Researchers, led by Kerri Boutelle, PhD, associate professor of pediatrics and psychiatry at the University of California, San Diego School of Medicine have found that obesity is a risk factor for depressive symptoms, but not for clinical depression, suggesting that weight status could play a part in the development of depression in some adolescent girls.
"This is important, because depressive symptoms are considered a precursor to major depression," said Boutelle.
According to the Centers for Disease and Prevention, childhood obesity has more than tripled in the past 30 years. The prevalence of obesity among adolescents aged 12 to 19 years increased from 5.0 percent to 18.1 percent in 2008. Similarly, the National Survey on Drug Use and Health, an annual survey sponsored by the Substance Abuse and Mental Health Services Administration, found that 2.0 million youths aged 12 to 17 experienced at least one major depressive episode in 2007.
Knowing that the teenage years are often a tumultuous period in a young person's life, Boutelle and her colleagues set out to determine whether obesity contributes to the development of depression among youth. This is in contrast to the well-documented conclusion that depression increases the risk of obesity. Results of their study will appear in the May 21st issue of Health Psychology.
Using a structured psychiatric interview test the Schedule for Affective Disorders and Schizophrenia for School-Age Children (K-SADS) assessors gathered responses from almost 500 girls between the ages of 13 and 16 years, of various ethnicities. To receive a diagnosis of depression, the girls had to report the presence and severity of at least five symptoms. At each of four yearly assessments, the girls were weighed and measured. Data from the interviews indicated that obese status was associated with an increase in depressive symptoms, but not Major Depression.
"Based on our findings, I would encourage parents, teachers and physicians to monitor overweight and obese girls for depressive symptoms, and refer them for evaluation if they are concerned," said Boutelle.
Additional contributors are Peter Hannan and Jayne A. Fulkerson, Scott J. Crow University of Minnesota, and Eric Stice, Oregon Research Institute.
This study was funded by a grant from the National Institute of Mental Health.
суббота, 14 мая 2011 г.
New Target For Antidepressants Revealed By Animal Study
University of Michigan scientists have provided the most detailed picture yet of a key receptor in the brain that influences the effectiveness of serotonin-related antidepressants, such as Prozac.
The findings, which appeared online Monday ahead of print in the journal Proceedings of the National Academy of Sciences, open the door to providing a more targeted treatment of depression and anxiety with fewer side effects.
Depressive disorders change a person's mood, emotions and physical well-being and can co-occur with anxiety disorders and substance abuse.
"There are big drawbacks in the current therapies for depression," says senior author John Traynor, Ph.D., professor of pharmacology at the U-M Medical School and director of the U-M Substance Abuse Research Center. "Therapeutic benefits are delayed, there are unwanted side effects, and it's not unusual for depressive symptoms to return."
Authors say the high relapse rate indicates a need for additional treatment options for the estimated 20.9 million Americans with depression.
The best current treatments for depression are selective serotonin reuptake inhibitors, or SSRIs. These drugs work by flooding the brain's synapses with serotonin, a neurotransmitter linked with mood, and increasing signaling through the more than 20 serotonin receptors in the brain.
However the team of researchers showed that one particular pathway, the serotonin 5HT1a receptor is linked with antidepressive and antianxiety behavior in mice.
"Rather than activating all serotonin receptors as SSRIs do, one could increase signaling through the one critical serotonin receptor that our research shows is important for anti-depressant behavior," says co-author Richard R. Neubig, M.D., Ph.D., co-director of the U-M Center for Chemical Genomics and professor of pharmacology at the U-M Medical School.
The new research details the complex actions of a family of proteins, known as RGS proteins, that act as brakes on neurotransmitter signaling.
Researchers created a mutant mouse to boost serotonin signaling at the 5HT1a receptor. This was done by genetically inhibiting the activity of braking proteins. Without the normal brake on serotonin signaling, these mutant mice showed antidepressive behavior even without being given antidepressant drugs. The mice were also more responsive to SSRIs.
Authors say that further research could lead to drugs capable of inhibiting the RGS proteins and which would target the antidepressant signal where it is required on critical 5HT1a receptors.
Additional authors in the study are: Jeffrey Talbot, Ph.D., Ohio Northern University, formerly of U-M who continued parts of this work with Crystal Clemans and Melanie Nicol, Pharm. D. Other U-M authors are Emily Jutkiewicz, Ph.D., Steven Graves, B.S., and Xinyan Huang, Ph.D., from the Department of Pharmacology and Richard Mortensen, M.D., Ph.D., from the Department of Molecular and Integrative Physiology.
Funding:
National Institute of General Medical Sciences; National Institute on Drug Abuse.
Reference:
Proceedings of the National Academy of Sciences, "RGS inhibition at Gai2 selectively potentiates 5-HT1A-mediated antidepressant effects," doi 10.1073/pnas.1000003107
The findings, which appeared online Monday ahead of print in the journal Proceedings of the National Academy of Sciences, open the door to providing a more targeted treatment of depression and anxiety with fewer side effects.
Depressive disorders change a person's mood, emotions and physical well-being and can co-occur with anxiety disorders and substance abuse.
"There are big drawbacks in the current therapies for depression," says senior author John Traynor, Ph.D., professor of pharmacology at the U-M Medical School and director of the U-M Substance Abuse Research Center. "Therapeutic benefits are delayed, there are unwanted side effects, and it's not unusual for depressive symptoms to return."
Authors say the high relapse rate indicates a need for additional treatment options for the estimated 20.9 million Americans with depression.
The best current treatments for depression are selective serotonin reuptake inhibitors, or SSRIs. These drugs work by flooding the brain's synapses with serotonin, a neurotransmitter linked with mood, and increasing signaling through the more than 20 serotonin receptors in the brain.
However the team of researchers showed that one particular pathway, the serotonin 5HT1a receptor is linked with antidepressive and antianxiety behavior in mice.
"Rather than activating all serotonin receptors as SSRIs do, one could increase signaling through the one critical serotonin receptor that our research shows is important for anti-depressant behavior," says co-author Richard R. Neubig, M.D., Ph.D., co-director of the U-M Center for Chemical Genomics and professor of pharmacology at the U-M Medical School.
The new research details the complex actions of a family of proteins, known as RGS proteins, that act as brakes on neurotransmitter signaling.
Researchers created a mutant mouse to boost serotonin signaling at the 5HT1a receptor. This was done by genetically inhibiting the activity of braking proteins. Without the normal brake on serotonin signaling, these mutant mice showed antidepressive behavior even without being given antidepressant drugs. The mice were also more responsive to SSRIs.
Authors say that further research could lead to drugs capable of inhibiting the RGS proteins and which would target the antidepressant signal where it is required on critical 5HT1a receptors.
Additional authors in the study are: Jeffrey Talbot, Ph.D., Ohio Northern University, formerly of U-M who continued parts of this work with Crystal Clemans and Melanie Nicol, Pharm. D. Other U-M authors are Emily Jutkiewicz, Ph.D., Steven Graves, B.S., and Xinyan Huang, Ph.D., from the Department of Pharmacology and Richard Mortensen, M.D., Ph.D., from the Department of Molecular and Integrative Physiology.
Funding:
National Institute of General Medical Sciences; National Institute on Drug Abuse.
Reference:
Proceedings of the National Academy of Sciences, "RGS inhibition at Gai2 selectively potentiates 5-HT1A-mediated antidepressant effects," doi 10.1073/pnas.1000003107
SSRIs May Pack More Punch At The Cellular Level Than Believed
A new discovery about selective serotonin reuptake inhibitors (SSRIs) suggests that these drugs, which are used to treat mental health disorders like depression and anxiety, have multiple effects on our cells. In a research report published in the August 2010 issue of Genetics, researchers used yeast cells to identify secondary drug targets or pathways affected by SSRIs. Such secondary pathways could help explain why different people taking the same drug may experience different effects, and could also lead to new types of drugs altogether.
"We hope that our study begins to illuminate the full breadth of pharmacological effects of antidepressants on cellular physiology starting with the simple unicellular eukaryote, budding yeast," said Ethan O. Perlstein, Ph.D, a researcher involved in the work from the Lewis-Sigler Institute for Integrative Genomics at Princeton University in New Jersey. "Furthermore, our work validates the notion that simple model organisms may be useful for the study of complex human disease."
Knowing that a high concentration of sertraline (Zoloft®) is toxic to yeast cells, scientists applied a lethal dose to millions of these cells and fished out a few cells that became resistant to the drug. Researchers then identified the underlying mutations in those cells and applied genetic, biochemical, and electron microscopic imaging techniques to characterize the molecular basis of resistance. Their results suggest that SSRIs may actually affect more than one process in a cell, including non-protein targets such as phospholipid membranes. Additionally, the study's results demonstrate that sertraline targets intracellular membranes and modulate pathways involved in vesicle trafficking that are present in both yeast and human cells. Vesicle trafficking plays an important role in how neural synapses develop and function. More work is necessary, however, to determine the exact clinical relevance of this secondary drug target.
"There's no question that SSRIs help thousands of people with mental health problems," said Mark Johnston, Editor-in-Chief of the journal GENETICS, "but as this research shows, there is still some mystery about how they help us. This study a key first-step toward giving us a comprehensive answer to how SSRI's work, and it may open doors to entirely new therapies."
"We hope that our study begins to illuminate the full breadth of pharmacological effects of antidepressants on cellular physiology starting with the simple unicellular eukaryote, budding yeast," said Ethan O. Perlstein, Ph.D, a researcher involved in the work from the Lewis-Sigler Institute for Integrative Genomics at Princeton University in New Jersey. "Furthermore, our work validates the notion that simple model organisms may be useful for the study of complex human disease."
Knowing that a high concentration of sertraline (Zoloft®) is toxic to yeast cells, scientists applied a lethal dose to millions of these cells and fished out a few cells that became resistant to the drug. Researchers then identified the underlying mutations in those cells and applied genetic, biochemical, and electron microscopic imaging techniques to characterize the molecular basis of resistance. Their results suggest that SSRIs may actually affect more than one process in a cell, including non-protein targets such as phospholipid membranes. Additionally, the study's results demonstrate that sertraline targets intracellular membranes and modulate pathways involved in vesicle trafficking that are present in both yeast and human cells. Vesicle trafficking plays an important role in how neural synapses develop and function. More work is necessary, however, to determine the exact clinical relevance of this secondary drug target.
"There's no question that SSRIs help thousands of people with mental health problems," said Mark Johnston, Editor-in-Chief of the journal GENETICS, "but as this research shows, there is still some mystery about how they help us. This study a key first-step toward giving us a comprehensive answer to how SSRI's work, and it may open doors to entirely new therapies."
Does It Help To Continue Antidepressant Drug Treatment For Preventing Recurrence In Depression?
Apparently not very much, according to a study by Dutch investigators published in the Jan 2008 issue of Psychotherapy and Psychosomatics.
Maintenance antidepressant (AD) medication is the most commonly used preventive strategy in a highly recurrent disease, i.e. depression. Little is known about the discontinuation of maintenance AD use and the association with recurrence in daily clinical practice. The purpose of this study was to examine the discontinuation rate of maintenance AD in daily clinical practice in recurrently depressed patients and the associated risk of recurrence.
Prospectively AD maintenance medication and recurrence were examined in 172 euthymic patients with recurrent depression. AD user profiles before recurrence (nonusers, intermittent users, continuous users) were examined and related to recurrence over a 2-year follow-up period.
Less than half of the patients (42%) used AD continuously. Taking into account the minimal required adequate used dosage (20 mg fluoxetine equivalent), only 26% of the patients used AD as recommended by international guidelines. Despite continuous use of AD, 60.4% relapsed in 2 years. This relapse rate was comparable to the rate of the intermittent users (63.6%). In patients who stopped taking AD after remission and who received additional preventive CT, the recurrence rates were significantly lower than in non-AD-using patients treated with usual care (8 vs. 46%).
The majority of recurrently depressed patients treated with AD discontinue maintenance AD therapy in daily primary and secondary clinical practice. AD seems to offer poor protection against relapse in this patient group. Patients who stopped using AD experienced less relapse, especially if they were treated with preventive CT. Alternative maintenance treatments (including preventive cognitive therapy after discontinuation of AD) should be studied in recurrently depressed patients with intermittent good remission, not only in secondary but also in primary care.
PSYCHOTHERAPY AND PSYCHOSOMATICS
karger/pps
Maintenance antidepressant (AD) medication is the most commonly used preventive strategy in a highly recurrent disease, i.e. depression. Little is known about the discontinuation of maintenance AD use and the association with recurrence in daily clinical practice. The purpose of this study was to examine the discontinuation rate of maintenance AD in daily clinical practice in recurrently depressed patients and the associated risk of recurrence.
Prospectively AD maintenance medication and recurrence were examined in 172 euthymic patients with recurrent depression. AD user profiles before recurrence (nonusers, intermittent users, continuous users) were examined and related to recurrence over a 2-year follow-up period.
Less than half of the patients (42%) used AD continuously. Taking into account the minimal required adequate used dosage (20 mg fluoxetine equivalent), only 26% of the patients used AD as recommended by international guidelines. Despite continuous use of AD, 60.4% relapsed in 2 years. This relapse rate was comparable to the rate of the intermittent users (63.6%). In patients who stopped taking AD after remission and who received additional preventive CT, the recurrence rates were significantly lower than in non-AD-using patients treated with usual care (8 vs. 46%).
The majority of recurrently depressed patients treated with AD discontinue maintenance AD therapy in daily primary and secondary clinical practice. AD seems to offer poor protection against relapse in this patient group. Patients who stopped using AD experienced less relapse, especially if they were treated with preventive CT. Alternative maintenance treatments (including preventive cognitive therapy after discontinuation of AD) should be studied in recurrently depressed patients with intermittent good remission, not only in secondary but also in primary care.
PSYCHOTHERAPY AND PSYCHOSOMATICS
karger/pps
Groundbreaking Kansas City Depression Initiative lauded by American Psychiatric Association
The American Psychiatric Association (APA) commends the Kansas City region for launching a bold and innovative depression
initiative: "Depression in the Workplace: What Does It Mean to Our Community?" A town hall meeting on March 29, sponsored by
the Greater Kansas City Chamber of Commerce, showcased the Mid-America Coalition on Health Care's Community Initiative on
Depression (CID). This first-of-its-kind community initiative addresses undiagnosed and untreated depression and brings
together the key stakeholders in the healthcare system: business and other employers, employees and their dependents,
governmental and educational organizations, and physicians and health plans.
The initiative is an unprecedented approach that attracted representatives from nearly two dozen other metropolitan regions -
including New York City, Chicago, Atlanta and Minneapolis - to Kansas City for a private APA-sponsored National Invitational
to discuss how to replicate the program in their communities.
"If the Community Initiative on Depression were implemented across the country, the impact on the health and wellness of the
American people would be profound," said Norman A. Clemens, M.D., chair of the APA's Committee on Business Relations and a
Cleveland, Ohio-based psychiatrist. "Not only would it alleviate a great deal of unnecessary suffering, but it would also
produce significant economic benefits."
He continued: "We expect the CID to have a continuing and positive impact on both the residents and business community of
Kansas City, and that's why other communities are so interested. The simple truth is that depression is a real medical
illness - not just a 'bad day' or a character weakness - and it can be effectively treated."
