 percent of costs due to interpersonal violence.


* The nearly 17,000 annual homicides result in $22.1 billion in costs. The average cost per homicide was $1.3 million in lost productivity and $4,906 in medical costs.


* The average cost per case for a non-fatal assault was $57,209 in lost productivity and $23,353 in medical costs.


* The average cost per case of suicide is $1 million in lost productivity and $2,596 in medical costs. The average cost for a non-fatal self inflicted injury was $9,726 in lost productivity and $7,234 in medical costs.



Corso points out that society often foots the bill for the medical costs of violence through programs such as Medicare and Medicaid. Productivity losses, by definition, are societal costs since they measure the contribution that the individual would have made through his or her work.



The researchers note that there are several programs that have been proven to reduce violence. Students participating in school-based programs that include a focus on enhancing academic progress and problem-solving skills, for example, have shown measurable decreases in violent behavior. Reductions in dating violence have been shown to persist four years after the completion of a program for adolescents known as Safe Dates.



Corso said the study probably underestimates the economic costs of violence because many people don't seek medical attention for violence-related injuries and often attribute injuries from domestic violence and suicide attempts to accidents.



She added that economic costs provide, at best, an incomplete measure of the toll of violence. Victims of violence are more likely to experience post-traumatic stress disorder, depression, anxiety and a host of other problems such as substance abuse.



"There is a huge quality of life component that this research doesn't capture," Corso said. "Thinking about the Virginia Tech victims, no one can put a value on the impact the violence had on those families and students."






Contact: Sam Fahmy


University of Georgia

Amicus Therapeutics Commences Phase 1 Clinical Trials For AT2220 For Pompe Disease

Amicus Therapeutics, a
biopharmaceutical company developing small molecule, orally-administered
pharmacological chaperones for the treatment of human genetic diseases,
today announced that it has commenced Phase 1 clinical trials for AT2220
for the treatment of Pompe disease, following acceptance of an
investigational new drug application (IND) by the U.S. Food and Drug
Administration (FDA).




Pompe disease, also known as glycogen storage disease type II or acid
maltase deficiency, is a relatively rare lysosomal storage disorder caused
by an inherited mutation in the lysosomal enzyme alpha-glucosidase (GAA).
GAA is normally made in the endoplasmic reticulum where it is properly
folded and subsequently trafficked to the lysosome where it catalyzes the
breakdown of glycogen. In many Pompe patients, a genetic mutation alters
the structure and stability of GAA which results in reduced levels of
enzyme in the lysosome and reduced cellular activity. The deficiency in GAA
activity leads to excessive glycogen accumulation in the cells of various
tissues, especially in heart and skeletal muscle.



AT2220 is a small molecule designed to act as a pharmacological
chaperone that specifically binds, stabilizes, and facilitates the proper
folding and trafficking of GAA to the lysosome, where it can perform its
normal function. AT2220 has been shown to increase GAA activity in cell
lines derived from Pompe patients and in transfected cells expressing
misfolded forms of GAA.



"We are very pleased to see continued progress in the fight against
Pompe disease," says Dr. Sharon Hesterlee, Vice President of Translational
Research at the Muscular Dystrophy Association (MDA). "We look forward to
exploring the opportunities to work with Amicus as this new potential
treatment option for individuals and families with Pompe disease is
evaluated through human clinical trials."



"AT2220 for Pompe disease is the third Amicus product to enter clinical
trials," says Donald Hayden, Amicus interim President and CEO. "This
accomplishment further demonstrates the company's progress in developing
new potential treatments for important diseases using pharmacological
chaperone technology."



The company's lead compound, Amigal(TM) (migalastat hydrochloride), is
in Phase 2 clinical trials for Fabry disease and AT2101 is in Phase 1
clinical trials for the treatment of Gaucher disease.



About Pompe Disease



Pompe disease affects an estimated 5,000-10,000 patients worldwide and
is clinically heterogeneous in the age of onset, the extent of organ
involvement, and the rate of progression. The early onset form of the
disease is the most severe, progresses most rapidly, and is characterized
by musculoskeletal, pulmonary, gastrointestinal, and cardiac symptoms that
usually lead to death from cardio-respiratory failure between 1 and 2 years
of age. The late onset form of the disease begins between childhood and
adulthood and has a slower rate of progression that is characterized by
musculoskeletal and pulmonary symptoms that usually lead to progressive
weakness and respiratory insufficiency.



About Amicus Therapeutics



Amicus Therapeutics is a biopharmaceutical company developing novel,
oral therapeutics known as pharmacological chaperones for the treatment of
a range of human genetic diseases. Pharmacological chaperone technology
involves the use of small molecules to restore or improve biological
activity in cells by selectively binding to misfolded proteins caused by
genetic mutations. Amicus is initially targeting lysosomal storage
disorders, which are severe, chronic genetic diseases with unmet medical
needs. Amicus is currently conducting Phase 2 clinical trials for its lead
compound, Amigal(TM), for Fabry disease, and is conducting Phase 1 clinical
trials of AT2101 for Gaucher disease and AT2220 for Pompe disease.


Amicus Therapeutics

amicustherapeutics/

Does Treatment Of Depression Improve Prognosis After Heart Attack?

Depression and heart disease are the two leading disorders with the strongest contributions to the global burden of disease. Depression and heart disease are also intertwined. In recent years, much attention has been given to depression following heart attack and its effects on prognosis. Several large scale studies have been undertaken (ENRICHD, SADHART, MIND-IT, CREATE) in which depression was targeted. Although we hoped that treating depression would result in an improved prognosis, these studies have not provided much evidence to support this position: effects on depression itself have been minor and did not translate into cardiovascular benefits. One of the reasons for these findings may be the heterogeneity of depression following heart attack, with some depression types being cardiotoxic and responding to treatment, and others not.


Two studies are discussed that were carried out across several hospitals in the Netherlands that will help us to understand the intriguing relation between depression and heart disease. 2,466 heart attack patients were assessed on depression and clinical characteristics during hospitalization and followed for more than 2.5 years. The results of these two studies show that it is important to distinguish between depression subtypes based on whether they are first-ever or recurrent, as these subtypes differ in cardiotoxicity and response to antidepressive treatment.


Moreover, those depressions may differ in symptomatology, and some symptoms may be more cardiotoxic than others. These two studies indicate that especially somatic and incident depressions are associated with poor prognosis in cardiac patients, which is very different from the 'typical' psychiatric depression that is usually characterised by cognitive and recurrent depressive symtoms. These results could lead to new treatment strategies to prevent future cardiac events, which may be quite different than those described in current guidelines for depression in the general population and could lead to more specific and effective treatments.


Authors

Dr. Elisabeth Martens

e.j.martensuvt.nl


Notes


This press release accompanies both a presentation and an ESC press conference given at the ESC Congress 2008. Written by the investigator himself/herself, this press release does not necessarily reflect the opinion of the European Society of Cardiology.