The APA and its National Partnership for Workplace Mental Health have been involved with the CID for almost three years.
Early on, the APA recognized the CID's potential and was particularly impressed with both the community's commitment and the
outstanding staff and leadership of the Mid-America Coalition on Health Care.
The National Partnership, which is a collaboration of the APA and America's employers, was created to address mental health
issues in the workplace. The Partnership does this through a variety of free programs and materials, many of which are being
used in the CID, and all of which can be found at workplacementalhealth.
"If there's one thing we have learned, it's that employers need to understand the enormous cost of depression in the
workplace, through its impact on productivity, absenteeism, disability and other medical costs," said William L. Bruning,
J.D., M.B.A., president of the Mid-America Coalition on Healthcare, the employer partnership that developed and runs the CID.
"Once they understand what undiagnosed and untreated depression is doing to their bottom line, business becomes the engine
for change since they're the major purchaser of health care in the community."
A U.S. Surgeon General report reveals that untreated depression costs businesses as much as $79 billion per year. Moreover,
recent research shows that depression is among the most treatable of all medical illnesses, said Dr. Clemens. Between 70 and
80 percent of people with depression respond well to treatment, which may include talk therapy, medication or a combination
of both. Depression can strike at any time, he said, but most often it appears for the first time during the prime "working
years" of life.
The American Psychiatric Association is a national medical specialty society, founded in 1844, whose more than 35,000
physician members specialize in the diagnosis, treatment and prevention of mental illnesses including substance use
disorders. For more information, visit the APA Web site at psych.
Don't miss APA's 2005 Annual Meeting: Psychosomatic Medicine: Integrating Psychiatry & Medicine in Atlanta, May 21-26, 2005.
Please visit APA's online press room for news releases, press policies, and media registration information - psych/news_room/virtual_pressrms/am2005.
psych
initiative: "Depression in the Workplace: What Does It Mean to Our Community?" A town hall meeting on March 29, sponsored by
the Greater Kansas City Chamber of Commerce, showcased the Mid-America Coalition on Health Care's Community Initiative on
Depression (CID). This first-of-its-kind community initiative addresses undiagnosed and untreated depression and brings
together the key stakeholders in the healthcare system: business and other employers, employees and their dependents,
governmental and educational organizations, and physicians and health plans.
The initiative is an unprecedented approach that attracted representatives from nearly two dozen other metropolitan regions -
including New York City, Chicago, Atlanta and Minneapolis - to Kansas City for a private APA-sponsored National Invitational
to discuss how to replicate the program in their communities.
"If the Community Initiative on Depression were implemented across the country, the impact on the health and wellness of the
American people would be profound," said Norman A. Clemens, M.D., chair of the APA's Committee on Business Relations and a
Cleveland, Ohio-based psychiatrist. "Not only would it alleviate a great deal of unnecessary suffering, but it would also
produce significant economic benefits."
He continued: "We expect the CID to have a continuing and positive impact on both the residents and business community of
Kansas City, and that's why other communities are so interested. The simple truth is that depression is a real medical
illness - not just a 'bad day' or a character weakness - and it can be effectively treated."
The APA and its National Partnership for Workplace Mental Health have been involved with the CID for almost three years.
Early on, the APA recognized the CID's potential and was particularly impressed with both the community's commitment and the
outstanding staff and leadership of the Mid-America Coalition on Health Care.
The National Partnership, which is a collaboration of the APA and America's employers, was created to address mental health
issues in the workplace. The Partnership does this through a variety of free programs and materials, many of which are being
used in the CID, and all of which can be found at workplacementalhealth.
"If there's one thing we have learned, it's that employers need to understand the enormous cost of depression in the
workplace, through its impact on productivity, absenteeism, disability and other medical costs," said William L. Bruning,
J.D., M.B.A., president of the Mid-America Coalition on Healthcare, the employer partnership that developed and runs the CID.
"Once they understand what undiagnosed and untreated depression is doing to their bottom line, business becomes the engine
for change since they're the major purchaser of health care in the community."
A U.S. Surgeon General report reveals that untreated depression costs businesses as much as $79 billion per year. Moreover,
recent research shows that depression is among the most treatable of all medical illnesses, said Dr. Clemens. Between 70 and
80 percent of people with depression respond well to treatment, which may include talk therapy, medication or a combination
of both. Depression can strike at any time, he said, but most often it appears for the first time during the prime "working
years" of life.
The American Psychiatric Association is a national medical specialty society, founded in 1844, whose more than 35,000
physician members specialize in the diagnosis, treatment and prevention of mental illnesses including substance use
disorders. For more information, visit the APA Web site at psych.
Don't miss APA's 2005 Annual Meeting: Psychosomatic Medicine: Integrating Psychiatry & Medicine in Atlanta, May 21-26, 2005.
Please visit APA's online press room for news releases, press policies, and media registration information - psych/news_room/virtual_pressrms/am2005.
psych
Older women with depression may have an increased risk of heart disease
New research shows older women with depression may have an increased risk of heart disease and death. Researchers in New York studied more than 93,600 older women who participated in the Women's Health Initiative Observational Study (WHI-OS).
The WHI-OS is a long-term program designed to determine how biological and lifestyle factors influence the risk of heart disease, cancer, osteoporosis, and other health conditions. For this study, participants were evaluated for depression and cardiovascular disease and were followed for about four years.
Researchers found nearly 16 percent of women reported experiencing symptoms of depression. They say depression was significantly linked to cardiovascular disease risk.
Women with depression were 12 percent more likely to have hypertension and 60 percent more likely to have a history of stroke. Women with depression were also 50 percent more likely to die from cardiovascular disease and about 30 percent more likely to die from another cause.
From the study it was concluded that a large proportion of older women report levels of depressive symptoms that are significantly related to increased risk of CVD [cardiovascular disease] death and all-cause mortality, even after controlling for established CVD risk factors. However whether an early recognition and treatment of subclinical depression will lower CVD risk remains to be determined in clinical trials.
The WHI-OS is a long-term program designed to determine how biological and lifestyle factors influence the risk of heart disease, cancer, osteoporosis, and other health conditions. For this study, participants were evaluated for depression and cardiovascular disease and were followed for about four years.
Researchers found nearly 16 percent of women reported experiencing symptoms of depression. They say depression was significantly linked to cardiovascular disease risk.
Women with depression were 12 percent more likely to have hypertension and 60 percent more likely to have a history of stroke. Women with depression were also 50 percent more likely to die from cardiovascular disease and about 30 percent more likely to die from another cause.
From the study it was concluded that a large proportion of older women report levels of depressive symptoms that are significantly related to increased risk of CVD [cardiovascular disease] death and all-cause mortality, even after controlling for established CVD risk factors. However whether an early recognition and treatment of subclinical depression will lower CVD risk remains to be determined in clinical trials.
Sildenafil Treatment Of Women With Antidepressant-Associated Sexual Dysfunction: A Randomized Controlled Trial
UroToday - Treatment emergent sexual dysfunction is a frequent adverse effect occurring with medication use and is a major influence for premature treatment discontinuation, which leads to treatment failure and costly disease management outcomes.
Sexual dysfunction is recognized as being associated with selective and nonselective serotonin reuptake inhibitor (SRI) antidepressants, the most frequently prescribed medications for outpatients aged 18 to 65 years in the United States, and is estimated to occur in 30% to 70% of men and women treated for major depression. Although numerous strategies have been proposed for managing sexual dysfunction associated with SRI treatment, the selective type 5 phosphodiesterase inhibitors, limited to studies involving men, have demonstrated the best evidence-based data to support broad based and clinically meaningful treatment efficacy. No randomized controlled trial (RCT) has demonstrated effectiveness for women, who compared with men, are prescribed antidepressants at rates of 2 to 1 and can be expected to represent the larger number of patients needing relief from sexual dysfunction associated with SRI treatment. Without evidence-based data to treat sexual function associated with SRIs in women, clinicians lack the confidence to manage it effectively, which leaves patients exposed to excess random pharmacology.
The objective of the current trial was to use a protocol similar to our previous study involving men with sexual dysfunction associated with SRI treatment to assess the efficacy of sildenafil in the treatment of women, specifically women whose major depressive disorder in remission while taking a stable dose of SRI antidepressants and who did not have a preexisting sexual dysfunction but due to the treatment had sexual dysfunction manifest as dysfunction of orgasm (delay) or arousal (lubrication). Recognizing the potential importance of hormonal factors on nitric oxide signaling involved in sexual function in women with depression, endocrine measures were examined.
The prevalence of sexual problems was high, with 96% of women reporting more than one complaint. They reported disturbances in desire (88%), subjective arousal (81%), lubrication (80%), orgasm delay (99%), and other difficulties (24%), which included anorgasmia, pain, and lack of pleasure. The difference in the Clinical Global Impression scale sexual function improvement showed a significant difference between groups (P=.03). Clinically, 72% of women taking sildenafil reported improvement compared with 27% on placebo. On the secondary outcome measures, the sildenafil group had a higher mean (SD) improvement on orgasm (p=.01) than women taking placebo. These findings are important not only because women experience major depressive disorder at nearly double the rate of men, and because they experience greater sexual dysfunction than men, but also because it establishes that selective phosphodiesterase type 5 inhibitors are effective in both sexes for treating this bothersome treatment-associated adverse effect in patients who have been effectively treated for depression, but need to continue on their medication to avoid relapse or recurrence, and reduce the current high rates of premature medication discontinuation.
Written by H. George Nurnberg, MD, as part of Beyond the Abstract on UroToday.
UroToday - the only urology website with original content written by global urology key opinion leaders actively engaged in clinical practice.
To access the latest urology news releases from UroToday, go to:
urotoday
Copyright © 2008 - UroToday
Sexual dysfunction is recognized as being associated with selective and nonselective serotonin reuptake inhibitor (SRI) antidepressants, the most frequently prescribed medications for outpatients aged 18 to 65 years in the United States, and is estimated to occur in 30% to 70% of men and women treated for major depression. Although numerous strategies have been proposed for managing sexual dysfunction associated with SRI treatment, the selective type 5 phosphodiesterase inhibitors, limited to studies involving men, have demonstrated the best evidence-based data to support broad based and clinically meaningful treatment efficacy. No randomized controlled trial (RCT) has demonstrated effectiveness for women, who compared with men, are prescribed antidepressants at rates of 2 to 1 and can be expected to represent the larger number of patients needing relief from sexual dysfunction associated with SRI treatment. Without evidence-based data to treat sexual function associated with SRIs in women, clinicians lack the confidence to manage it effectively, which leaves patients exposed to excess random pharmacology.
The objective of the current trial was to use a protocol similar to our previous study involving men with sexual dysfunction associated with SRI treatment to assess the efficacy of sildenafil in the treatment of women, specifically women whose major depressive disorder in remission while taking a stable dose of SRI antidepressants and who did not have a preexisting sexual dysfunction but due to the treatment had sexual dysfunction manifest as dysfunction of orgasm (delay) or arousal (lubrication). Recognizing the potential importance of hormonal factors on nitric oxide signaling involved in sexual function in women with depression, endocrine measures were examined.
The prevalence of sexual problems was high, with 96% of women reporting more than one complaint. They reported disturbances in desire (88%), subjective arousal (81%), lubrication (80%), orgasm delay (99%), and other difficulties (24%), which included anorgasmia, pain, and lack of pleasure. The difference in the Clinical Global Impression scale sexual function improvement showed a significant difference between groups (P=.03). Clinically, 72% of women taking sildenafil reported improvement compared with 27% on placebo. On the secondary outcome measures, the sildenafil group had a higher mean (SD) improvement on orgasm (p=.01) than women taking placebo. These findings are important not only because women experience major depressive disorder at nearly double the rate of men, and because they experience greater sexual dysfunction than men, but also because it establishes that selective phosphodiesterase type 5 inhibitors are effective in both sexes for treating this bothersome treatment-associated adverse effect in patients who have been effectively treated for depression, but need to continue on their medication to avoid relapse or recurrence, and reduce the current high rates of premature medication discontinuation.
Written by H. George Nurnberg, MD, as part of Beyond the Abstract on UroToday.
UroToday - the only urology website with original content written by global urology key opinion leaders actively engaged in clinical practice.
To access the latest urology news releases from UroToday, go to:
urotoday
Copyright © 2008 - UroToday
Study Examines Depression Among Arab, Chaldean, African Immigrants In Detroit
"Factors Associated With Self-Reported Depression in Arab-, Chaldean-, and African-Americans" (.pdf), Ethnicity & Disease: Researchers led by Hikmet Jamil of Wayne State University and colleagues surveyed 3,543 adults of Arab, Chaldean and African backgrounds living in Detroit, seeking to determine ethnicity-specific prevalence of self-reported depression. Researchers also examined the risk factors associated with self-reported depression. Overall, 18.2% of participants reported being depressed, with the highest rate among Arab-Americans at 23.2%, followed by African-Americans at 15% and Chaldean-Americans at 13.3%. Having school-aged children and being unemployed, disabled or in poor health were all factors associated with depression. Depression prevalence also varied significantly by country of origin, according to the study. Researchers note, "Our results show the need to provide culturally competent mental health services for Arab-Americans and other minority American subgroups," adding that further research is "needed to identify risk factors, preferably modifiable factors, and to ascertain which factors are similar and non-similar to the general American population" (Jamil et al., Ethnicity & Disease, Autumn 2008).
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.
© 2009 Advisory Board Company and Kaiser Family Foundation. All rights reserved.
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.
© 2009 Advisory Board Company and Kaiser Family Foundation. All rights reserved.
Top Ranked Breakthrough: Depression Linked To Your Genetic Double Helix DNA
Since 2003, the link between a gene that regulates the neurotransmitter serotonin and an individual's ability to rebound from serious emotional trauma, such as childhood physical or sexual abuse has been hotly debated. Today, University of Michigan Health System researchers have found new evidence that our genes help determine our susceptibility to depression.
The journal Science ranked the findings among the top discoveries of the year, and the director of the National Institute of Mental Health has stated, "It is a very important discovery and a real advance for the field."
The controversy started seven and a half years ago when researchers at Duke University first published reference to this genetic link and caused a tremendous stir in the mental health community. However in 2009 the research was questioned in a study published in the Journal of the American Medical Association (JAMA). That same year The New York Times reported that analysis, which examined results from 14 different studies, showed the initial 2003 findings had "not held up to scientific scrutiny."
Today in the Archives of General Psychiatry online, Srijan Sen, M.D., Ph.D, an assistant professor of psychiatry at the University of Michigan Medical School, and his colleagues present a broader analysis of the follow-up studies recorded to date. The Michigan team examined 54 studies existing from 2001 to 2010 comprised of nearly 41,000 participants.
This has been the largest analysis of the serotonin gene's relationship to depression ever conducted.
Dr. Sen states:
"This brings us one step closer to being able to identify individuals who might benefit from early interventions or to tailor treatments to specific individuals. When we included all the relevant studies, we found that an individual's genetic make-up does make a difference in how he or she responds to stress."