European Society of Cardiology

Earlier Bedtimes May Help Protect Adolescents Against Depression And Suicidal Thoughts

A study in the Jan. 1 issue of the journal Sleep found that adolescents with bedtimes that were set earlier by parents were significantly less likely to suffer from depression and to think about committing suicide, suggesting that earlier bedtimes could have a protective effect by lengthening sleep duration and increasing the likelihood of getting enough sleep.



Results show that adolescents with parental set bedtimes of midnight or later were 24 percent more likely to suffer from depression (odds ratio = 1.24) and 20 percent more likely to have suicidal ideation (OR=1.20) than adolescents with parental set bedtimes of 10 p.m. or earlier. This association was appreciably attenuated by self-reported sleep duration and the perception of getting enough sleep. Adolescents who reported that they usually sleep for five or fewer hours per night were 71 percent more likely to suffer from depression (OR=1.71) and 48 percent more likely to think about committing suicide (OR=1.48) than those who reported getting eight hours of nightly sleep. Participants who reported that they "usually get enough sleep" were significantly less likely to suffer from depression (OR=0.35) and suicidal ideation (OR=0.71).



Lead author James E. Gangwisch, PhD, assistant professor at Columbia University Medical Center in New York, N.Y., said that the results strengthen the argument that short sleep duration could play a role in the etiology of depression.



"Our results are consistent with the theory that inadequate sleep is a risk factor for depression, working with other risk and protective factors through multiple possible causal pathways to the development of this mood disorder," said Gangwisch. "Adequate quality sleep could therefore be a preventative measure against depression and a treatment for depression."



Data were collected from 15,659 adolescents and their parents who had participated in the National Longitudinal Study of Adolescent Health (Add Health), a school-based, nationally representative, probability-based sample of U.S. students in grades seven to 12 in 1994 to 1996. Seven percent of participants (1,050) were found to have depression using the Centers for Epidemiologic Study-Depression Scale, and 13 percent (2,038) reported that they seriously thought about committing suicide during the past 12 months. Depression and suicidal ideation were associated with later parental set bedtime, shorter sleep duration, self-perception of not getting enough sleep, female sex, older age and lower self-perception of how much parents care.



Fifty-four percent of parents reported that their adolescent had to go to bed by 10 p.m. or earlier on weeknights, 21 percent reported setting a bedtime of 11 p.m., and 25 percent reported setting a bedtime of midnight or later. Caucasians were more likely than adolescents of other racial/ethnic groups to have a parental set bedtime of 11 p.m. Nearly 70 percent of adolescents reported going to bed at a time that complied with the weeknight bedtime that was set by their parents. Adolescents reported going to bed only about five minutes later on average than their parental set bedtime.



The average adolescent-reported sleep duration was seven hours and 53 minutes, which contrasted sharply with the nine or more hours of nightly sleep that the AASM recommends for adolescents. Participants with a parental set bedtime of 10 p.m. or earlier reported that they usually slept for an average of eight hours and 10 minutes, which was 33 minutes more than adolescents with a bedtime of 11 p.m. (seven hours, 37 minutes) and 40 minutes more than those with a bedtime of midnight or later (seven hours, 30 minutes). With the exception of sleep durations of 10 hours or more per night, higher average self-reported sleep durations were associated with progressively earlier average bedtimes.



The authors reported that there are a number of potential mechanisms by which chronic partial sleep deprivation could contribute to depression and suicidal ideation. A lack of sleep may affect the modulation of emotional brain responses to aversive stimuli; produce moodiness that hinders the ability to cope with daily stresses and impairs relationships with peers and adults; and affect judgment, concentration and impulse control.



They also suggested that behavioral interventions that involve educating adolescents and their parents about healthier sleep hygiene practices and helping them modify maladaptive sleep habits could sever as primary preventative measures against depression and suicidal ideation.



The study: "Earlier Parental Set Bedtimes as a Protective Factor Against Depression and Suicidal Ideation"

Gene Responsible For Severe Skin Condition Identified By Scientists

The drug, called carbamazepine, is commonly used to treat patients with epilepsy and other diseases such as depression and trigeminal neuralgia. Although successful in treating the majority of patients, carbamazepine can cause side-effects that range from a mild skin irritation to severe blistering of the whole body.



The team, in collaboration with the Wellcome Trust Sanger Institute, screened more than a million variants in DNA across the human genome to understand why some patients are more prone to the drug's side-effects than others. Research in Taiwan has already identified a gene that predisposes Asian patients to the skin condition, but Liverpool scientists discovered that this gene could not be used to predict the reaction in Caucasian people.



Researchers have now identified a gene, called HLA-A*3101, in Caucasian patients that increases the risk of developing a reaction to the drug from 5% to 26%. Researchers are now working with clinicians and drug regulators to investigate how these new findings can translate into clinical practice.



Professor Munir Pirmohamed, NHS Chair in Pharmacogenetics from the University's Wolfson Centre for Personalised Medicines, said: "Adverse drug reactions are a major cause of hospital admissions. Carbamazepine is widely used and the majority of patients respond well to the treatment, but a small percentage develop skin conditions that in severe circumstances can result in painful blistering all over the body.



"For the first time we have found a significant link between the drug and the skin condition in Caucasian people that also complements the findings in Asian patients. We can now begin to work with clinicians and regulators to maximise the benefits of the drug and minimise the side-effects."



Dr Ana Alfirevic, from the University's Wolfson Centre for Personalised Medicine, said: "This is a significant finding that highlights the importance and advancement of new genetic technologies. We aim to support the development of medicines based on a patient's unique genetic make-up to allow clinicians to prescribe the most effective and safe treatments."



Dr Gianpiero Cavalleri, from the Royal College of Surgeons, said: "Rapid advances in genetic technology, together with a strong collaborative effort, have allowed us to make this important advance, which should make the treatment of epilepsy safer. Working with colleagues in Europe and the US, we have been able to access large numbers of patients to allow us to investigate common genetic trends and the mechanisms that result in this potentially serious condition."


Notes:


Research conducted at the University was funded by the Department of Health and is published in the New England Journal of Medicine.


Other collaborators in the research include Imperial College London; University College London; Harvard University; and Duke University.


Other funders of the research include the National Institute for Health Research (NIHR); the Wellcome Trust; the Wolfson Foundation; and the Medical Research Council (MRC) Centre for Drug Safety Science.

Nicotinic Receptor Deletion Could Result In Developmental Delay

The loss of a gene through deletion of genetic material on chromosome 15 is associated with significant abnormalities in learning and behavior, said a consortium of researchers led by Baylor College of Medicine in a report that appears online in the journal Nature Genetics.



"This research goes about 95 percent of the way to pinning these problems in a specific group of individuals to this gene," said Dr. Arthur L. Beaudet, chair of molecular and human genetics at BCM. He believes that the deletion will be identified in other people with behavioral problems as well as schizophrenia, developmental delay and epilepsy. The gene's role in schizophrenia has been under study for some time.



Previously, a larger deletion containing more genes had been reported in people with the same constellation of disorders. In this work, Beaudet, Dr. Pawel Stankiewicz, assistant professor of molecular and human genetics at BCM, and colleagues found that a smaller deletion of genetic material - the whole of the gene in question, CHRNA7, and a part of another - was associated with similar problems in 10 members of four families.



"We scanned the genome of about 10,000 people to find this rare but important defect," said Stankiewicz.



"This gene encodes a subunit of a nicotinic receptor," said Beaudet. "It is a gene that mediates the response to nicotine via a receptor whose normal ligand is acetylcholine." The gene encodes a protein called an ion channel, which allows ions to flow in and out of neurons in the brain. Defects in ion channels have previously been associated with forms of epilepsy or seizure disorder.



"If insufficient expression of the nicotinic receptor causes most or all of the problems associated with deletions in this particular area of chromosome 15, then it offers a target for drug treatment," said Stankiewicz. One such drug mentioned in the paper is Chantix, a medicine now used in smoking cessation efforts.



In this study, an international group of researchers identified 10 people from four unrelated families with the same deletion in the chromosome. The area deleted encompasses all of CHRNA7, which encodes a whole subunit of the nicotinic receptor.



Nine of the 10 subjects had developmental delay and/or mental retardation. Four of the 10 had seizure disorders or an abnormal electroencephalogram (EEG).



In two of the families studied, the patients had inherited the deletion from a parent. In one family, researchers found the same deletion in the patient's mother, two siblings, maternal aunt and maternal grandmother. Both the patient's mother and her sister had mental retardation and epilepsy. His both siblings had developmental delay. The patient had severe mental retardation and obesity and mild facial dysmorphism.



A second patient with impaired growth and severe developmental delay inherited her deletion from her mother, who had normal intelligence but had suffered from epilepsy from childhood.



Others who took part in this study include Marwan Shinawi, Christian P. Schaaf, Samarth S. Bhatt, Zhilian Xia, Ankita Patel, Sau Wai Cheung and Jennifer Ruth German, all of BCM; Brendan Lanpher of Vanderbilt University in Nashville, Tenn.; Sandra Nagl and Claudia Nevinny-Stickel of MVZ Humane Genetik in Munich, Germany; Heinrich Stephan Herding of Praxis f??r Kinder und Jugendmedizin in Meldorf, Germany; LaDonna L Immken and Gayle Simpson Patel of Specially for Children Subspecialty of Clinical Genetics in Austin, Texas. Stankiewicz is also with the Institute of Mother and Child, Warsaw, Poland.



Funding for this work came from the National Institutes of Health; the Mental Retardation and Developmental Disabilities Research Center; the Rare Disease Clinical Research Consortia; and the Polish Ministry of Science and Higher Education.



Source: Glenna Picton


Baylor College of Medicine


View drug information on Chantix.

Long Term Depression Eased By Phone-Based Therapy

When people receive brief telephone-based psychotherapy soon after starting on antidepressant medication, strong positive effects may continue 18 months after their first session. So concludes a Group Health study in the April Journal of Consulting and Clinical Psychology.



This paper describes one more year of follow-up since a 2004 Journal of the American Medical Association (JAMA) report on the same random sample of Group Health patients.



"With close to 400 patients, this is the largest study yet of psychotherapy delivered over the telephone," said Evette J. Ludman, PhD, senior research associate, Group Health Center for Health Studies, the paper's lead author. "It's also the first to study the effectiveness of combining phone-based therapy with antidepressant drug treatment as provided in everyday medical practice."



Long-term positive effects of initially adding phone-based therapy included improvements in patients' symptoms of depression and satisfaction with their care, said Ludman. At 18 months, 77 percent of those who got phone-based therapy (but only 63 percent of those receiving regular care) reported their depression was "much" or "very much" improved. Those who received phone-based therapy were slightly better at taking their antidepressant medication as recommended, but that did not account for most of their improvement. And effects were stronger for patients with moderate to severe depression than for those with mild depression.



"We were surprised at how well the positive effects were maintained over time," said Ludman. "As with weight control, maintaining improvement is the hardest part of treating depression."



As is usual in clinical practice, the patients' primary care doctors diagnosed their depression and prescribed their antidepressants. Half of the patients also received eight sessions of telephone psychotherapy during the first six months, then two to four "booster" sessions in the second six months as well as medication follow-up and support from masters-level therapists.



The patients and therapists never met face to face, only over the phone, said Ludman. Patients weren't always easy to reach by phone, and the therapists worked hard to reach them all. Therapists followed a structured protocol for psychotherapy. They encouraged the patients to identify and counter their negative thoughts (cognitive behavioral therapy), pursue activities they had enjoyed in the past (behavioral activation), and develop a plan to care for themselves.



"The patients participated more fully in psychotherapy and completed more sessions than do most depressed people in the community," said Ludman. Nationally, only about half of insured patients receiving depression treatment make any psychotherapy visit, and less than a third make four or more visits. By contrast, in this study, three in four patients completed at least six phone therapy sessions. This is striking, she added, because the study did not include people who were already in counseling or planning to be.
















"Giving psychotherapy to people with depression who were not seeking therapy may help them significantly," said Ludman. Depression symptoms, including feeling discouraged and avoiding other people, can prevent people from seeking help. One in four depressed people who make appointments for in-person therapy are no-shows. "They slip through the cracks," she added.



Few of the patients who received phone-based therapy - even fewer than those who did not receive it - sought in-person therapy. "This suggests the phone-based therapy met their needs, without whetting their appetite for more," said Ludman. Phone-based therapy is more convenient and acceptable to patients than in-person psychotherapy, she said.



Next, Ludman said, the researchers plan to explore the combination treatment's cost-effectiveness and impact on work and home life. They also want to compare the effectiveness of phone-based treatment with that of in-person visits.



The National Institute of Mental Health funded the study. The other authors are Greg E. Simon, MD, MPH, and Michael Von Korff, ScD, senior investigators at Group Health Center for Health Studies; and Steve Tutty, MA, now a doctoral student in clinical psychology at Brigham Young University in Provo, Utah.



About Group Health Center for Health Studies Founded in 1947, Group Health is a Seattle-based, consumer-governed, nonprofit health care system that coordinates care and coverage. Group Health Center for Health Studies conducts research related to prevention, diagnosis, and treatment of major health problems. It is funded primarily through government and private research grants.









Please visit the virtual newsroom on our Web site, ghc/ under "Newsroom."



Contact: Joan DeClaire


Group Health Cooperative Center for Health Studies

Genetic Risk For Anxiety Does Not Have To Be Destiny

A growing body of basic animal research and studies of abused and neglected children provide a strong basis of support for the hypothesis that individuals with particular genotypes are at greater risk for depression, anxiety disorders, and problems with the abuse of alcohol and other substances. These gene-by-environment interactions are so powerful that some might assume that these genotypes identify people who are predestined to negative life outcomes.



However, a new study in the May 1st issue of Biological Psychiatry, published by Elsevier, challenges this view. Investigators studied infant monkeys from four different rearing conditions to examine how social context and different forms of early adversity interact with genotype to influence behavior.



Animals reared in small social groups were more likely to be aggressive and anxious, particularly among those with a low activity MAOA genotype. However, no genotype effects were evident in monkeys reared in larger social cages.