The University of Michigan analysis supports previous findings that individuals who had a short allele on a particular area of the serotonin gene had a harder time bouncing back from trauma than those with long alleles. An allele is an alternative form of a gene (one member of a pair) that is located at a specific position on a specific chromosome. These DNA codings determine distinct traits that can be passed on from parents to offspring.
It is now confirmed that there is a link between sensitivity to stress and a short allele in those who had been mistreated as children and in people suffering with specific, severe medical conditions. Only a marginal relationship was found in those who had undergone stressful life events.
Note though that different stressful life events may have very different effects, Sen says. For example, there is no reason to think that the effects of divorce, at a biological level, would be similar to the effects of losing your home or being physically assaulted.
Terrie Moffitt, Ph.D., a professor at Duke University and one of the authors of the 2003 study proclaimed:
"Their careful and systematic approach reveals why the JAMA meta-analysis got it wrong. We hope that the same journalists who were so hasty to publish a simplistic claim in 2009 will cover this more thoughtful new analysis."
However, when the U of M team restricted their analysis to the 14 studies as the 2009 study did, they also failed to find a genetic link. Dr. Sen believes that the scope of the analysis, and not the methodology, was responsible for the new findings.
From across the pond, London clinical researcher Rudolf Uher, Ph.D. at the Institute of Psychiatry in London says the American research will refocus the field on making new advances to help those affected by mental illness by helping cut through the debate about the genetic connection.
Usher continues:
"The major strength of the analysis is that it is the first such work that included all studies that were available on the topic and it gives a very clear answer: the 'short' variant of the serotonin transporter does make people more sensitive to the effects of adversity."
Additional research will help to map an individual's genetic profile for depression. It is a groundbreaking discovery that this is even possible.
Additional U-M Authors: Margit Burmeister, Ph.D., Kerby Shedden, Ph.D., former graduate student Katja Karg
Reference: Archives of General Psychiatry 10.1001/archgenpsychiatry.2010.189
Written by Sy Kraft, B.A.
The journal Science ranked the findings among the top discoveries of the year, and the director of the National Institute of Mental Health has stated, "It is a very important discovery and a real advance for the field."
The controversy started seven and a half years ago when researchers at Duke University first published reference to this genetic link and caused a tremendous stir in the mental health community. However in 2009 the research was questioned in a study published in the Journal of the American Medical Association (JAMA). That same year The New York Times reported that analysis, which examined results from 14 different studies, showed the initial 2003 findings had "not held up to scientific scrutiny."
Today in the Archives of General Psychiatry online, Srijan Sen, M.D., Ph.D, an assistant professor of psychiatry at the University of Michigan Medical School, and his colleagues present a broader analysis of the follow-up studies recorded to date. The Michigan team examined 54 studies existing from 2001 to 2010 comprised of nearly 41,000 participants.
This has been the largest analysis of the serotonin gene's relationship to depression ever conducted.
Dr. Sen states:
"This brings us one step closer to being able to identify individuals who might benefit from early interventions or to tailor treatments to specific individuals. When we included all the relevant studies, we found that an individual's genetic make-up does make a difference in how he or she responds to stress."
The University of Michigan analysis supports previous findings that individuals who had a short allele on a particular area of the serotonin gene had a harder time bouncing back from trauma than those with long alleles. An allele is an alternative form of a gene (one member of a pair) that is located at a specific position on a specific chromosome. These DNA codings determine distinct traits that can be passed on from parents to offspring.
It is now confirmed that there is a link between sensitivity to stress and a short allele in those who had been mistreated as children and in people suffering with specific, severe medical conditions. Only a marginal relationship was found in those who had undergone stressful life events.
Note though that different stressful life events may have very different effects, Sen says. For example, there is no reason to think that the effects of divorce, at a biological level, would be similar to the effects of losing your home or being physically assaulted.
Terrie Moffitt, Ph.D., a professor at Duke University and one of the authors of the 2003 study proclaimed:
"Their careful and systematic approach reveals why the JAMA meta-analysis got it wrong. We hope that the same journalists who were so hasty to publish a simplistic claim in 2009 will cover this more thoughtful new analysis."
However, when the U of M team restricted their analysis to the 14 studies as the 2009 study did, they also failed to find a genetic link. Dr. Sen believes that the scope of the analysis, and not the methodology, was responsible for the new findings.
From across the pond, London clinical researcher Rudolf Uher, Ph.D. at the Institute of Psychiatry in London says the American research will refocus the field on making new advances to help those affected by mental illness by helping cut through the debate about the genetic connection.
Usher continues:
"The major strength of the analysis is that it is the first such work that included all studies that were available on the topic and it gives a very clear answer: the 'short' variant of the serotonin transporter does make people more sensitive to the effects of adversity."
Additional research will help to map an individual's genetic profile for depression. It is a groundbreaking discovery that this is even possible.
Additional U-M Authors: Margit Burmeister, Ph.D., Kerby Shedden, Ph.D., former graduate student Katja Karg
Reference: Archives of General Psychiatry 10.1001/archgenpsychiatry.2010.189
Written by Sy Kraft, B.A.
McCain, Obama On Mental Health Care
The National Alliance on Mental Illness (NAMI) has released the responses of presidential candidates John McCain and Barack Obama to a detailed questionnaire about mental health care--along with highlights of the Democratic and Republican platforms.
"Mental health is part of the national dialogue on healthcare," said NAMI executive director Michael J. Fitzpatrick. "We offer the candidate responses as part of the process of public education."
"One out of four Americans are affected by mental illness at some point during their lifetimes. It does not discriminate between Democrats and Republicans. We hope mental health services will be addressed in the upcoming debates."
The presidential debate on October 2 in Nashville coincides with Mental Illness Awareness Week (MIAW).
During the primaries, Senator Obama answered 24 specific questions on a NAMI questionnaire. McCain provided a statement in lieu of specific answers. His campaign noted that it was not his policy to reply to questionnaires.
NAMI also is highlighting excerpts from the Democratic and Republic party platforms adopted by the recent party platforms in the areas of healthcare, education and veterans.
About NAMI
The National Alliance on Mental Illness is a non-partisan organization with 1100 state and local affiliates, dedicated to improving the lives of individuals and families affected by mental illness. It does not endorse political candidates. nami
Mental Health: The Candidates & Party Platforms: nami/election2008/candidates
White House Advocate Needed for Special Needs, click here.
National Alliance on Mental Illness
"Mental health is part of the national dialogue on healthcare," said NAMI executive director Michael J. Fitzpatrick. "We offer the candidate responses as part of the process of public education."
"One out of four Americans are affected by mental illness at some point during their lifetimes. It does not discriminate between Democrats and Republicans. We hope mental health services will be addressed in the upcoming debates."
The presidential debate on October 2 in Nashville coincides with Mental Illness Awareness Week (MIAW).
During the primaries, Senator Obama answered 24 specific questions on a NAMI questionnaire. McCain provided a statement in lieu of specific answers. His campaign noted that it was not his policy to reply to questionnaires.
NAMI also is highlighting excerpts from the Democratic and Republic party platforms adopted by the recent party platforms in the areas of healthcare, education and veterans.
About NAMI
The National Alliance on Mental Illness is a non-partisan organization with 1100 state and local affiliates, dedicated to improving the lives of individuals and families affected by mental illness. It does not endorse political candidates. nami
Mental Health: The Candidates & Party Platforms: nami/election2008/candidates
White House Advocate Needed for Special Needs, click here.
National Alliance on Mental Illness
Repligen Announces Completion Of Patient Enrollment In Phase 2b Clinical Trial Of RG2417 For Bipolar Depression
Repligen Corporation (Nasdaq: RGEN) reported that it has completed enrollment of patients in its Phase 2b clinical trial of RG2417, an oral formulation of uridine, in patients with bipolar depression. This study is a double-blind, placebo-controlled trial designed to assess the efficacy of 8 weeks of treatment with RG2417 or a placebo on the symptoms of bipolar depression as measured by the Montgomery-Asberg Depression Rating Scale (MADRS). The study enrolled 175 patients at 29 clinical sites within the United States, and we expect to report top-line results in the first quarter of 2011.
The primary objective of this study is to assess the safety and efficacy of RG2417 on the symptoms of bipolar depression by demonstrating a greater improvement in the MADRS score of the patients receiving RG2417 when compared to placebo over the 8-week treatment period. Patients were initially screened for a score of bipolar depression symptoms of greater than 20 on the MADRS and subsequently confirmed to meet the criteria for bipolar depression using an alternate diagnostic tool to ensure that patients have the appropriate diagnosis for inclusion in the study. Evaluations for symptoms of depression are conducted at baseline and then weekly using the MADRS, a standardized, rater-administered scale, which has been used for numerous drug trials in bipolar disorder. In addition to the MADRS ratings, patients conduct a weekly self-assessment of their symptoms, which is used to cross check the fidelity of the MADRS raters. Additional secondary and exploratory objectives include improvements in the Clinical Global Impression Scale, difference in the end of study MADRS scores, and a lack of increase in mania as measured by the Young's Mania Rating Scale.
The average baseline MADRS of the 175 patients recruited into this study was 31.3 compared to 30.4 in the Phase 2a study and there has been a high degree of fidelity between the MADRS scores determined by the raters and the patient's self-assessment of depression symptoms during the 8-week treatment period. To date, there have been no serious adverse events determined to be related to RG2417, which continues to support an advantageous tolerability and safety profile for the drug.
"We are very pleased to have completed the patient enrollment phase of this study," stated Walter C. Herlihy, President and Chief Executive Officer of Repligen Corporation. "We believe that this study has been adequately powered to detect a potential benefit of treatment with RG2417 consistent with our Phase 2a results."
This study was designed to confirm and extend the results of a Phase 2a study in which 6 weeks of treatment with RG2417 improved the symptoms of bipolar depression when compared to placebo as measured by the MADRS. The positive effect of treatment with RG2417 in the Phase 2a study was primarily observed in patients with a significant history of disease as determined by the number of episodes of mania and depression experienced during their lifetime. The Phase 2a results demonstrated that RG2417 was safe and well tolerated.
Bipolar disorder, also known as manic depression, is an illness marked by extreme changes in mood, thought, energy and behavior in which a person's mood can alternate between the "poles" of mania and depression. Bipolar disorder is a chronic illness associated with substantial morbidity and mortality, ranking worldwide behind unipolar depression and alcohol abuse among psychiatric illnesses for related disabilities and overall economic burden of illness. The lifetime financial burden of bipolar disorder in the United States is about $600,000 per patient, depending on resistance to treatment and persistence of symptoms. Although several therapies are approved for the treatment of bipolar disorder, many individuals are unable to tolerate the treatment-related side effects, and incomplete clinical response, relapse and recurrence remain common clinical problems. There are more than five million adults worldwide with bipolar disorder, an area of high unmet medical need due to the ineffectiveness and significant side effects of current therapies.
This press release contains forward-looking statements which are made pursuant to the safe harbor provisions of Section 27A of the Securities Act of 1933, as amended, and Section 21E of the Securities Exchange Act of 1934, as amended. The forward-looking statements in this release do not constitute guarantees of future performance. Investors are cautioned that statements in this press release which are not strictly historical statements, including, without limitation, statements regarding future financial performance and position, management's strategy, plans and objectives for future operations, plans and objectives for product development, plans and objectives for present and future clinical trials and results of such trials, plans and objectives for regulatory approval, litigation, intellectual property protection, product development, manufacturing plans and performance, projected changes in the size of our markets, our market share and product sales and other statements identified by words like "believe," "expect," "may," "will," "should," "seek," or "could" and similar expressions, constitute forward-looking statements. Such forward-looking statements are subject to a number of risks and uncertainties that could cause actual results to differ materially from those anticipated, including, without limitation, risks associated with: the success of our clinical trials; our ability to develop and commercialize products; our ability to obtain required regulatory approvals; the success of current and future collaborative relationships; the market acceptance of our products; our ability to compete with larger, better financed pharmaceutical and biotechnology companies; new approaches to the treatment of our targeted diseases; our expectation of incurring continued losses; our uncertainty of product revenues and profits; our ability to generate future revenues; our ability to raise additional capital to continue our drug development programs; our compliance with all Food and Drug Administration regulations; our ability to obtain; maintain and protect intellectual property rights for our products; the risk of litigation regarding our intellectual property rights; our limited sales and manufacturing capabilities; our dependence on third-party manufacturers and value added resellers; our ability to hire and retain skilled personnel; our volatile stock price; and other risks detailed in Repligen's annual report on Form 10-K on file with the Securities and Exchange Commission and the other reports that Repligen periodically files with the Securities and Exchange Commission. Actual results may differ materially from those Repligen contemplated by these forward-looking statements. These forward looking statements reflect management's current views and Repligen does not undertake to update any of these forward-looking statements to reflect a change in its views or events or circumstances that occur after the date hereof except as required by law.
The primary objective of this study is to assess the safety and efficacy of RG2417 on the symptoms of bipolar depression by demonstrating a greater improvement in the MADRS score of the patients receiving RG2417 when compared to placebo over the 8-week treatment period. Patients were initially screened for a score of bipolar depression symptoms of greater than 20 on the MADRS and subsequently confirmed to meet the criteria for bipolar depression using an alternate diagnostic tool to ensure that patients have the appropriate diagnosis for inclusion in the study. Evaluations for symptoms of depression are conducted at baseline and then weekly using the MADRS, a standardized, rater-administered scale, which has been used for numerous drug trials in bipolar disorder. In addition to the MADRS ratings, patients conduct a weekly self-assessment of their symptoms, which is used to cross check the fidelity of the MADRS raters. Additional secondary and exploratory objectives include improvements in the Clinical Global Impression Scale, difference in the end of study MADRS scores, and a lack of increase in mania as measured by the Young's Mania Rating Scale.
The average baseline MADRS of the 175 patients recruited into this study was 31.3 compared to 30.4 in the Phase 2a study and there has been a high degree of fidelity between the MADRS scores determined by the raters and the patient's self-assessment of depression symptoms during the 8-week treatment period. To date, there have been no serious adverse events determined to be related to RG2417, which continues to support an advantageous tolerability and safety profile for the drug.
"We are very pleased to have completed the patient enrollment phase of this study," stated Walter C. Herlihy, President and Chief Executive Officer of Repligen Corporation. "We believe that this study has been adequately powered to detect a potential benefit of treatment with RG2417 consistent with our Phase 2a results."
This study was designed to confirm and extend the results of a Phase 2a study in which 6 weeks of treatment with RG2417 improved the symptoms of bipolar depression when compared to placebo as measured by the MADRS. The positive effect of treatment with RG2417 in the Phase 2a study was primarily observed in patients with a significant history of disease as determined by the number of episodes of mania and depression experienced during their lifetime. The Phase 2a results demonstrated that RG2417 was safe and well tolerated.
Bipolar disorder, also known as manic depression, is an illness marked by extreme changes in mood, thought, energy and behavior in which a person's mood can alternate between the "poles" of mania and depression. Bipolar disorder is a chronic illness associated with substantial morbidity and mortality, ranking worldwide behind unipolar depression and alcohol abuse among psychiatric illnesses for related disabilities and overall economic burden of illness. The lifetime financial burden of bipolar disorder in the United States is about $600,000 per patient, depending on resistance to treatment and persistence of symptoms. Although several therapies are approved for the treatment of bipolar disorder, many individuals are unable to tolerate the treatment-related side effects, and incomplete clinical response, relapse and recurrence remain common clinical problems. There are more than five million adults worldwide with bipolar disorder, an area of high unmet medical need due to the ineffectiveness and significant side effects of current therapies.