There are some circumstances in a child's development - such as abusive parenting - that everyone would agree constitutes "adversity." This study suggests, however, that other, more subtle features of the broader social environment influence development, and that genes that affect our behavioral responses are sensitive to these influences. So even though an infant may be reared with its nurturing mother, the relative absence of other social partners, for both the mother and the infant, can result in the infant developing an anxious style of responding to challenges, particularly if it possesses a "risky" genotype.



Of particular significance, said senior author John Capitanio, Ph.D., is "that animals that were raised in rich, complex settings with mothers, other kin, and peers, were completely protected from the potentially deleterious effects of having the 'risky' form of the MAOA gene."



Highlighting the importance of this study's findings, John Krystal, M.D., editor of Biological Psychiatry, noted that "we now urgently need research that can tell us whether genetics can help us to do a better job in matching particular maltreated children to supportive interventions. It would seem that in the case of some of the negative consequences of childhood maltreatment, genetics is not destiny but it may seem so if society doesn't provide these children with help that they need."



The article is "What is an "Adverse" Environment? Interactions of Rearing Experiences and MAOA Genotype in Rhesus Monkeys" by Genesio M. Karere, Erin L. Kinnally, Jessica N. Sanchez, Thomas R. Famula, Leslie A. Lyons, and John P. Capitanio. Authors Karere and Lyons are affiliated with the Department of Population Health and Reproduction, Kinnally and Capitanio are with the Department of Psychology, and Sanchez and Famula are from the Department of Animal Science, all at the University of California, Davis, California. Kinnally, Lyons, and Capitanio are also with the California National Primate Research Center, University of California, Davis, California. Karere is also from the Institute of Primate Research, Nairobi, Kenya. The article appears in Biological Psychiatry, Volume 65, Issue 9 (May 1, 2009), published by Elsevier. The authors' disclosures of financial and conflicts of interests are available in the article.

Actavis Receives Approval Of Generic Wellbutrin XL(R) 300mg In The United States

Actavis Group, the international generic pharmaceuticals company, announced that it has received approval from the US Food & Drug Administration to market Bupropion Hydrochloride extended-release tablets (XL) 300mg. Distribution of the product will commence immediately.


Bupropion Hydrochloride extended-release tablets (XL), available in 300mg strength, are the generic equivalent of Wellbutrin XL® for the treatment of major depressive disorder. Annual US sales of brand and generic Wellbutrin XL® 300mg were US$581 million for the 12 months ending June 2008 according to IMS Health data.


Commenting on the new approval, Douglas Boothe, Chief Executive Officer of Actavis, Inc. in the United States said: "Bupropion XL compliments our existing Bupropion SR offerings and expands the dosage options for our customers and patients. This approval also highlights Actavis Group's focus and expertise in bringing complex controlled-release technologies to the marketplace."


About Actavis


Actavis is one of the world's leading generic pharmaceutical companies specializing in the development, manufacture and sale of generic pharmaceuticals. With headquarters in Iceland, Actavis has operations in 40 countries, with 11,000 employees. The United States is the company's single largest market. Actavis' US operations are located in New Jersey, Maryland, North Carolina and Florida.


actavis

Three Of Four Louisiana Gubernatorial Candidates Say They Support Efforts To Ban Somatic Cell Nuclear Transfer

Three of the candidates running in the Louisiana gubernatorial race -- U.S. Rep. Bobby Jindal (R), businessman John Georges, who is running as an independent, and state Sen. Walter Boasso (D) -- recently said they support efforts to ban somatic cell nuclear transfer in the state, the New Orleans Times-Picayune reports. Gubernatorial candidate Foster Campbell (D), the state public service commissioner, said that "[i]n general" he is for allowing the technique to be used for research purposes (Moller, New Orleans Times-Picayune, 10/18).

Somatic cell nuclear transfer is conducted by inserting the genetic material from a patient's cell -- usually from a skin cell -- into an unfertilized egg from another person. The patient's genetic material incorporates into the egg and causes it to develop into an embryo that is a genetic match to the skin cell patient (Kaiser Daily Women's Health Policy Report, 10/12). Human reproductive cloning currently is banned in the state, and efforts in 2004 and 2005 to ban all somatic cell nuclear transfer in the state did not pass in the Legislature.

Some researchers at Louisiana State University's Pennington Biomedical Research Center are concerned that a ban on the technique would hinder the center's ability to attract top scientists, the Times-Picayune reports. Jindal said he did not believe a ban on therapeutic cloning would compromise research in the state because of recent advances in adult stem cell research. "I certainly oppose the creation of life for the purpose of destroying it for research or for other purposes," Jindal said.

Boasso, who voted to ban somatic cell nuclear transfer while serving in the state Senate, said he still believes the technique should be banned. Georges initially said he supports adult stem cell research and then said he would have to consult the Roman Catholic Church's and the Greek Orthodox Church's positions on the research before providing a definitive answer. He later said his position is in line with the churches' positions, the Times-Picayune reports. Campbell said he has not followed the debate over stem cell research closely but added that he favors research that has the potential to cure serious diseases (New Orleans Times-Picayune, 10/18).

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

What Is Mental Health? What Is Mental Disorder?

Mental health refers to our cognitive, and/or emotional wellbeing - it is all about how we think, feel and behave. Mental health, if somebody has it, can also mean an absence of a mental disorder. Approximately 25% of people in the UK have a mental health problem during their lives. The USA is said to have the highest incidence of people diagnosed with mental health problems in the developed world. Your mental health can affect your daily life, relationships and even your physical health. Mental health also includes a person's ability to enjoy life - to attain a balance between life activities and efforts to achieve psychological resilience.


According to Medilexicon's medical dictionary, mental health is "emotional, behavioral, and social maturity or normality; the absence of a mental or behavioral disorder; a state of psychological well-being in which one has achieved a satisfactory integration of one's instinctual drives acceptable to both oneself and one's social milieu; an appropriate balance of love, work, and leisure pursuits".


According to WHO (World Health Organization), mental health is "a state of well-being in which the individual realizes his or her own abilities, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to his or her community". WHO stresses that mental health "is not just the absence of mental disorder".


WHO explains that especially in low- and middle-income countries, mental health services are very underfunded - both human and financial. Most resources are channeled into treating and caring for mentally ill patients, rather than on any integrated mental health system. Countries should integrate mental health into primary health care (general practice), provide mental health care in general hospitals, and improve community-based mental health services, rather than just providing care in large psychiatric hospitals.
Mental health problems (disorders) can affect anyone
Experts say we all have the potential for suffering from mental health problems, no matter how old we are, whether we are male or female, rich or poor, or ethnic group we belong to. In the UK over one quarter of a million people are admitted into psychiatric hospitals each year, and more than 4,000 people kill themselves. They come from all walks of life.



Interesting related articles:


What is psychology? What are the branches of psychology?


What is psychotherapy? What are the benefits of psychotherapy?


What is anxiety? What causes anxiety?


What is dementia? What causes dementia?


What is stress? What causes stress?


What is insomnia? What causes insomnia?


What is depression? What causes depression?


What is schizophrenia?


What is anorexia? What is bulimia?


What is autism?


What is ADHD




According to the NIMH (National Institute of Mental Health, USA) mental disorders are "common in the USA and internationally". Approximately 57.7 million Americans suffer from a mental disorder in a given year, that is approximately 26.2% of adults. However, the main burden of illness is concentrated in about 1 in 17 people (6%) who suffer from a serious mental illness. Approximately half of all people who suffer from a mental disorder probably suffer from another mental disorder at the same time, experts say.


In the UK, Canada, the USA and much of the developed world, mental disorders are the leading cause of disability among people aged 15 to 44.
What are - mental illness, mental disorders and mental health problems?
Mental illness is a term that is used to refer to a wide range of mental disorders that can be diagnosed by a health care professional. In this article, mental illness, mental disorders and mental health problems have the same meaning.
What are the most common mental illnesses?
The most common forms of mental illnesses are:

Anxiety disorders - the most common group of mental illnesses. The sufferer has a severe fear or anxiety which is linked to certain objects or situations. Most people with an anxiety disorder will try to avoid exposure to whatever triggers their anxiety. Examples of anxiety disorders include:


Panic disorder - the person experiences sudden paralyzing terror or imminent disaster.

Phobias - these may include simple phobias - disproportionate fear of objects, social phobias - fear of being subject to the judgment of others, and agoraphobia - dread of situations where getting away or breaking free may be difficult. We really do not know how many phobias people may experience globally - there could be hundreds and hundreds of them.

(OCD) Obsessive-compulsive disorder - the person has obsessions and compulsions. In other words, constant stressful thoughts (obsessions), and a powerful urge to perform repetitive acts, such as hand washing (compulsion).


PSTD (Post-traumatic stress disorder) - this can occur after somebody has been through a traumatic event - something horrible and scary that the person sees or that happens to them. During this type of event the person thinks that his/her life or other people's lives are in danger. The sufferer may feel afraid or feel that he/she has no control over what is happening.


Mood disorders - these are also known as affective disorders or depressive disorders. Patients with these illnesses share disturbances or mood changes, generally involving either mania (elation) or depression. Experts say that approximately 80% of patients with depressive disorder improve significantly with treatment. Examples of mood disorders include:


Major depression - the sufferer is not longer interested in and does not enjoy activities and events that he/she previously got pleasure from. There are extreme or prolonged periods of sadness.

Bipolar disorder - also known as manic-depressive illness, or manic depression. The sufferer oscillates from episodes of euphoria (mania) and depression (despair).

Dysthymia - mild chronic depression. Chronic in medicine means continuous and long-term. The patient has a chronic feeling of ill being and/or lack of interest in activities he/she once enjoyed - but to a lesser extent than in major depression.

SAD (seasonal affective disorder) - a type of major depression. However, this one is triggered by lack of daylight. People get it in countries far from the equator during late autumn, winter, and early spring.


Schizophrenia disorders
Whether or not schizophrenia is a single disorder or a group of related illnesses has yet to be fully determined. It is a highly complex illness, with some generalizations which exist in virtually all patients diagnosed with schizophrenia disorders. Most sufferers experience onset of schizophrenia between 15 and 25 years of age. The sufferer has thoughts that appear fragmented; he/she also finds it hard to process information. Schizophrenia can have negative or positive symptoms. Positive symptoms include delusions, thought disorders and hallucinations. Negative symptoms include withdrawal, lack of motivation and a flat or inappropriate mood. (See the article "What is schizophrenia")

What are the most common serious mental disorders (illnesses)?
Most major (serious) mental illnesses tend to have symptoms that come and go, with periods in between when the person can lead a relatively normal life (episodic illness). The most common serious mental disorders are:

Schizophrenia (See the article "What is schizophrenia")
Bipolar disorder (see article "What is bipolar disorder")
Depression (see article "What is depression")

Treatments and strategies for mental health problems
There are various ways people with mental health problems might receive treatment. It is important to know that what works for one person may not work for another; this is especially the case with mental health. Some strategies or treatment are more successful when combined with others. The patient himself/herself with a chronic (long-term) mental disorder may draw on different options at different stages in his/her life. The majority of experts say that the well informed patient is probably the best judge of what treatment suits him/her better. It is crucial that healthcare professionals be aware of this.


Self help


There are a lot people with mental health problems may do to improve their mental health. Alterations in lifestyle, which may include a better diet, lower alcohol and illegal drug consumption, exercise and getting enough sleep can make enormous differences to a mental health patient's mental health. Let's have a closer look and some of these strategies:

Diet and mental health


Scientists, psychiatrists, and other health care professionals know that the brain is made up in large part of essential fatty acids, water and other nutrients. It is an accepted fact that food affects how people feel, think and behave. Most experts accept that dietary interventions could have an impact on a number of the mental health challenges society faces today. So, why is it that governments and public health authorities in developed economies invest so little in developing this knowledge?


The evidence is growing and becoming more compelling that diet can play a significant role in the care and treatment of people with mental health problems, including depression, ADHD (attention deficit hyperactivity disorder) to name but a few. If experts are talking about an integrated approach which recognizes the interplay of biological, psychological, social and environmental factors - with diet in the middle of it as being key - and challenging the growing burden of mental health problems in developed nations, surely individuals can speed things up and do something about their diet themselves and improve their mental health.



Interesting related article:


What is healthy eating? What is a good diet?

It is estimated that in the UK people eat 4 kilograms of food additives each year. We are not sure what effect decades of such consumption may have on the brain. We don't know for one simple reason - governments are reluctant to fund, conduct or publish rigorously controlled large scale studies which look at the effect of additives on human mental health.


Changing farming practices have introduced higher levels of different types of fat into our diet. For example, chickens reach their ideal weight for slaughter twice as quickly today compared to three decades ago - this has changed the nutritional profile of meat, according to a report by the Mental Health Foundation (UK). Three decades ago a typical chicken carcass used to be 2% fat - today they are a whopping 22%. The omega-3 fatty acid content in chicken meat has dropped while the omega-6 fatty acids have risen. The same is happening to farmed fish.

Little Evidence To Determine Whether Genetic Tests In Depression Treatment Are Useful

There is insufficient evidence to determine if current gene-based tests intended to personalize the dose of medications in a class of drugs called selective serotonin reuptake inhibitors (SSRIs) improve patient outcomes or aid in treatment decisions in the clinical setting, according to a new evidence report supported by a collaboration of the Agency for Healthcare Research and Quality and the Centers for Disease Control and Prevention??™s National Office of Public Health Genomics.? 


This evidence report is the first step in the two-step process of CDC??™s Evaluation of Genomic Applications in Practice and Prevention (EGAPP) pilot project to evaluate and make recommendations regarding the use of gene-based tests.?  Funding for the report was provided by CDC.


The report found that tests evaluating differences in genes belonging to the Cytochrome P450, or CYP450, family that affect the rate at which a person metabolizes SSRIs are largely accurate. However, the researchers did not find any evidence that such tests led to improved patient outcomes or had an impact on treatment decisions for patients with depression. The researchers noted that other genetic factors and non-genetic factors such as diet and other medical conditions may have an impact on a patient??™s response to treatment.? 