This press release contains forward-looking statements which are made pursuant to the safe harbor provisions of Section 27A of the Securities Act of 1933, as amended, and Section 21E of the Securities Exchange Act of 1934, as amended. The forward-looking statements in this release do not constitute guarantees of future performance. Investors are cautioned that statements in this press release which are not strictly historical statements, including, without limitation, statements regarding future financial performance and position, management's strategy, plans and objectives for future operations, plans and objectives for product development, plans and objectives for present and future clinical trials and results of such trials, plans and objectives for regulatory approval, litigation, intellectual property protection, product development, manufacturing plans and performance, projected changes in the size of our markets, our market share and product sales and other statements identified by words like "believe," "expect," "may," "will," "should," "seek," or "could" and similar expressions, constitute forward-looking statements. Such forward-looking statements are subject to a number of risks and uncertainties that could cause actual results to differ materially from those anticipated, including, without limitation, risks associated with: the success of our clinical trials; our ability to develop and commercialize products; our ability to obtain required regulatory approvals; the success of current and future collaborative relationships; the market acceptance of our products; our ability to compete with larger, better financed pharmaceutical and biotechnology companies; new approaches to the treatment of our targeted diseases; our expectation of incurring continued losses; our uncertainty of product revenues and profits; our ability to generate future revenues; our ability to raise additional capital to continue our drug development programs; our compliance with all Food and Drug Administration regulations; our ability to obtain; maintain and protect intellectual property rights for our products; the risk of litigation regarding our intellectual property rights; our limited sales and manufacturing capabilities; our dependence on third-party manufacturers and value added resellers; our ability to hire and retain skilled personnel; our volatile stock price; and other risks detailed in Repligen's annual report on Form 10-K on file with the Securities and Exchange Commission and the other reports that Repligen periodically files with the Securities and Exchange Commission. Actual results may differ materially from those Repligen contemplated by these forward-looking statements. These forward looking statements reflect management's current views and Repligen does not undertake to update any of these forward-looking statements to reflect a change in its views or events or circumstances that occur after the date hereof except as required by law.
For Patients With Alzheimer's, Vitamin B Supplementation Does Not Slow Cognitive Decline
For patients with mild- to moderate- Alzheimer's disease, cognitive
decline was not slowed by the administration of high-dose vitamin B
supplementation in an article released on October 14, 2008 in JAMA.
Alzheimer's Disease (AD) is a degenerative neurological disease that is
a common form of dementia. There has been evidence that an amino acid
naturally produced in the body, homocysteine, is present in higher
levels in cases of Alzheimer's patients, and homocysteine's
relationship to various neuropathological mechanisms suggests that
reducing its levels may alter the course of the disease. According to
the authors, B vitamins that influence metabolism of homocysteine have
been considered to this end, but previous studies have not yet had
sufficient size or duration of follow-up to actually assess their
effects on this cognitive disorder.
To investigate the potential of B vitamins in Alzheimer's treatment,
Paul S. Aisen, M.D., of the University of California, San Diego, and
colleagues, examined 409 individuals in a randomized controlled trial.
One group was supplemented with folic acid (5 mg/d of folate,) vitamin
B6 (25 mg/d of vitamin B6,) and vitamin B12 (1 mg/d of vitamin B12) for
18 months. The second group was treated with a placebo. The patients
were medicated throughout the study and were tested for their cognitive
abilities using the Alzheimer Disease Assessment Scale (ADAS-cog).
It was found that the vitamin supplement was linked to a reduction in
homocysteine levels in the blood plasma. however, when examined in
light of cognitive testing, ADAS-cog scores did not differ
significantly between the two treatment groups. Notably, depression
symptoms were more common in the supplemented group.
The authors conclude that, while homocysteine levels dropped in the
supplemented patients, but this did not improve cognitive outcomes:
“Many studies suggest that relative elevation of homocysteine
is characteristic of AD, and laboratory research implicates
homocysteine in neurodegenerative mechanisms. High-dose B vitamin
supplementation in individuals with normal levels of B vitamins was
effective in reducing homocysteine levels. However, our study does not
support the treatment of individuals with mild to moderate AD and
normal vitamin levels with B vitamin supplements.”
High-Dose B Vitamin Supplementation and Cognitive Decline in
Alzheimer Disease: A Randomized Controlled Trial
Paul S. Aisen; Lon S. Schneider; Mary Sano; Ramon Diaz-Arrastia;
Christopher H. van Dyck; Myron F. Weiner; Teodoro Bottiglieri; Shelia
Jin; Karen T. Stokes; Ronald G. Thomas; Leon J. Thal; for the Alzheimer
Disease Cooperative Study
JAMA. 2008;300(15):1774-1783.
Click Here for Journal
Written by Anna Sophia McKenney
decline was not slowed by the administration of high-dose vitamin B
supplementation in an article released on October 14, 2008 in JAMA.
Alzheimer's Disease (AD) is a degenerative neurological disease that is
a common form of dementia. There has been evidence that an amino acid
naturally produced in the body, homocysteine, is present in higher
levels in cases of Alzheimer's patients, and homocysteine's
relationship to various neuropathological mechanisms suggests that
reducing its levels may alter the course of the disease. According to
the authors, B vitamins that influence metabolism of homocysteine have
been considered to this end, but previous studies have not yet had
sufficient size or duration of follow-up to actually assess their
effects on this cognitive disorder.
To investigate the potential of B vitamins in Alzheimer's treatment,
Paul S. Aisen, M.D., of the University of California, San Diego, and
colleagues, examined 409 individuals in a randomized controlled trial.
One group was supplemented with folic acid (5 mg/d of folate,) vitamin
B6 (25 mg/d of vitamin B6,) and vitamin B12 (1 mg/d of vitamin B12) for
18 months. The second group was treated with a placebo. The patients
were medicated throughout the study and were tested for their cognitive
abilities using the Alzheimer Disease Assessment Scale (ADAS-cog).
It was found that the vitamin supplement was linked to a reduction in
homocysteine levels in the blood plasma. however, when examined in
light of cognitive testing, ADAS-cog scores did not differ
significantly between the two treatment groups. Notably, depression
symptoms were more common in the supplemented group.
The authors conclude that, while homocysteine levels dropped in the
supplemented patients, but this did not improve cognitive outcomes:
“Many studies suggest that relative elevation of homocysteine
is characteristic of AD, and laboratory research implicates
homocysteine in neurodegenerative mechanisms. High-dose B vitamin
supplementation in individuals with normal levels of B vitamins was
effective in reducing homocysteine levels. However, our study does not
support the treatment of individuals with mild to moderate AD and
normal vitamin levels with B vitamin supplements.”
High-Dose B Vitamin Supplementation and Cognitive Decline in
Alzheimer Disease: A Randomized Controlled Trial
Paul S. Aisen; Lon S. Schneider; Mary Sano; Ramon Diaz-Arrastia;
Christopher H. van Dyck; Myron F. Weiner; Teodoro Bottiglieri; Shelia
Jin; Karen T. Stokes; Ronald G. Thomas; Leon J. Thal; for the Alzheimer
Disease Cooperative Study
JAMA. 2008;300(15):1774-1783.
Click Here for Journal
Written by Anna Sophia McKenney
Increased Risk Of Intellectual Decline In Older People Suffering From Depression
Depression in the elderly increases the risk of subsequent mental impairment and can act as a predictor of future intellectual decline, University of Rochester Medical Center psychiatrists and researchers have found.
"We can't conclude that treatment or prevention of depression would reduce or prevent cognitive decline but these findings certainly raise the possibility and that would be our hope," said Jeffrey M. Lyness, M.D., professor of psychiatry, associate chair for education in the Department of Psychiatry and senior author of an article on the research.
This is the first study to analyze simultaneously the roles of depression and intellectual dysfunction over time in a large group of older people. The researchers followed more than 700 patients over two years for the study that was published in The American Journal of Psychiatry.
The researchers looked at loss of so-called executive functions that involve high-level mental processes, such a making decisions, organizing, planning and doing a series of things in sequence.
"You can have a good memory and good language skills but if you lose executive function, you can't do very well in daily life," Lyness said.
Participants, who were 65 years of age and older, were recruited from private practices and University-affiliated clinics in Monroe County, New York. Trained interviewers questioned participants in their homes or in research offices at the Medical Center. They also reviewed each patient's primary care medical chart, recording information about mood and cognitive symptoms, disorders, or treatments as well as active and past medical problems and current medications.
The patient interviews included assessments of cognition, functional status, and depression. Additional interviews and chart reviews were conducted one year after the initial interview and then again two years later. Sophisticated methods of statistical analysis were used to review the results.
"Not every elderly person who is depressed becomes intellectually impaired, but depression raises the risk of executive dysfunction," Lyness said. "We began to see it at the one-year mark and it was clear after two years."
Physicians who treat older patients should be aware of the increased risk of loss of mental functions for depressed patients, the researchers concluded.
"The next step is to study whether treatment or prevention of depression can prevent decline in executive function," Lyness said.
In addition to Lyness, the authors of the article include: Xingjia Cui, M.D., M.P.H., M.S., who was a resident in psychiatry at the Medical Center and now works at the Veterans Affairs Medical Center in Canandaigua; Xin Tu, Ph.D., professor of biostatistics and professor of psychiatry; Deborah A. King, Ph.D., associate professor of psychiatry, and Eric D. Caine, M.D., chair of the Department of Psychiatry. The article was published in the August issue of the journal. A follow-up discussion of the results will appear in an upcoming issue.
"We can't conclude that treatment or prevention of depression would reduce or prevent cognitive decline but these findings certainly raise the possibility and that would be our hope," said Jeffrey M. Lyness, M.D., professor of psychiatry, associate chair for education in the Department of Psychiatry and senior author of an article on the research.
This is the first study to analyze simultaneously the roles of depression and intellectual dysfunction over time in a large group of older people. The researchers followed more than 700 patients over two years for the study that was published in The American Journal of Psychiatry.
The researchers looked at loss of so-called executive functions that involve high-level mental processes, such a making decisions, organizing, planning and doing a series of things in sequence.
"You can have a good memory and good language skills but if you lose executive function, you can't do very well in daily life," Lyness said.
Participants, who were 65 years of age and older, were recruited from private practices and University-affiliated clinics in Monroe County, New York. Trained interviewers questioned participants in their homes or in research offices at the Medical Center. They also reviewed each patient's primary care medical chart, recording information about mood and cognitive symptoms, disorders, or treatments as well as active and past medical problems and current medications.
The patient interviews included assessments of cognition, functional status, and depression. Additional interviews and chart reviews were conducted one year after the initial interview and then again two years later. Sophisticated methods of statistical analysis were used to review the results.
"Not every elderly person who is depressed becomes intellectually impaired, but depression raises the risk of executive dysfunction," Lyness said. "We began to see it at the one-year mark and it was clear after two years."
Physicians who treat older patients should be aware of the increased risk of loss of mental functions for depressed patients, the researchers concluded.
"The next step is to study whether treatment or prevention of depression can prevent decline in executive function," Lyness said.
In addition to Lyness, the authors of the article include: Xingjia Cui, M.D., M.P.H., M.S., who was a resident in psychiatry at the Medical Center and now works at the Veterans Affairs Medical Center in Canandaigua; Xin Tu, Ph.D., professor of biostatistics and professor of psychiatry; Deborah A. King, Ph.D., associate professor of psychiatry, and Eric D. Caine, M.D., chair of the Department of Psychiatry. The article was published in the August issue of the journal. A follow-up discussion of the results will appear in an upcoming issue.
Three In Five Patients Feel Depressed Or Anxious As A Result Of Their Pain
Despite treatment efforts, chronic pain management is failing
one in three (n = 377) patients suffering from severe chronic pain, and three
in five (n = 336) patients feel moderately or extremely anxious or depressed
as a result of their pain. Whilst eight in ten (n = 377) chronic pain
patients are taking prescription medication, one in two (n = 307) of these
patients are suffering the additional burden of side effects. These are the
findings released today from the interim data from PainSTORY (Pain Study
Tracking Ongoing Responses for Year), the first survey of its kind to provide
in-depth insight into how chronic pain impacts the lives of patients over one
year in 13 European countries.
Today's data provide a picture of patients' lives over the
three months since the survey was initiated and shows that despite
consultation with a healthcare professional and treatment patients are still
struggling with their pain, impacting patients' quality of life.
"Interim results from PainSTORY are important and highlight
that patients continue to suffer from chronic pain despite seeking medical
attention," said Dr Varrassi, President of the European Federation of IASP
Chapters, a leading pain society. "The medical community need to provide
adequate treatment for patients in moderate-severe pain, but there seems to
still be barriers that need to be overcome".
Since their initial interview three months ago, for 77 percent
(n = 377) of patients the level of pain they experience has either stayed the
same or even deteriorated further. 33% (n=377) of patients continue to suffer
from severe chronic pain, 15% (n = 377) had progressed from moderate to
severe pain, and 1% (n = 377) from mild to severe pain.
PainSTORY shows that both the physical and psychological
aspects of patients' lives are affected by their pain. Six out of ten (n =
336) patients are experiencing problems walking about and over half (n= 336)
experience problems sleeping. The influence of pain also extends into
patients' working lives, and almost half (n = 195) have changed the way they
work. "I couldn't interact. The pain trapped me and I couldn't socialise. I
felt like a prisoner of the pain and really conditioned by it," said patient
14 from the United Kingdom.
Today's data show patients are being prescribed suboptimal
treatment for their pain. Of the 81 percent (n = 377) of patients in
moderate-severe pain on prescription medication, only 13 percent were
prescribed strong opioids. Over half of patients were suffering at least one
side effect as a result of their prescribed medication (n = 162), including
constipation, dizziness and drowsiness, which are common symptoms for both
weak and strong opioids.
"Side effects are affecting these patients. Patients are
finding themselves in situations where they need to choose between using pain
relief medications, or compromising their pain management by not taking
medications to avoid the burden of side effects," stated Professor Erdine
from the World Institute of Pain. "We are interested to see the next wave of
results for PainSTORY. There has already been some interesting issues that
have been brought to light. This survey demonstrates the pressing need for
improved management of pain across Europe."
About the survey
PainSTORY (Pain Study Tracking Ongoing Responses for a Year)
is the first study of its kind to track patients with chronic pain for a
year, providing a picture of the lives of people living in pain, and the
management of pain in 13 European countries.
Baseline results from the study show that chronic pain has a
significant impact on the daily lives of patients. The survey aims to better
understand the management of chronic pain across Europe.
The PainSTORY survey is being conducted by an independent
research company, IPSOS, in collaboration with the following independent
third parties:
- European Federation of IASP Chapters
- World Institute of Pain
- Arthritis and Rheumatism International
- OPEN Minds
The survey is sponsored by a restricted educational grant from
Mundipharma International Limited.