"This report highlights how systematically reviewing scientific findings can help guide future research," said Beth A. Collins Sharp, Ph.D., R.N., director of AHRQ??™s Evidence-based Practice Center Program. "This information will help identify the types of studies that are necessary to help better understand? various treatment response issues."


Researchers performed a comprehensive review of the literature and found no well-designed studies that evaluated clinical outcomes of tests to detect differences in genes belonging to the CYP450 family.?  These genes produce enzymes that break down SSRIs and many other classes of drugs. Most studies included a small number of people, did not test for all variations of the enzymes, and were poorly designed, according to the researchers.?  The majority of studies also reported the rate of metabolism after just one dose or were done in patients without depression - factors that do not accurately represent the long-term use of these drugs in patients with depression.? 


Because patient response to SSRIs varies, there has been strong interest in using gene-based tests to predict whether the person will be a poor, intermediate, extensive, or ultra-rapid metabolizer.?  Theoretically, ultra-rapid metabolizers could require higher doses than those who metabolize the drug slowly.?  Poor metabolizers might respond to a lower dose, which could also prevent side effects. The goal of testing is to personalize health care by selecting therapy based on a patient??™s genetic makeup.? 
The report found a relationship between genetic differences and the occurrence of adverse effects from SSRIs in depressed patients in only two of six studies.?  However, the researchers concluded that all six studies were poorly designed, which limits the ability to draw conclusions about how differences in CYP450 genes influence adverse effects of SSRIs.















"This report emphasizes that well-designed observational studies and clinical trials are needed to clearly establish the clinical validity and utility of the many emerging genomic tests for treatment and prevention of common diseases of public health significance," said Muin Khoury, M.D., Ph.D., director of CDC??™s National Office of Public Health Genomics. "Early availability of the evidence base is key to the effective use of genomics for the benefit of population health."


Since their introduction in the late 1980s, SSRIs (such as citalopram, fluoxetine, paroxetine, and sertraline) have become the most commonly prescribed class of drugs for treatment of depression. However, the likelihood that a person will experience relief from all symptoms of depression after 1 year of treatment is approximately 40 percent, and side effects cause 12 percent to 15 percent of people who start treatment to stop taking the drug.? ?  Following the recent FDA approval of a test to predict differences in the CYP450 gene, clinicians and patients must decide whether using such tests to choose a type or dose of an SSRI might improve the patient's response to treatment.? 


In early 2007, the EGAPP working group, an independent, non-federal panel that advises the CDC, will issue recommendations on the use of CYP450 tests in the treatment of depression based on the evidence report and other considerations, including alternative approaches for dosing and monitoring of drug therapy, patient access to testing, and cost.?  The working group will also assess current knowledge gaps and describe additional research needs identified by the report.?  Future evidence reports that are part of the AHRQ/CDC collaboration will evaluate the use of genomic tests for specific diseases or conditions, such as a rare type of inherited colorectal cancer.


The report was prepared by a team of researchers led by David Matchar, M.D. and Mugdha Thakur, M.D. of AHRQ??™s Duke University Evidence-based Practice Center in Durham, North Carolina. Testing for CYP450 Polymorphisms in Adults With Non-Psychotic Depression Treated With SSRIs can be found online here.


ahrq

Mental Health Week 2010: Nurses Want More Action To Treat Chronic Illness, Australia

Mental health week 2010 will focus on the detrimental impact of untreated mental health disorders on patients suffering from chronic illnesses.


ANF federal secretary Lee Thomas said it is alarming that patients with chronic illnesses suffer much greater rates of depression and anxiety than the general population.


Ms Thomas said that we must focus more on early treatment of depression in people with chronic illness, so they have a chance of overcoming the symptoms and enjoying a better quality of life.


"Optimum mental health leads to greatly improved physical health and faster recovery rates, which is good for the Australian community, and which will reduce the cost of long term treatments and health support she said.


Nurses and midwives play a crucial role in intervention, assistance and referral of patients across all health sectors, but we must invest more into urgent education at universities and in the workplace to better equip nurses, midwives and allied health professionals.


"Better training and education will ensure that nurses have the skills to recognise the symptoms and assist with treatment and referral," Ms Thomas said.


It is widely recognized by health professionals that depression is the most common complication to almost all chronic or serious medical conditions. Four chronic illnesses - cardiovascular, diabetes, cancer and respiratory conditions - are responsible for 60% of deaths worldwide.


Ms Thomas said that despite the obvious connection between mental health and recovery from serious illness, not enough was being done. "Families, patients and nurses want action to help those who are suffering. Treating both mental and physical illness is the best way to ensure patients achieve optimal recovery.

Omega-3 Supplements Affect Alzheimer's Symptoms

Omega-3 supplements can, in certain cases, help combat the depression and agitation symptoms associated with Alzheimer's disease, according to a clinical study conducted at the Swedish medical university Karolinska Institutet.



A number of epidemiological studies have shown that eating fatty fish provides a certain degree of protection against Alzheimer's and other dementia diseases - an effect often thought attributable to the omega-3 fatty acids it contains. Some studies also suggest that omega-3 can have a therapeutic effect on some psychiatric conditions.



Researchers at Karolinska Institutet and Uppsala University have now examined whether omega-3 supplementation has any effect on the psychiatric symptoms associated with Alzheimer's disease. Just under 200 patients with mild Alzheimer's were divided into two groups, one of which received omega-3, and one a placebo. The study lasted for one year.



There was no observable difference in therapeutic effect between the patients receiving the omega-3 and the placebo group. However, when the researchers took into account which of the patients carried the susceptibility gene APOE ?4 and which did not, an appreciable difference appeared. Carriers of the gene who had received active treatment responded positively to the omega-3 as regards agitation symptoms, while non-bearers of the gene showed an improvement in depressive symptoms.



The team points out that no general therapeutic recommendations can be made from the results until larger studies on individuals with more pronounced neuropsychiatric symptoms are conducted.






Publication:



Omega-3 supplementation in mild to moderate Alzheimer's disease: effects on neuropsychiatric symptoms
Yvonne Freund-Levi, Hans Basun, Tommy Cederholm, Gerd Fax?©n-Irving, Anita Garlind, Mikaela Grut, Inger Vedin, Jan Palmblad, Lars-Olof Wahlund and Maria
Eriksdotter-J?¶nhagen

International Journal of Geriatric Psychiatry, doi 10.1002/gps.1857

Published online 21 June 2007; www3.interscience.wiley/cgi-bin/jissue/112161699



For further information, please contact:



Senior Physician, PhD Student Yvonne Freund-Levi

Department of Neurobiology, Care Sciences and Society



Professor Lars-Olof Wahlund

Department of Neurobiology, Care Sciences and Society



Associate Professor Maria Eriksdotter-J?¶nhagen

Department of Neurobiology, Care Sciences and Society



Contact: Sabina Bossi


Karolinska Institutet

Depressed Patients Offered Hope With Music Therapy

A therapist may be able to use music to help some patients fight depression and improve, restore and maintain their health, states a Systematic Review from The Cochrane Library.



About 121 million people world-wide are believed to suffer from depression. This can be seen in disturbed appetite, sleep patterns and overall functioning as well as leading to low self-esteem and feelings of worthlessness and guilt. It can lead to suicide and is associated with 1 million deaths a year.



Drugs and psychotherapy are common treatments, but a group of Cochrane Researchers set out to see whether there was evidence that music therapy could deliver benefits.



After searching the international literature, they identified five studies that met their criteria. Four of these reported greater reduction in symptoms of depression among people who had been given music therapy than those who had been randomly assigned to a therapy group that did not involve music. The fifth study, however, did not find this effect.



"While the evidence came from a few small studies, it suggests that this is an area that is well worth further investigation and, if the use of music therapy is supported by future trials, we need to find out which forms have greatest effect," says lead author Anna Maratos, an Arts Therapist who works in the Central and Northwest London Foundation NHS Trust, London, UK.



"The current studies indicate that music therapy may be able to improve mood and has low drop-out rates," says Maratos.



"It is important to note that at the moment there are only a small number of relatively low quality studies in this area, and we will only be able to be confident about the effectiveness of music therapy once some high quality trials have been conducted," says Maratos.







The latest findings from The Cochrane Library

The Health Benefits Of Daughters-In-Law On Chinese Elders

In a new twist on the Confucian ideal of filial piety, a study finds that the assistance of daughters-in-law - but not their own children - helps mitigate depression among older people in China. This is particularly true in rural areas, where elders may rely more heavily on family to be support providers.



"The inability to secure assistance from children may induce depression not only because needs are likely to go unmet but because the absence of such support may induce feelings of helplessness and strain intergenerational relations," says Zhen Cong, who received her Ph.D. in May 2008 from the USC Davis School of Gerontology.



Cong and Professor Merril Silverstein of the USC Davis School of Gerontology were intrigued by earlier findings showing that intergenerational support, particularly hands-on care, had inconsistent effects on the psychological well-being of Chinese elders.



"Unlike emotional and financial support, instrumental support - in spite of its apparent cultural and practical significance - has shown inconsistent effects on the psychological well-being," Silverstein explains.



Cong and Silverstein looked at rural Anhui province, where rates of depression are twice that of their urban counterparts (though still much lower than in the West). They found that "instrumental support" - such as personal care and household chores - had a positive effect on well-being, depending on who was providing the service.



When women shared a home with their in-laws, their presence and support was particularly beneficial to the psychological well-being of older mothers. Daughters-in-law provided the overwhelming majority of personal care for older women in a household, the researchers found.



However, household support and personal care from sons was particularly damaging and increased depressive symptoms, according to the study, appearing in the August 2008 issue of the Journal of Marriage and Family.



Similarly, mothers who received an increase in household support from daughters-in-law had fewer depressive symptoms, while those who experienced an increase in household support from their own daughters had more depressive symptoms.



"A general pattern emerged that supported the prolific and meaningful contributions of daughters-in-law in the support systems of older people in rural China," Silverstein says.



The study confirms prior research by Silverstein and others showing that perceived appropriateness of support is often more important to subjective well being than the support itself.



As Cong explains: "Aversion to household support from daughters and sons was sufficiently strong among older mothers and fathers to cause negative psychological outcomes, affirming the adverse emotional consequences that result when traditional expectations are violated."



The researchers note that almost two-thirds of the older population in China lives in rural areas, making it the largest concentration of older adults in the world.



"Our results suggest that attachment to traditional expectations for support may make elders more depressed in such a rapidly changing society as China," says Cong. "Elders will be psychologically disadvantaged unless they contemporize their expectations to match the changing social realities of Chinese society."







The research was supported by a grant from the Fogarty International Center of the National Institutes of Health.



Cong, Zhen and Merril Silverstein, "Intergenerational Support and Depression Among Elders in Rural China: Do Daughters-In-Law Matter?" Journal of Marriage and Family: August 2008.

NYU Study Finds Psychiatry's Main Method To Prevent Mistaken Diagnoses Of Depression Doesn't Work

A study in the March edition of the American Journal of Psychiatry senior-authored by Jerome C. Wakefield, a professor at the Silver School of Social Work at New York University with Mark Schmitz of Temple University and Judith Baer of Rutgers University, empirically challenges the effectiveness of psychiatrists' official diagnostic manual in preventing mistaken, false-positive diagnoses of depression.



The findings concerning the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders' (DSM) criteria for diagnosing depression rebuts recent criticism of earlier research by Wakefield. That earlier research suggested that misdiagnoses of depression are widespread, and touched off considerable controversy.



According to the DSM, the diagnosis of major depression requires the presence - for two weeks - of at least five possible symptoms out of a list of nine, which include, for example, sadness, loss of interest in usual activities, lowered appetite, fatigue, and insomnia. However, these symptoms can also occur in normal responses to loss and stress. False positive diagnoses occur when someone reacting with intense normal sadness to life's stresses is misdiagnosed as having major depressive disorder. Recent studies suggest that a very large percentage of people have such symptoms for two weeks or longer at some point in their lives; therefore, how many of these individuals really are afflicted by a mental disorder or are responding within normal limits to loss or stress has been a matter of debate.



The journal article, entitled "Does the DSM-IV Clinical Significance Criterion for Major Depression Reduce False Positives? Evidence From the National Comorbidity Survey Replication," examines the primary method by which the official diagnostic criteria for depression - the Clinical Significance Criterion (CSC) - are supposed to distinguish normal from disordered cases and thereby prevent false positive diagnoses. The CSC was added to the symptom and duration criteria in the DSM's fourth edition in 1994 (DSM-IV) in the wake of criticism that too many of the listed symptoms - loss of appetite, say, or sadness, insomnia, or fatigue - were being identified as evidence of major depressive disorder even when they were mild and possibly normal responses to distress arising from such events as the loss of a job, the dissolution of a marriage, or other triggers for sadness, and that such errors might be contributing to the very high reported rates of untreated depression in the American population drawn from epidemiological surveys. Under the 1994 DSM revision, in addition to the two weeks of sadness and other depressive symptoms, a specified minimal "clinically significant" threshold in the form of harm due to distress or role impairment (in occupational, family, or interpersonal contexts) must have resulted from the symptoms in evidence before they could be considered signs of depression. Researchers have subsequently assumed - without definitive evidence - that the CSC eliminates substantial numbers of false positives.
















In a 1999 article in American Journal of Psychiatry, Wakefield and co-author Robert Spitzer, the originator of the modern DSM symptom-based approach to diagnosis, argued that the CSC would not eliminate false-positive diagnoses of major depression because anyone having the specified symptoms - even an individual experiencing a normal intense reaction to loss - would be likely to experience distress or role impairment. Thus, they asserted, the CSC was redundant with the symptom criteria and could not distinguish normal from disordered symptoms - a claim that has come to be known as the "redundancy hypothesis." The researchers' argument was purely conceptual, and largely ignored.