Methodology
PainSTORY recruited patients suffering from non-malignant
(osteoarthritis, back pain / lower back pain, osteoporosis, neuropathic pain,
mixed pain, other long term pain), moderate to severe (rate 5-10 on a pain
scale) chronic pain (i.e. lasting for more than three months). Respondents
are studied for 12 months. The research is being carried out in 13 countries
across Europe: United Kingdom, France, Germany, Switzerland, Italy, Spain,
Ireland, Belgium, Sweden, Denmark, Finland, Netherlands, Norway by an
independent research company, IPSOS.
The study consists of four waves of qualitative interviews
between April 2008 and March 2009. Interim engagement activities between the
four waves are sent to patients to provide additional insight, such as
diaries and lifebooks. Comparisons between baseline data and subsequent wave
results will show how the impact of pain and pain management changes over the
course of a year.
About the European Week Against Pain
The European Week Against Pain (EWAP) which takes place
annually, was started as part of the European Federation of IASP Chapters'
(EFIC's), Europe Against Pain Initiative, in October 2001. EWAP aims to
create more awareness of pain as a major healthcare problem amongst the
general public, healthcare workers and healthcare policy makers.
The theme of this year's EWAP is fibromyalgia, a widespread
musculoskeletal pain and fatigue disorder that occurs predominately in women.
Unexplained widespread pain occurs in about 10% of the general adult
population in Western countries, with approximately half of those affected
meeting American College of Rheumatology (ACR) classification criteria for
fibromyalgia.
The PainSTORY survey was sponsored by a restricted educational
grant from Mundipharma International Ltd, Cambridge, England
PainSTORY
What is pain?
For more information on what pain is and possible treatments, please see:
What is Pain? What Causes Pain?
one in three (n = 377) patients suffering from severe chronic pain, and three
in five (n = 336) patients feel moderately or extremely anxious or depressed
as a result of their pain. Whilst eight in ten (n = 377) chronic pain
patients are taking prescription medication, one in two (n = 307) of these
patients are suffering the additional burden of side effects. These are the
findings released today from the interim data from PainSTORY (Pain Study
Tracking Ongoing Responses for Year), the first survey of its kind to provide
in-depth insight into how chronic pain impacts the lives of patients over one
year in 13 European countries.
Today's data provide a picture of patients' lives over the
three months since the survey was initiated and shows that despite
consultation with a healthcare professional and treatment patients are still
struggling with their pain, impacting patients' quality of life.
"Interim results from PainSTORY are important and highlight
that patients continue to suffer from chronic pain despite seeking medical
attention," said Dr Varrassi, President of the European Federation of IASP
Chapters, a leading pain society. "The medical community need to provide
adequate treatment for patients in moderate-severe pain, but there seems to
still be barriers that need to be overcome".
Since their initial interview three months ago, for 77 percent
(n = 377) of patients the level of pain they experience has either stayed the
same or even deteriorated further. 33% (n=377) of patients continue to suffer
from severe chronic pain, 15% (n = 377) had progressed from moderate to
severe pain, and 1% (n = 377) from mild to severe pain.
PainSTORY shows that both the physical and psychological
aspects of patients' lives are affected by their pain. Six out of ten (n =
336) patients are experiencing problems walking about and over half (n= 336)
experience problems sleeping. The influence of pain also extends into
patients' working lives, and almost half (n = 195) have changed the way they
work. "I couldn't interact. The pain trapped me and I couldn't socialise. I
felt like a prisoner of the pain and really conditioned by it," said patient
14 from the United Kingdom.
Today's data show patients are being prescribed suboptimal
treatment for their pain. Of the 81 percent (n = 377) of patients in
moderate-severe pain on prescription medication, only 13 percent were
prescribed strong opioids. Over half of patients were suffering at least one
side effect as a result of their prescribed medication (n = 162), including
constipation, dizziness and drowsiness, which are common symptoms for both
weak and strong opioids.
"Side effects are affecting these patients. Patients are
finding themselves in situations where they need to choose between using pain
relief medications, or compromising their pain management by not taking
medications to avoid the burden of side effects," stated Professor Erdine
from the World Institute of Pain. "We are interested to see the next wave of
results for PainSTORY. There has already been some interesting issues that
have been brought to light. This survey demonstrates the pressing need for
improved management of pain across Europe."
About the survey
PainSTORY (Pain Study Tracking Ongoing Responses for a Year)
is the first study of its kind to track patients with chronic pain for a
year, providing a picture of the lives of people living in pain, and the
management of pain in 13 European countries.
Baseline results from the study show that chronic pain has a
significant impact on the daily lives of patients. The survey aims to better
understand the management of chronic pain across Europe.
The PainSTORY survey is being conducted by an independent
research company, IPSOS, in collaboration with the following independent
third parties:
- European Federation of IASP Chapters
- World Institute of Pain
- Arthritis and Rheumatism International
- OPEN Minds
The survey is sponsored by a restricted educational grant from
Mundipharma International Limited.
Methodology
PainSTORY recruited patients suffering from non-malignant
(osteoarthritis, back pain / lower back pain, osteoporosis, neuropathic pain,
mixed pain, other long term pain), moderate to severe (rate 5-10 on a pain
scale) chronic pain (i.e. lasting for more than three months). Respondents
are studied for 12 months. The research is being carried out in 13 countries
across Europe: United Kingdom, France, Germany, Switzerland, Italy, Spain,
Ireland, Belgium, Sweden, Denmark, Finland, Netherlands, Norway by an
independent research company, IPSOS.
The study consists of four waves of qualitative interviews
between April 2008 and March 2009. Interim engagement activities between the
four waves are sent to patients to provide additional insight, such as
diaries and lifebooks. Comparisons between baseline data and subsequent wave
results will show how the impact of pain and pain management changes over the
course of a year.
About the European Week Against Pain
The European Week Against Pain (EWAP) which takes place
annually, was started as part of the European Federation of IASP Chapters'
(EFIC's), Europe Against Pain Initiative, in October 2001. EWAP aims to
create more awareness of pain as a major healthcare problem amongst the
general public, healthcare workers and healthcare policy makers.
The theme of this year's EWAP is fibromyalgia, a widespread
musculoskeletal pain and fatigue disorder that occurs predominately in women.
Unexplained widespread pain occurs in about 10% of the general adult
population in Western countries, with approximately half of those affected
meeting American College of Rheumatology (ACR) classification criteria for
fibromyalgia.
The PainSTORY survey was sponsored by a restricted educational
grant from Mundipharma International Ltd, Cambridge, England
PainSTORY
What is pain?
For more information on what pain is and possible treatments, please see:
What is Pain? What Causes Pain?
Retirement Reduces Tiredness And Depression
Retirement leads to a substantial reduction in mental and physical fatigue and depressive symptoms, finds a study published on bmj today. However, the research also concludes that retirement does not change the risk of major chronic illnesses such as respiratory disease, diabetes and heart disease.
The authors, led by Dr Hugo Westerlund from Stockholm University, say their research findings have important implications given that people will be working for longer and retiring later in life.
Retirement is a major life transition, says the study. But the results of various studies investigating the health effects of retirement have been inconsistent with some suggesting a beneficial effect and others concluding the reverse.
This large scale population based study is ground-breaking as it observes participants for a long period of time (15 years) and for 7 years prior to retirement and 7 years post retirement. The research is based on almost 190,000 observation years.
The participants were drawn from a large French cohort study and included 11,246 men and 2,858 women who were surveyed annually from 1989 to 2007. The researchers argue that "a major strength of this study is that it is based on repeated yearly measurements over an extended time period."
Most participants were married (89%) and belonged to higher or middle employment grades. They all retired on a statutory basis - 72% between the ages of 53 and 57 inclusive - and all participants had retired by the age of 64. In the year before retirement, one in four (25%) participants had suffered from depressive symptoms and 728 (7%) were diagnosed with one or more of the following: respiratory disease, diabetes, heart disease or stroke.
Unmarried respondents and those in low employment grades had higher odds of physical (but not mental) fatigue.
The results show that retirement is linked with a substantial decrease in both mental and physical fatigue, with a smaller but significant decrease in depressive symptoms. However, the research also shows there is no association between retirement and chronic disease. As expected, say the authors, these diseases gradually increased with age.
The authors believe there are a number of explanations for the findings: "if work is tiring for many older workers, the decrease in fatigue could simply reflect removal of the source of the problem ... furthermore, retirement may allow people more time to engage in stimulating and restorative activities, such as physical exercise," they write.
They conclude that their research results "indicate that fatigue may be an underlying reason for early exit from the labour market and decreased productivity, and redesign of work, healthcare interventions or both may be necessary to enable a larger proportion of older people to work in full health."
In an accompanying editorial, Alex Burdorf, a professor in the determinants of public health in the Netherlands, says the study "is unique in that annual health measurements were carried out several years before and after retirement."
Burdorf believes further research is needed to corroborate the findings as they contradict other studies and says "it is too early to make definite claims about positive and negative benefits from retirement at a particular age." The author agrees, however, that efforts are needed to improve and adapt working conditions "to help elderly workers maintain good health."
Click here to view full paper
Click here to view full editorial
The authors, led by Dr Hugo Westerlund from Stockholm University, say their research findings have important implications given that people will be working for longer and retiring later in life.
Retirement is a major life transition, says the study. But the results of various studies investigating the health effects of retirement have been inconsistent with some suggesting a beneficial effect and others concluding the reverse.
This large scale population based study is ground-breaking as it observes participants for a long period of time (15 years) and for 7 years prior to retirement and 7 years post retirement. The research is based on almost 190,000 observation years.
The participants were drawn from a large French cohort study and included 11,246 men and 2,858 women who were surveyed annually from 1989 to 2007. The researchers argue that "a major strength of this study is that it is based on repeated yearly measurements over an extended time period."
Most participants were married (89%) and belonged to higher or middle employment grades. They all retired on a statutory basis - 72% between the ages of 53 and 57 inclusive - and all participants had retired by the age of 64. In the year before retirement, one in four (25%) participants had suffered from depressive symptoms and 728 (7%) were diagnosed with one or more of the following: respiratory disease, diabetes, heart disease or stroke.
Unmarried respondents and those in low employment grades had higher odds of physical (but not mental) fatigue.
The results show that retirement is linked with a substantial decrease in both mental and physical fatigue, with a smaller but significant decrease in depressive symptoms. However, the research also shows there is no association between retirement and chronic disease. As expected, say the authors, these diseases gradually increased with age.
The authors believe there are a number of explanations for the findings: "if work is tiring for many older workers, the decrease in fatigue could simply reflect removal of the source of the problem ... furthermore, retirement may allow people more time to engage in stimulating and restorative activities, such as physical exercise," they write.
They conclude that their research results "indicate that fatigue may be an underlying reason for early exit from the labour market and decreased productivity, and redesign of work, healthcare interventions or both may be necessary to enable a larger proportion of older people to work in full health."
In an accompanying editorial, Alex Burdorf, a professor in the determinants of public health in the Netherlands, says the study "is unique in that annual health measurements were carried out several years before and after retirement."
Burdorf believes further research is needed to corroborate the findings as they contradict other studies and says "it is too early to make definite claims about positive and negative benefits from retirement at a particular age." The author agrees, however, that efforts are needed to improve and adapt working conditions "to help elderly workers maintain good health."
Click here to view full paper
Click here to view full editorial
Psychiatry Symposium To Address Collaborations In Mood Disorder Research, Treatments
The Johns Hopkins University School of Medicine will hold its 24th Annual Mood Disorders Research and Education Symposium on April 20, focusing on joint efforts between researchers and clinicians to study and treat depression and bipolar disease.
Speakers on these topics from Hopkins and elsewhere will give talks from 12:45 p.m. to 6 p.m. in Turner Auditorium on Johns Hopkins Medicine's East Baltimore campus.
Among the presenters:
- Col. Elspeth Cameron Ritchie, M.D., adult and forensic psychiatrist and medical director of the Army Medical Department's Office of Strategic Communications. An internationally recognized expert, she brings a public health approach to the management of disaster- and combat-related mental health issues. She will address the challenges of recognizing and treating mood disorders and posttraumatic stress disorder in the military communit
- Kay Redfield Jamison, Ph.D., professor of psychiatry and behavioral sciences, co-director of the Johns Hopkins Mood Disorders Center, and an internationally recognized author. She will offer a historical perspective on mood disorders focusing on the biography of 19th century poet Nathaniel Hawthorne.
- James Potash, M.D., M.P.H., associate professor of psychiatry at the Johns Hopkins University School of Medicine, will describe current collaborative efforts to understand the underlying causes of mood disorders through genetic research. His recent research includes the identification of a novel genetic component in major depression, found by analyzing data from three major genetic studies of mood disorders.
Other speakers include Karen Swartz, M.D., director of the Mood Disorders Clinical Programs at the Johns Hopkins University School of Medicine; John Greden, M.D., former chair of psychiatry at the University of Michigan, founder of the Michigan Depression Center, and founding chair of the National Network of Depression Centers; Frank DeGruy, M.D., M.S.F.M., professor and chair of the Department of Family Medicine and director of primary care outreach and research at the University of Colorado Denver School of Medicine; and David A. Axelson, M.D., associate professor of psychiatry at the University of Pittsburgh School of Medicine and director of the Child and Adolescent Bipolar Services Program at the Western Psychiatric Institute and Clinic.
Mood disorders are among the most common illnesses in the world. An estimated 20 percent of adults suffer from depression or bipolar disorder.
Intended for psychiatrists, social workers, psychologists and counselors, the symposium is also open to patients, family members and anyone who has an interest in learning more about bipolar disorders and recurrent depression.
The symposium is presented by the Johns Hopkins Department of Psychiatry and Behavioral Sciences, the Johns Hopkins Mood Disorders Center and the Institute for Johns Hopkins Nursing.
Source
Johns Hopkins Medicine
Speakers on these topics from Hopkins and elsewhere will give talks from 12:45 p.m. to 6 p.m. in Turner Auditorium on Johns Hopkins Medicine's East Baltimore campus.
Among the presenters:
- Col. Elspeth Cameron Ritchie, M.D., adult and forensic psychiatrist and medical director of the Army Medical Department's Office of Strategic Communications. An internationally recognized expert, she brings a public health approach to the management of disaster- and combat-related mental health issues. She will address the challenges of recognizing and treating mood disorders and posttraumatic stress disorder in the military communit
- Kay Redfield Jamison, Ph.D., professor of psychiatry and behavioral sciences, co-director of the Johns Hopkins Mood Disorders Center, and an internationally recognized author. She will offer a historical perspective on mood disorders focusing on the biography of 19th century poet Nathaniel Hawthorne.
- James Potash, M.D., M.P.H., associate professor of psychiatry at the Johns Hopkins University School of Medicine, will describe current collaborative efforts to understand the underlying causes of mood disorders through genetic research. His recent research includes the identification of a novel genetic component in major depression, found by analyzing data from three major genetic studies of mood disorders.
Other speakers include Karen Swartz, M.D., director of the Mood Disorders Clinical Programs at the Johns Hopkins University School of Medicine; John Greden, M.D., former chair of psychiatry at the University of Michigan, founder of the Michigan Depression Center, and founding chair of the National Network of Depression Centers; Frank DeGruy, M.D., M.S.F.M., professor and chair of the Department of Family Medicine and director of primary care outreach and research at the University of Colorado Denver School of Medicine; and David A. Axelson, M.D., associate professor of psychiatry at the University of Pittsburgh School of Medicine and director of the Child and Adolescent Bipolar Services Program at the Western Psychiatric Institute and Clinic.
Mood disorders are among the most common illnesses in the world. An estimated 20 percent of adults suffer from depression or bipolar disorder.
Intended for psychiatrists, social workers, psychologists and counselors, the symposium is also open to patients, family members and anyone who has an interest in learning more about bipolar disorders and recurrent depression.
The symposium is presented by the Johns Hopkins Department of Psychiatry and Behavioral Sciences, the Johns Hopkins Mood Disorders Center and the Institute for Johns Hopkins Nursing.
Source
Johns Hopkins Medicine
Clinical Trial Finds Cognitive Training Software Helps Combat Effects Of Depression In Baby Boomers, Seniors
New findings
on the effects of computer based-training on cognitive function for baby
boomers and seniors suggest that cognitive training offers a positive
impact and should be prescribed for individuals living with depression.
The findings, presented here at The Alzheimer's Association
International Conference on the Prevention of Dementia, are the latest data
from a first-of- its-kind, double-blind clinical trial on the effects of
computer-based training on cognitive function during two years for the
over-50 crowd.
"The results of our clinical trial suggest that cognitive training
should be widely encouraged among depressed patients," said Amos Korczyn,
M.D., trial investigator, as well as chairman of the Department of
Neurology for Tel-Aviv University's Tel-Aviv Sourasky Medical Center,
professor and incumbent of the chair of neurology at Tel-Aviv University's
Sackler School of Medicine and Chief Scientist for NexSig, a company that
develops adaptive diagnostic systems for early detection of neurological
disorders. "Scientists have established that depression is associated with
dementia, cognitive decline and Alzheimer's disease, as well as with
greater cognitive and functional decline and higher rates of
institutionalization."
In the research, the computer training in MindFit(TM) cognitive skill
assessment and training software, created by CogniFit, Ltd.
(cognifit), was found to improve short-term memory, spatial
relations and attention focus-for all subjects. While all study
participants benefited from the use of computer games, MindFit users
experienced greater improvement in the cognitive domains of spatial short
term memory, visuo-spatial learning and focused attention.
"Research has shown that regularly scheduled cognitive exercise can not
only improve cognitive function among healthy boomers and seniors, but in
patients diagnosed with MCI (minimal cognitive impairment) as well," said
Prof. Shlomo Breznitz, Ph.D., founder and president of CogniFit. "As such,
cognitive therapy--either alone or with existent drugs--can help fend-off
Alzheimer's and help sharpen the cognitive function of those living with
depression."
In the latest findings, 15.7 percent of study participants were shown
to have depression (Geriatric Depression Scale>5) at baseline. Yet, the
cognitive side effects of depression did not prevent that population from
benefiting as much as other users from cognitive training to improve
attention focus and sustainment; recognition, recall and spacial short-term
memory; visuo-spatial learning; executive functions; and, mental
flexibility.
The trial was conducted at the Tel-Aviv Sourasky Medical Center of Tel-
Aviv University in Israel, where researchers are taking a leading role in
the study of age-related disorders. During the two-year clinical trial,
doctors conducted a prospective, randomized, double-blind study with active
comparators of 121 self-referred volunteer participants age 50 and older.
Each study participant was randomly assigned to spend 30 minutes, three
times a week during the course of three months at home, using either
MindFit or sophisticated computer games.
While all study participants benefited from the use of computer games,
MindFit users experienced greater improvement in the cognitive domains of
spatial short term memory, visuo-spatial learning and focused attention.
Additionally, MindFit users in the study with lower baseline cognitive
performance gained more than those with normal cognition, showing the
potential therapeutic effect of home-based computer training software in
those already suffering the effects of aging or more serious diseases.
MindFit software helps to assess and build overall cognitive skills for
baby boomers, seniors and people of all ages. In other research studies,
MindFit has helped users to improve their short-term memory by 18 percent.
The comprehensive cognitive training program assesses, trains and enhances
cognitive skills--including memory, focus, learning and concentration--and
safeguards overall cognitive vitality, an overall concept patented by
CogniFit. Unlike any other cognitive assessment and training software on
the market, MindFit's patented, personally tailoring technology provides
fun, individualized training to match users' unique cognitive skill sets,
changing exercises and levels to suit each individual's unique needs.
In March, MindFit was recognized with a 2007 American Society on Aging
Business and Aging Award.
About Tel-Aviv Sourasky Medical Center
Tel-Aviv Sourasky Medical Center (tasmc.il/e) is
Israel's second largest hospital, serving the Tel-Aviv metropolitan area.
Founded in 1963 as a 1-building facility, The Tel Aviv Medical Center is
now spread-out over an area of 150,000 meters and incorporates three
hospitals: the Ichilov General Hospital and Ida Sourasky Rehabilitation
Center, the Lis Maternity Hospital, and the Dana Children's Hospital. The
Tel Aviv Medical Center also serves as an instructional and research center
affiliated with the Sackler Medical School and the Sheinborn Nursing School
of Tel Aviv University.
About CogniFit, Ltd.
CogniFit (cognifit) is a pioneer in the assessment and training
of human cognitive abilities. The company focuses on developing advanced
software tools for consumers and businesses that assess and enhance basic
cognitive skills such as memory, perception and attention. Its initial
award-winning product offerings are DriveFit and MindFit. DriveFit is a
suite of programs aimed at helping to assess and build the cognitive and
psychomotor skills needed by novice, senior and fleet drivers. The MindFit
family of products helps to assess and build overall cognitive skills for
Baby Boomers, seniors and people of all ages.
The company was founded in 1999 by Prof. Shlomo Breznitz, Ph.D.,
international psychology authority and founding director of the Center for
Study of Psychological Stress at the University of Haifa.
CogniFit, MindFit and MindFit Corporate are all trademarks of CogniFit,
Ltd. All other trade names are the property of their respective owners.
CogniFit
cognifit
on the effects of computer based-training on cognitive function for baby
boomers and seniors suggest that cognitive training offers a positive
impact and should be prescribed for individuals living with depression.
The findings, presented here at The Alzheimer's Association
International Conference on the Prevention of Dementia, are the latest data
from a first-of- its-kind, double-blind clinical trial on the effects of
computer-based training on cognitive function during two years for the
over-50 crowd.
"The results of our clinical trial suggest that cognitive training
should be widely encouraged among depressed patients," said Amos Korczyn,
M.D., trial investigator, as well as chairman of the Department of
Neurology for Tel-Aviv University's Tel-Aviv Sourasky Medical Center,
professor and incumbent of the chair of neurology at Tel-Aviv University's
Sackler School of Medicine and Chief Scientist for NexSig, a company that
develops adaptive diagnostic systems for early detection of neurological
disorders. "Scientists have established that depression is associated with
dementia, cognitive decline and Alzheimer's disease, as well as with
greater cognitive and functional decline and higher rates of
institutionalization."
In the research, the computer training in MindFit(TM) cognitive skill
assessment and training software, created by CogniFit, Ltd.
(cognifit), was found to improve short-term memory, spatial
relations and attention focus-for all subjects. While all study
participants benefited from the use of computer games, MindFit users
experienced greater improvement in the cognitive domains of spatial short
term memory, visuo-spatial learning and focused attention.
"Research has shown that regularly scheduled cognitive exercise can not
only improve cognitive function among healthy boomers and seniors, but in
patients diagnosed with MCI (minimal cognitive impairment) as well," said
Prof. Shlomo Breznitz, Ph.D., founder and president of CogniFit. "As such,
cognitive therapy--either alone or with existent drugs--can help fend-off
Alzheimer's and help sharpen the cognitive function of those living with
depression."
In the latest findings, 15.7 percent of study participants were shown
to have depression (Geriatric Depression Scale>5) at baseline. Yet, the
cognitive side effects of depression did not prevent that population from
benefiting as much as other users from cognitive training to improve
attention focus and sustainment; recognition, recall and spacial short-term
memory; visuo-spatial learning; executive functions; and, mental
flexibility.
The trial was conducted at the Tel-Aviv Sourasky Medical Center of Tel-
Aviv University in Israel, where researchers are taking a leading role in
the study of age-related disorders. During the two-year clinical trial,
doctors conducted a prospective, randomized, double-blind study with active
comparators of 121 self-referred volunteer participants age 50 and older.
Each study participant was randomly assigned to spend 30 minutes, three
times a week during the course of three months at home, using either
MindFit or sophisticated computer games.
While all study participants benefited from the use of computer games,
MindFit users experienced greater improvement in the cognitive domains of
spatial short term memory, visuo-spatial learning and focused attention.
Additionally, MindFit users in the study with lower baseline cognitive
performance gained more than those with normal cognition, showing the
potential therapeutic effect of home-based computer training software in
those already suffering the effects of aging or more serious diseases.
MindFit software helps to assess and build overall cognitive skills for
baby boomers, seniors and people of all ages. In other research studies,
MindFit has helped users to improve their short-term memory by 18 percent.
The comprehensive cognitive training program assesses, trains and enhances
cognitive skills--including memory, focus, learning and concentration--and
safeguards overall cognitive vitality, an overall concept patented by
CogniFit. Unlike any other cognitive assessment and training software on
the market, MindFit's patented, personally tailoring technology provides
fun, individualized training to match users' unique cognitive skill sets,
changing exercises and levels to suit each individual's unique needs.
In March, MindFit was recognized with a 2007 American Society on Aging
Business and Aging Award.
About Tel-Aviv Sourasky Medical Center
Tel-Aviv Sourasky Medical Center (tasmc.il/e) is
Israel's second largest hospital, serving the Tel-Aviv metropolitan area.
Founded in 1963 as a 1-building facility, The Tel Aviv Medical Center is
now spread-out over an area of 150,000 meters and incorporates three
hospitals: the Ichilov General Hospital and Ida Sourasky Rehabilitation
Center, the Lis Maternity Hospital, and the Dana Children's Hospital. The
Tel Aviv Medical Center also serves as an instructional and research center
affiliated with the Sackler Medical School and the Sheinborn Nursing School
of Tel Aviv University.
About CogniFit, Ltd.
CogniFit (cognifit) is a pioneer in the assessment and training
of human cognitive abilities. The company focuses on developing advanced
software tools for consumers and businesses that assess and enhance basic
cognitive skills such as memory, perception and attention. Its initial
award-winning product offerings are DriveFit and MindFit. DriveFit is a
suite of programs aimed at helping to assess and build the cognitive and
psychomotor skills needed by novice, senior and fleet drivers. The MindFit
family of products helps to assess and build overall cognitive skills for
Baby Boomers, seniors and people of all ages.
The company was founded in 1999 by Prof. Shlomo Breznitz, Ph.D.,
international psychology authority and founding director of the Center for
Study of Psychological Stress at the University of Haifa.
CogniFit, MindFit and MindFit Corporate are all trademarks of CogniFit,
Ltd. All other trade names are the property of their respective owners.
CogniFit
cognifit
Diabetes - Depression link
A new study shows women with diabetes have a higher risk of depression.
British researchers studied more than 4,200 women between ages 60 and 79. The participants were divided into two groups.
The first group included women with diabetes, and the second included those without diabetes. Women who did not have diabetes were again divided into four smaller groups, based on their levels of insulin resistance.
Researchers assessed the women's mental states by evaluating their medications, medical history, and results from a mood questionnaire. Results of the study show women without diabetes, who have increasing levels of insulin resistance, are not likely to be depressed.
However, the risk of depression increases in women with diabetes. Previous studies have shown individuals who are insulin-resistant may have higher serotonin concentrations and may be more prone to depression and even suicide.
Authors of the study write, "Insulin resistance is inversely associated with depression. Our results are consistent with a large prospective study in which indicators of insulin sensitivity were associated with suicide risk."
They say women with diabetes may be more likely to suffer depression because of the clinical diagnosis.
Authors of the study conclude, "If our findings are confirmed, there may be an indication for assessing depressive symptoms among individuals receiving treatments that affect insulin resistance, since depressive symptoms are often disabling and could affect compliance with treatment and quality of life."
British researchers studied more than 4,200 women between ages 60 and 79. The participants were divided into two groups.
The first group included women with diabetes, and the second included those without diabetes. Women who did not have diabetes were again divided into four smaller groups, based on their levels of insulin resistance.
Researchers assessed the women's mental states by evaluating their medications, medical history, and results from a mood questionnaire. Results of the study show women without diabetes, who have increasing levels of insulin resistance, are not likely to be depressed.
However, the risk of depression increases in women with diabetes. Previous studies have shown individuals who are insulin-resistant may have higher serotonin concentrations and may be more prone to depression and even suicide.
Authors of the study write, "Insulin resistance is inversely associated with depression. Our results are consistent with a large prospective study in which indicators of insulin sensitivity were associated with suicide risk."
They say women with diabetes may be more likely to suffer depression because of the clinical diagnosis.
Authors of the study conclude, "If our findings are confirmed, there may be an indication for assessing depressive symptoms among individuals receiving treatments that affect insulin resistance, since depressive symptoms are often disabling and could affect compliance with treatment and quality of life."
Depression May Be Both Consequence Of And Risk Factor For Diabetes
Diabetes appears to be associated with the risk of depression and vice versa, suggesting the relationship between the two works in both directions, according to a report in the November 22 issue of Archives of Internal Medicine, one of the JAMA/Archives journals.
An estimated 23.5 million U.S. adults-more than 10 percent-have diabetes, including 23 percent of those ages 60 and older, according to background information in the article. Major depressive disorder affects about 14.8 million U.S. adults each year. "Although it has been hypothesized that the diabetes-depression relation is bidirectional, few studies have addressed this hypothesis in a prospective setting," the authors write.
An Pan, Ph.D., of the Harvard School of Public Health, Boston, and colleagues assessed the relationship between the two diseases among 65,381 women who were age 50 to 75 in 1996. Participants completed an initial questionnaire about their medical history and health practices, and then follow-up questionnaires every two years through 2006. They were classified as having depression if they reported symptoms of depression, using antidepressant medication or being given a diagnosis of depression by a physician. Women who reported a new diagnosis of diabetes completed a supplementary questionnaire about symptoms, diagnostic tests and treatments.
During the 10-year follow-up, 2,844 women were diagnosed with type 2 diabetes and 7,415 developed depression. Women with depression were about 17 percent more likely to develop diabetes after controlling for other risk factors, such as physical activity and body mass index (BMI). Those who were taking antidepressants had a 25 percent higher risk of developing diabetes than those who did not have depression.
After controlling for other risk factors for mood disorders, women with diabetes were 29 percent more likely to develop depression. Women who took insulin for diabetes had a further increased risk-53 percent higher than women without diabetes.
"The findings from this well-characterized cohort of more than 55,000 U.S. women with 10 years' follow-up add to the growing evidence that depression and diabetes are closely related to each other, and this reciprocal association also depends on the severity or treatment of each condition," the authors write. "All the associations were independent of sociodemographic, diet and lifestyle factors."