The issue of whether the redundancy hypothesis is correct became suddenly more important after Wakefield senior-authored a much-discussed 2007 article in Archives of General Psychiatry. The article argued that there were indeed large numbers of false-positive diagnoses of major depression in community surveys of mental disorder - possibly as high as 25% to 33%. However, that study used data from a national survey that was conducted before the DSM-IV's addition of the CSC to the major depression diagnostic criteria. Thus, there was no CSC in the criteria that Wakefield and his team used to identify cases of major depression at the time. Critics of that study argued that the lack of a CSC was fatal to the argument because if the CSC had been used, then the supposed false-positive diagnoses that Wakefield and his group identified would likely have been eliminated as cases too mild for diagnosis. For example, one noted psychiatrist argued that Wakefield's results were due to a "glitch" in the diagnostic criteria Wakefield used, and that the diagnosed individuals identified by Wakefield as having normal reactions would have been eliminated from the depression category if current diagnostic criteria including the CSC were used. A paper later submitted by Wakefield that built on the 2007 article was rejected for publication partly based on a reviewer's assertion that if the CSC had been included in the earlier study, the supposed false positives likely would have been eliminated. So, the issue of whether the CSC is in fact redundant or actually eliminated many false-positive major depression diagnoses became key to the debate, which is still ongoing, about the prevalence of depressive disorder.



The latest study, coming in the American Journal of Psychiatry, offers an empirical demonstration, based on nationally representative data, that the Critical Significance Criterion fails to distinguish normal from disordered conditions. In this analysis, Wakefield undertook to evaluate independently the impact of the CSC on epidemiological survey estimates of major depressive disorder by using data from a later survey that included a carefully worked out CSC criterion for depression whose inclusion, according to the claims of its authors, was an effective way of eliminating former false positives. Wakefield then compared estimates of depressive disorder with and without the use of the CSC. Confirming the redundancy hypothesis put forward a decade earlier, he found that the CSC eliminated virtually no one from diagnosis - in fact, even among those who experienced prolonged sadness without meeting other diagnostic criteria for depression, about 94% of them satisfied the CSC just on the basis of the "distress" component alone. Thus the Clinical Significance Criterion, according to Wakefield and his co-authors, is not doing what it is supposed to do - reducing the over-diagnosis of normal mood fluctuations as depression - and the issue of preventing false positives needs to be revisited. And contrary to critics' speculations, the earlier findings suggesting many false positives in community surveys cannot be dismissed on the basis of the CSC.



The results take on further importance, Wakefield says, in light of proposals for changes to the DSM in a revision currently taking place that will lead to DSM-V. Concern about increasing false positives is at the heart of criticisms of the proposals that have been put forward by leading psychiatrists, including Allen Frances, the Editor of DSM-IV. Moreover, some of the proposals seem to rely heavily on the CSC to justify diagnosis of disorder even when symptoms are minimal - when in fact the current research underscores that normal distress can easily satisfy the CSC.



To see the research abstract, please visit ajp.psychiatryonline/cgi/content/abstract/appi.ajp.2009.09040553v1

Internet Program Helps Prevent Depression In Teens

An Internet program helps to reduce depressive symptoms and prevent episodes of clinical depression in adolescent patients at risk, reports a study in the February issue of the Journal of Developmental & Behavioral Pediatrics. The journal is published by Lippincott Williams & Wilkins, a part of Wolters Kluwer Health, a leading provider of information and business intelligence for students, professionals, and institutions in medicine, nursing, allied health, pharmacy and the pharmaceutical industry.


Called "Project CATCH-IT," the program is an engaging and effective new alternative for managing depression in teens, according to a study led by Dr. Benjamin W. Van Voorhees of University of Chicago. "[A]n Internet-based program may offer a low-cost way to implement depression prevention in community settings," Dr. Van Voorhees and colleagues write. This study was sponsored by the National Alliance for Research on Schizophrenia and Depression (NARSAD), the Robert Wood Johnson Foundation, and the National Institute of Mental Health.


Project CATCH-IT Teaches Strategies to Head Off Depression


The researchers tested the benefits of Project CATCH-IT in 83 adolescent and young adult patients considered at risk for depression all had relatively mild depressive symptoms lasting longer than a few weeks. Patients were randomly assigned to undergo a brief discussion regarding depression with their doctor, or to a longer "motivational interview."


Both groups were then given the Internet address for Project CATCH-IT, which the researchers describe as an "Internet-based behavior change/resiliency building intervention." Based on proven therapies such as cognitive-behavioral therapy, behavioral activation, and interpersonal therapy, Project CATCH-IT is designed to reduce thoughts, behaviors, and relations that increase vulnerability to depression. At the same time, the program builds skills that reduce the risk of depression and promote a successful transition to adulthood.


The program includes a series of 14 modules that the teens can work through privately on a secure website. A version of Project CATCH-IT for use by physicians and the general public is available online at catchit public.bsd.uchicago.


Program Helps Improve Mood, Prevent Episodes of Depression


Most of the teens in the study used the Project CATCH-IT website, including 90 percent of those assigned to the longer motivational interview with their doctor. Most importantly, Project CATCH-IT was effective in preventing episodes of clinical depression. Based on a standard score, the percentage of patients with "clinically significant" depression decreased from about 50 percent at the start of the study to no more than 15 percent at three months' follow-up.















The researchers hypothesized that teens receiving the longer motivational interview would do better. However, overall depression scores were similar to those of patients assigned to the brief interview. Teens receiving the motivational interview did have better outcomes in some areas, including fewer thoughts of self-harm or hopelessness and were much less likely to be diagnosed with a depressive episode during the follow-up period. Patients assigned to the motivational interview spent more time using the site, which may have led to the additional improvements. Similarly, perhaps the teens who received the motivational interview were more motivated to take change behaviors to prevent a depressive episode.


New approaches to preventing depression are needed, and the primary care doctor's office is an important location for the identification and treatment of depression in teens. Previous studies have reported success with Internet-based programs for depression. "However, few similar interventions have been developed for adolescents and they have been limited by low levels of participation," according to the authors.


The new results show that teens with depressive symptoms will use Project CATCH-IT at their doctor's recommendation, and that the program may reduce the risk of depression. "Nearly half the sample was asymptomatic at six weeks, prevalence of clinically significant depressed mood dropped by more than half, and the incidence of any depressive disorder remained low," Dr. Van Voorhees and colleagues write. They call for further research, including the development of "more engaging Internet models" and randomized trials comparing Internet-based interventions with standard treatment for depression in adolescents.


About the Journal of Developmental & Behavioral Pediatrics


Written for physicians, clinicians, psychologists and researchers, each bimonthly issue of the Journal of Developmental & Behavioral Pediatrics (jrnldbp) is devoted entirely to the developmental and psychosocial aspects of pediatric health care. Each issue features original articles, case reports, challenging cases and reviews that help professionals across disciplines stay current with the latest information in the field. Relevant areas covered include learning disorders, developmental disabilities, and emotional, behavioral, and psychosomatic problems. Journal of Developmental & Behavioral Pediatrics is the official journal of the Society for Developmental and Behavioral Pediatrics.


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