The results indicate that lifestyle factors such as physical activity and BMI may partially mediate the association between depression and new cases of diabetes, but since the association remained significant after adjusting for these factors, depression may have an effect on risk for diabetes beyond weight and inactivity. In addition, the findings reinforce the idea that diabetes is related to stress, the authors note. "A diagnosis of diabetes may lead to the symptoms of depression for the following reasons: depression may result from the biochemical changes directly caused by diabetes or its treatment, or from the stresses and strains associated with living with diabetes and its often debilitating consequences," they write.
"Future studies are needed to confirm our findings in different populations and to investigate the potential mechanisms underlying this association," the authors conclude. "Furthermore, depression and diabetes are highly prevalent in the middle-aged and elderly population, particularly in women. Thus, proper lifestyle interventions including adequate weight management and regular physical activity are recommended to lower the risk of both conditions."
(Arch Intern Med. 2010;170[21]:1884-1891.)
An estimated 23.5 million U.S. adults-more than 10 percent-have diabetes, including 23 percent of those ages 60 and older, according to background information in the article. Major depressive disorder affects about 14.8 million U.S. adults each year. "Although it has been hypothesized that the diabetes-depression relation is bidirectional, few studies have addressed this hypothesis in a prospective setting," the authors write.
An Pan, Ph.D., of the Harvard School of Public Health, Boston, and colleagues assessed the relationship between the two diseases among 65,381 women who were age 50 to 75 in 1996. Participants completed an initial questionnaire about their medical history and health practices, and then follow-up questionnaires every two years through 2006. They were classified as having depression if they reported symptoms of depression, using antidepressant medication or being given a diagnosis of depression by a physician. Women who reported a new diagnosis of diabetes completed a supplementary questionnaire about symptoms, diagnostic tests and treatments.
During the 10-year follow-up, 2,844 women were diagnosed with type 2 diabetes and 7,415 developed depression. Women with depression were about 17 percent more likely to develop diabetes after controlling for other risk factors, such as physical activity and body mass index (BMI). Those who were taking antidepressants had a 25 percent higher risk of developing diabetes than those who did not have depression.
After controlling for other risk factors for mood disorders, women with diabetes were 29 percent more likely to develop depression. Women who took insulin for diabetes had a further increased risk-53 percent higher than women without diabetes.
"The findings from this well-characterized cohort of more than 55,000 U.S. women with 10 years' follow-up add to the growing evidence that depression and diabetes are closely related to each other, and this reciprocal association also depends on the severity or treatment of each condition," the authors write. "All the associations were independent of sociodemographic, diet and lifestyle factors."
The results indicate that lifestyle factors such as physical activity and BMI may partially mediate the association between depression and new cases of diabetes, but since the association remained significant after adjusting for these factors, depression may have an effect on risk for diabetes beyond weight and inactivity. In addition, the findings reinforce the idea that diabetes is related to stress, the authors note. "A diagnosis of diabetes may lead to the symptoms of depression for the following reasons: depression may result from the biochemical changes directly caused by diabetes or its treatment, or from the stresses and strains associated with living with diabetes and its often debilitating consequences," they write.
"Future studies are needed to confirm our findings in different populations and to investigate the potential mechanisms underlying this association," the authors conclude. "Furthermore, depression and diabetes are highly prevalent in the middle-aged and elderly population, particularly in women. Thus, proper lifestyle interventions including adequate weight management and regular physical activity are recommended to lower the risk of both conditions."
(Arch Intern Med. 2010;170[21]:1884-1891.)
Depression Ups Risk Of Complications Following Heart Attack
People who suffer from severe depression following a heart attack might be more likely to experience cardiac complications while hospitalized, according to a new study.
"There is good evidence that if a person has depression after a heart attack, they are more likely to die from cardiac causes in the following months and years," said lead author Jeff Huffman, M.D., assistant professor of psychiatry at Harvard Medical School. "No one had yet studied whether depression impacts cardiac outcomes immediately after a heart attack-the time we see the most complications."
The study included 129 patients at Massachusetts General Hospital. Within 72 hours of having a heart attack, each participant underwent an interview to determine if he or she suffered from depression or anxiety. Seventeen of the original group members had a diagnosis of major depression lasting for at least two weeks.
The presence of major depression was a significant predictor of heart rhythm problems, congestive heart failure or a second heart attack.
Anxiety did not affect the risk for any in-hospital complication.
"The results suggest that physicians should be especially mindful of treating depression in patients with cardiac risk factors," Huffman said. "They also suggest close in-hospital monitoring of heart attack patients with major depression given this increased risk for complications."
Huffman noted that the study, which appears in the July-August issue of the journal Psychosomatics, is a small, preliminary study. Most of the participants were white males, so its findings might not apply to other groups.
"What is surprising is that differences in outcomes were seen in a relatively short time. The new observation is that risk for these bad outcomes start while patients are still in the hospital," said David Bush, M.D., associate professor at The Johns Hopkins University School of Medicine and Heart Institute.
"The separation between heart disease, typically managed by cardiologists and internists, and mental disease, typically managed by psychiatrists, is not as great as many seem to think." Bush said. "Physicians and patients should be sensitive to this and work on treating depression in addition to controlling diabetes, lowering blood pressure and lowering cholesterol."
Pre-existing major depression predicts in-hospital cardiac complications after acute myocardial infarction.
Huffman JC, et al.
Psychosomatics 49(4), 2008.
Health Behavior News Service
"There is good evidence that if a person has depression after a heart attack, they are more likely to die from cardiac causes in the following months and years," said lead author Jeff Huffman, M.D., assistant professor of psychiatry at Harvard Medical School. "No one had yet studied whether depression impacts cardiac outcomes immediately after a heart attack-the time we see the most complications."
The study included 129 patients at Massachusetts General Hospital. Within 72 hours of having a heart attack, each participant underwent an interview to determine if he or she suffered from depression or anxiety. Seventeen of the original group members had a diagnosis of major depression lasting for at least two weeks.
The presence of major depression was a significant predictor of heart rhythm problems, congestive heart failure or a second heart attack.
Anxiety did not affect the risk for any in-hospital complication.
"The results suggest that physicians should be especially mindful of treating depression in patients with cardiac risk factors," Huffman said. "They also suggest close in-hospital monitoring of heart attack patients with major depression given this increased risk for complications."
Huffman noted that the study, which appears in the July-August issue of the journal Psychosomatics, is a small, preliminary study. Most of the participants were white males, so its findings might not apply to other groups.
"What is surprising is that differences in outcomes were seen in a relatively short time. The new observation is that risk for these bad outcomes start while patients are still in the hospital," said David Bush, M.D., associate professor at The Johns Hopkins University School of Medicine and Heart Institute.
"The separation between heart disease, typically managed by cardiologists and internists, and mental disease, typically managed by psychiatrists, is not as great as many seem to think." Bush said. "Physicians and patients should be sensitive to this and work on treating depression in addition to controlling diabetes, lowering blood pressure and lowering cholesterol."
Pre-existing major depression predicts in-hospital cardiac complications after acute myocardial infarction.
Huffman JC, et al.
Psychosomatics 49(4), 2008.
Health Behavior News Service
Innovative University Of Queensland Tai Chi Program Treats Depression, Diabetes And Obesity, Australia
Promising results from an innovative UQ Tai Chi-based study show depression, diabetes and obesity can all be improved through a gentle mind-body therapeutic program.
The proportion of participants with clinical levels of depression decreased from 60 percent to 20 percent. BMI and waist circumference also significantly decreased by 4 percent and 3 percent respectively.
This specific program may be the first exercise program that has scientifically shown significant effects of exercise alone on both depression and diabesity (diabetes and obesity).
Dr Liu Xin, a UQ scientist and a renowned expert in the field of mind-body therapy, developed this unique program for the control of depression and diabesity.
The three month pilot study, funded by the Diabetes Australia Research Trust, was conducted at The University of Queensland.
"Without involvement of any dietary intervention and high intensity training, it was very encouraging to see such impressive results over a short period of time," Dr Liu said.
"In addition to the improvements in depression and obesity, the results of the study also show that this specific program has a beneficial effect on indicators of blood glucose control (decreased by 6 percent), hypertension (decreased by 9 percent and 12 percent in systolic and diastolic blood pressure respectively) and insulin resistance (decreased by 20 percent)," he said.
"Other reported benefits include improvements in energy levels, sleeping patterns, urinary control, breathing, immunity, confidence, self-esteem and coping; and positive changes in life perspective and family harmony".
"The majority of the promising findings were replicated in a following randomized controlled trial."
An extended large controlled study named SMILE* Tai Chi Program focusing on depression and obesity has recently been funded by the National Heart Foundation and Beyondblue (SMILE* refers to Mental and Metabolic Syndrome Innovative Life-long Exercise).
The funding is the second largest grant ever provided under the National Heart Foundation and Beyondblue Cardiovascular Disease and Depression Strategic Research Program.
The prevalence of depression and obesity are two of the most common health problems in the western world.
In Australia, one in five people experience depression at some stage of their lives, and more than half of Australian adults are either overweight or obese.
"If this SMILE program can be further confirmed to have beneficial effects on indicators of depression, obesity and other risk factors for developing cardiovascular diseases in the large trial, the findings can be translated into great social and economic benefit for public health," Dr Liu said.
Information: the researchers are currently looking to recruit more volunteers to take part in this upcoming large study, which starts now.
People with both depression and central obesity [waist of more than 94 cm (men), more than 80 cm (women) or Body Mass Index of more than 30] can contact the Smile Program Hot Line by email (smileprogramuq.au).
Source
University of Queensland
The proportion of participants with clinical levels of depression decreased from 60 percent to 20 percent. BMI and waist circumference also significantly decreased by 4 percent and 3 percent respectively.
This specific program may be the first exercise program that has scientifically shown significant effects of exercise alone on both depression and diabesity (diabetes and obesity).
Dr Liu Xin, a UQ scientist and a renowned expert in the field of mind-body therapy, developed this unique program for the control of depression and diabesity.
The three month pilot study, funded by the Diabetes Australia Research Trust, was conducted at The University of Queensland.
"Without involvement of any dietary intervention and high intensity training, it was very encouraging to see such impressive results over a short period of time," Dr Liu said.
"In addition to the improvements in depression and obesity, the results of the study also show that this specific program has a beneficial effect on indicators of blood glucose control (decreased by 6 percent), hypertension (decreased by 9 percent and 12 percent in systolic and diastolic blood pressure respectively) and insulin resistance (decreased by 20 percent)," he said.
"Other reported benefits include improvements in energy levels, sleeping patterns, urinary control, breathing, immunity, confidence, self-esteem and coping; and positive changes in life perspective and family harmony".
"The majority of the promising findings were replicated in a following randomized controlled trial."
An extended large controlled study named SMILE* Tai Chi Program focusing on depression and obesity has recently been funded by the National Heart Foundation and Beyondblue (SMILE* refers to Mental and Metabolic Syndrome Innovative Life-long Exercise).
The funding is the second largest grant ever provided under the National Heart Foundation and Beyondblue Cardiovascular Disease and Depression Strategic Research Program.
The prevalence of depression and obesity are two of the most common health problems in the western world.
In Australia, one in five people experience depression at some stage of their lives, and more than half of Australian adults are either overweight or obese.
"If this SMILE program can be further confirmed to have beneficial effects on indicators of depression, obesity and other risk factors for developing cardiovascular diseases in the large trial, the findings can be translated into great social and economic benefit for public health," Dr Liu said.
Information: the researchers are currently looking to recruit more volunteers to take part in this upcoming large study, which starts now.
People with both depression and central obesity [waist of more than 94 cm (men), more than 80 cm (women) or Body Mass Index of more than 30] can contact the Smile Program Hot Line by email (smileprogramuq.au).
Source
University of Queensland
Forest Laboratories And Gedeon Richter Plc Announce Results From A Phase II Study Of Cariprazine As Adjunctive Therapy In Major Depressive Disorder
Forest Laboratories, Inc. (NYSE: FRX) and Gedeon Richter Plc. announced preliminary top-line results from an 8-week Phase II clinical trial of the novel, investigational antipsychotic agent cariprazine as adjunctive therapy in major depressive disorder. Cariprazine is currently undergoing Phase III trials for the separate and additional indications of schizophrenia and bipolar mania.
In this exploratory Phase II trial, a total of 231 patients were randomized to enter one of two active (low dose or high dose) treatment arms or placebo. The primary endpoint was the Montgomery Asberg Depression Rating Scale (MADRS) score. Although the overall difference observed between the drug-treated and placebo-treated groups was not statistically significant, over the course of the trial, there was evidence of a treatment effect in the high-dose arm of the study compared to placebo.
In addition, tolerability results for cariprazine support further investigation in this patient population. Approximately 3% of patients discontinued the study early due to adverse events in the high-dose and 1% in the low-dose study arm compared to 3% in the placebo arm.
The companies are considering conducting an additional Phase II dose-response trial examining a wider range of doses.
About the Study
This Phase II trial was a U.S. multicenter, randomized double-blind, placebo-controlled, parallel, flexible-dose group study that evaluated the efficacy, safety and tolerability of once-daily cariprazine in patients with major depressive disorder who failed to respond to at least 2 antidepressant therapies (ADT). Following a washout period of no drug therapy for one week and 8 weeks of prospective ADTs, a total of 231 patients, between ages 18 and 65 years old, were randomized to one of three treatment arms (either 0.1-0.3 mg per day cariprazine + ADT, 1.0-2.0 mg per day cariprazine + ADT, or placebo + ADT). The primary endpoint was defined as change from randomization baseline to end of Week 8 in the MADRS total score.
About Cariprazine
Cariprazine, discovered by researchers at Gedeon Richter, is an orally active, potent D3/D2 partial agonist that preferentially binds to D3 receptors. Cariprazine also has a relatively low potency at other receptor sites, such as 5-HT2C, histamine H1, and muscarinic and adrenergic receptor sites which have been associated with adverse events. Cariprazine demonstrated a reduction in symptoms in previously reported Phase II clinical trials for schizophrenia and bipolar mania.
In this exploratory Phase II trial, a total of 231 patients were randomized to enter one of two active (low dose or high dose) treatment arms or placebo. The primary endpoint was the Montgomery Asberg Depression Rating Scale (MADRS) score. Although the overall difference observed between the drug-treated and placebo-treated groups was not statistically significant, over the course of the trial, there was evidence of a treatment effect in the high-dose arm of the study compared to placebo.
In addition, tolerability results for cariprazine support further investigation in this patient population. Approximately 3% of patients discontinued the study early due to adverse events in the high-dose and 1% in the low-dose study arm compared to 3% in the placebo arm.
The companies are considering conducting an additional Phase II dose-response trial examining a wider range of doses.
About the Study
This Phase II trial was a U.S. multicenter, randomized double-blind, placebo-controlled, parallel, flexible-dose group study that evaluated the efficacy, safety and tolerability of once-daily cariprazine in patients with major depressive disorder who failed to respond to at least 2 antidepressant therapies (ADT). Following a washout period of no drug therapy for one week and 8 weeks of prospective ADTs, a total of 231 patients, between ages 18 and 65 years old, were randomized to one of three treatment arms (either 0.1-0.3 mg per day cariprazine + ADT, 1.0-2.0 mg per day cariprazine + ADT, or placebo + ADT). The primary endpoint was defined as change from randomization baseline to end of Week 8 in the MADRS total score.
About Cariprazine
Cariprazine, discovered by researchers at Gedeon Richter, is an orally active, potent D3/D2 partial agonist that preferentially binds to D3 receptors. Cariprazine also has a relatively low potency at other receptor sites, such as 5-HT2C, histamine H1, and muscarinic and adrenergic receptor sites which have been associated with adverse events. Cariprazine demonstrated a reduction in symptoms in previously reported Phase II clinical trials for schizophrenia and bipolar mania.
Patient Groups Tackle Stigma Attached To Bipolar Disorder And Other Mental Illnesses With New Tools
Mental illness is one of the last surviving stigmas in today's liberal society. Class, race, religion, gender and sexual orientation, are all off-limits now as reasons for discrimination, social exclusion, jokes or disparaging remarks of any kind. Where these are concerned, we've come a long way in terms of tolerance, fairness and sensitivity to the feelings of others; as a rule, words are chosen carefully so as not to offend and legislation ensures fair treatment. Mental illness, however, despite affecting one in four of us at some point in our lives, still provokes prejudice, especially in the workplace. Job applications frequently ask potential employees to declare treatment for a mental illness. Those who answer truthfully are invariably unsuccessful and those in work who report mental illness can find themselves passed over for promotion. As a result many people with mental illness experience rejection, unemployment and a sense of social isolation through no fault of their own. Fewer than 20 per cent manage to hold down a job, according to patient advocacy groups.
"Living with mental illness is tough enough without having added to the burden of illness, the pain and rejection of stigma," points out John Bowis, a member of the European parliament. But it's not just employers who are to blame. "We all contribute to the stigmatisation of people, who if they had a physical problem, would receive our sympathy and support," he suggests.
Stigma attached to mental illness appears to remain a worldwide problem, affecting people of all cultures. In a recent survey among people with bipolar disorder, conducted globally by the pharmaceutical company AstraZeneca, 88 per cent said they felt stigmatised and socially isolated on account of their condition. Bipolar disorder, characterised by severe and recurring mood changes along a spectrum ranging from overactive, excited behaviour (mania) at one end to deep depression at the other, usually requires pharmacological treatment and psychosocial training in behavioural strategies to maintain mental equilibrium. Therapies are available that could potentially help many people who are currently keeping their illness to themselves, struggling on without medication. Treatment would give them a better chance to lead fulfilling lives at work and home. Unfortunately, perceived stigma is a major factor stopping them coming forward for diagnosis and treatment. The issue is a serious one because there is a high risk of suicide among inadequately managed people with bipolar disorder.
A Lexicon to help the media avoid negative stereotyping
How public perceptions of mental illness are formed and give rise to stigma is debateable. The role of the media may be merely to reflect rather than shape public perceptions; but many people believe misrepresentations of mentally ill people are constantly reinforced unnecessarily by all kinds of media from newspaper and broadcast news-reporting, to literary fiction, TV drama and film. In Spain, the US and the UK, over half of people with bipolar disorder, and their carers, said they believe the media is a major propagator of discrimination against people with mental illnesses.
Ignorance is the root cause of stigma. Overcoming it requires education and greater awareness at public level of what mental illness involves and how recovery is possible with treatment, say organisations such as the World Federation for Mental Health (WFMH). As they see it, the media could be potential allies in changing public attitudes.
The WFMH and six other patient advocacy groups recently collaborated on a publishing initiative for journalists titled "The Lexicon: International Media guide for Mental Health" with the help of an educational grant from AstraZeneca. "The Lexicon" has been designed in consultation with people with first-hand experience of mental illness as well as senior journalists, to help journalists promote responsible and accurate coverage of mental health issues and to give a balanced perspective. Journalists can consult "The Lexicon" when writing news stories involving a mentally disturbed person to select appropriate terminology and to write with sensitivity instead of opting for pejorative labels. It includes expert contact details, facts and statistics about mental illness, the correct definition of much misused terms like "schizophrenic" and "split personality", and gives examples of good and bad reporting.
Discussing "The Lexicon" at a recent AstraZeneca media event, WFMH immediate past president Dr Patt Franciosi said: "It shows journalists how to replace words that hurt with words that could help". Instead of terms no better than playground insults such as "nutter", "psycho", "schizo" and "sicko", The Lexicon suggests instead using the person's correct diagnosis or a term such as "disturbed" which does not carry condemnation. Before publishing a story involving a mentally ill person, Dr Franciosi suggests journalists should ask themselves if mentioning a diagnostic label is relevant. She advises. "Read it through and ask yourself - is this offensive? If it involved a relative of yours, would you want someone to say that about them?" The Lexicon is available from the website forum4mentalhealth/lexicon.
"Learning about Bipolar Disorder"
Another publishing initiative from the WFMH, also supported by an educational grant from AstraZeneca, is an educational 'tool-kit' titled "Learning about bipolar disorder". This is aimed principally at people seeking help for mood disorders but includes a special section for healthcare professionals.
"Until the nature of bipolar disorder is better understood, and until stigma is reduced, many people with mood disorders will avoid or delay seeking help and remain in denial," believes Dr Franciosi. "In the process, marriages are wrecked and jobs lost." Around 27 million people worldwide are affected by bipolar disorder. It is the sixth leading cause of disability, yet much of it goes undiagnosed for years, she points out. The tool-kit is designed to empower people with bipolar disorder and their families by giving them the information they need to recognise, accept and manage symptoms more effectively. Of equal importance is the inclusion of advice directing them on how to create and maintain a healthy lifestyle, she notes. "Over half of people with bipolar disorder abuse substances such as alcohol. This has to be recognised and help given to overcome it."
The "Learning about Bipolar Disorder" tool-kit also provides information for health care professionals in primary care to whom people with bipolar disorder are likely to turn first for help. Explaining bipolar disorder to new patients presenting with mood disorder symptoms can present a challenge Dr Franciosi acknowledges. "Primary care staff cannot be expected to teach every patient all they need to know in detail." The tool-kit offers them a way to pass on that information in a format that is quick and easy to access and in which medical knowledge is translated into layman's language.
As a patient information guide Dr Franciosi claims the tool-kit is particularly effective for a reason. "We found that what makes this special is the inclusion of personal stories. These are what hit home the most," she explained. "People read the experiences of others and find they resonate with their own." It helps them find the means to understand their own illness history and articulate it, and to see how others have learned to manage their condition. "Cultural differences are reflected in people's stories but these have nothing to with who gets bipolar disorder and who doesn't. The condition affects people of all cultures and people are vulnerable to it throughout the world."
The tool-kit "Learning about bipolar disorder" can be downloaded from the internet at wfmh
Written by Olwen Glynn Owen
forum4mentalhealth/lexicon
glynnowen(at)macline.co.uk
"Living with mental illness is tough enough without having added to the burden of illness, the pain and rejection of stigma," points out John Bowis, a member of the European parliament. But it's not just employers who are to blame. "We all contribute to the stigmatisation of people, who if they had a physical problem, would receive our sympathy and support," he suggests.
Stigma attached to mental illness appears to remain a worldwide problem, affecting people of all cultures. In a recent survey among people with bipolar disorder, conducted globally by the pharmaceutical company AstraZeneca, 88 per cent said they felt stigmatised and socially isolated on account of their condition. Bipolar disorder, characterised by severe and recurring mood changes along a spectrum ranging from overactive, excited behaviour (mania) at one end to deep depression at the other, usually requires pharmacological treatment and psychosocial training in behavioural strategies to maintain mental equilibrium. Therapies are available that could potentially help many people who are currently keeping their illness to themselves, struggling on without medication. Treatment would give them a better chance to lead fulfilling lives at work and home. Unfortunately, perceived stigma is a major factor stopping them coming forward for diagnosis and treatment. The issue is a serious one because there is a high risk of suicide among inadequately managed people with bipolar disorder.
A Lexicon to help the media avoid negative stereotyping
How public perceptions of mental illness are formed and give rise to stigma is debateable. The role of the media may be merely to reflect rather than shape public perceptions; but many people believe misrepresentations of mentally ill people are constantly reinforced unnecessarily by all kinds of media from newspaper and broadcast news-reporting, to literary fiction, TV drama and film. In Spain, the US and the UK, over half of people with bipolar disorder, and their carers, said they believe the media is a major propagator of discrimination against people with mental illnesses.
Ignorance is the root cause of stigma. Overcoming it requires education and greater awareness at public level of what mental illness involves and how recovery is possible with treatment, say organisations such as the World Federation for Mental Health (WFMH). As they see it, the media could be potential allies in changing public attitudes.
The WFMH and six other patient advocacy groups recently collaborated on a publishing initiative for journalists titled "The Lexicon: International Media guide for Mental Health" with the help of an educational grant from AstraZeneca. "The Lexicon" has been designed in consultation with people with first-hand experience of mental illness as well as senior journalists, to help journalists promote responsible and accurate coverage of mental health issues and to give a balanced perspective. Journalists can consult "The Lexicon" when writing news stories involving a mentally disturbed person to select appropriate terminology and to write with sensitivity instead of opting for pejorative labels. It includes expert contact details, facts and statistics about mental illness, the correct definition of much misused terms like "schizophrenic" and "split personality", and gives examples of good and bad reporting.
Discussing "The Lexicon" at a recent AstraZeneca media event, WFMH immediate past president Dr Patt Franciosi said: "It shows journalists how to replace words that hurt with words that could help". Instead of terms no better than playground insults such as "nutter", "psycho", "schizo" and "sicko", The Lexicon suggests instead using the person's correct diagnosis or a term such as "disturbed" which does not carry condemnation. Before publishing a story involving a mentally ill person, Dr Franciosi suggests journalists should ask themselves if mentioning a diagnostic label is relevant. She advises. "Read it through and ask yourself - is this offensive? If it involved a relative of yours, would you want someone to say that about them?" The Lexicon is available from the website forum4mentalhealth/lexicon.
"Learning about Bipolar Disorder"
Another publishing initiative from the WFMH, also supported by an educational grant from AstraZeneca, is an educational 'tool-kit' titled "Learning about bipolar disorder". This is aimed principally at people seeking help for mood disorders but includes a special section for healthcare professionals.
"Until the nature of bipolar disorder is better understood, and until stigma is reduced, many people with mood disorders will avoid or delay seeking help and remain in denial," believes Dr Franciosi. "In the process, marriages are wrecked and jobs lost." Around 27 million people worldwide are affected by bipolar disorder. It is the sixth leading cause of disability, yet much of it goes undiagnosed for years, she points out. The tool-kit is designed to empower people with bipolar disorder and their families by giving them the information they need to recognise, accept and manage symptoms more effectively. Of equal importance is the inclusion of advice directing them on how to create and maintain a healthy lifestyle, she notes. "Over half of people with bipolar disorder abuse substances such as alcohol. This has to be recognised and help given to overcome it."
The "Learning about Bipolar Disorder" tool-kit also provides information for health care professionals in primary care to whom people with bipolar disorder are likely to turn first for help. Explaining bipolar disorder to new patients presenting with mood disorder symptoms can present a challenge Dr Franciosi acknowledges. "Primary care staff cannot be expected to teach every patient all they need to know in detail." The tool-kit offers them a way to pass on that information in a format that is quick and easy to access and in which medical knowledge is translated into layman's language.
As a patient information guide Dr Franciosi claims the tool-kit is particularly effective for a reason. "We found that what makes this special is the inclusion of personal stories. These are what hit home the most," she explained. "People read the experiences of others and find they resonate with their own." It helps them find the means to understand their own illness history and articulate it, and to see how others have learned to manage their condition. "Cultural differences are reflected in people's stories but these have nothing to with who gets bipolar disorder and who doesn't. The condition affects people of all cultures and people are vulnerable to it throughout the world."
The tool-kit "Learning about bipolar disorder" can be downloaded from the internet at wfmh
Written by Olwen Glynn Owen
forum4mentalhealth/lexicon
glynnowen(at)macline.co.uk
New Insights Into Autoimmunity And Depression
Systemic lupus erythomatosus (SLE), often simply called lupus, is a complex autoimmune disease marked by joint pain, skin rashes, extreme fatigue, and depression, among other symptoms. Some studies have described a possible link between SLE's most severe psychiatric manifestation, psychosis, and a protein autoantibody associated with the central nervous system, anti-ribosomal P.
To investigate how an autoantibody could stimulate behavioral changes by interaction with the brain, researchers at Tel Aviv University set out to induce depressive hallmarks in mice. Their findings, presented in the March 2007 issue of Arthritis & Rheumatism, shed light on the brain pathways of depression in general and in central nervous system dysfunction in SLE in particular.
Healthy female mice received injections, directly into the brain, of human anti-ribosomal P antibodies extracted from the blood sample of an SLE patient. For control purposes, equal numbers of mice were injected with normal human immunoglobin G. All the mice were then subjected to a series of tests: a forced swimming test in a glass beaker partially filled water to evaluate escape-oriented behaviors, such as rearing and jumping; rotarod and grip strength tests to gauge motor function; a staircase test; a swim T-maze test to assess cognitive function; and a passive avoidance test to measure the ability of mice to remember a foot shock delivered 24-hours earlier.
Depression-like behavior was strongly observed in the performance of anti-ribosomal P antibody-injected mice on the forced swimming test. The immobility time of these mice was twice as high as that of the control group, indicating a state of despair. In the remaining tests of cognitive and motor functions, there were no significant differences detected between the mice in each group, ruling out neurological damage.
In an additional experiment, the "depressed" mice were randomly divided into treatment groups. Some mice were treated with fluoxetine, the antidepressant marketed as Prozac, and some mice were treated with haloperidol, a psychotropic drug used to treat anxiety, addiction, and depression. To determine the effectiveness of each therapy, mice were subjected to repeating the forced swimming, staircase, and rotarod tests. Depression-like behavior was significantly blocked by long-term treatment with fluoxetine, but not by short- or long-term treatment with haloperidol.
At the culmination of the experiments, the brains of mice were sectioned and scrutinized through immunostaining. The staining pattern delineated the limbic system, which regulates the automatic nervous system's response to stress. It also highlighted areas of the brain associated with the sense of smell.
These findings provide a novel line of research into the mechanisms underlying the limbic and olfactory pathways in depression. Imaging studies both in patients with clinical depression and patients with SLE could help determine whether these pathways are similarly affected in humans.
"The relevance of the results to the involvement of the central nervous system in SLE is another intriguing aspect of the present study," notes its leading author, Yehuda Shoenfeld, M.D., while emphasizing the need for further investigation through large-scale clinical studies. "Elucidating the mechanisms by which anti-ribosomal P induces behavioral changes may lead to novel therapeutic advances for SLE patients with depression," Dr. Shoenfeld reflects.
Article: "Induction of Autoimmune Depression in Mice by Anti-Ribosomal P Antibodies via the Limbic System," Aviva Katzav, Inna Solodeev, Ori Brodsky, Joab Chapman, Chaim G. Pick, Miri Blank, Wei Zhang, Morris Reichin, and Yehuda Shoenfeld, Arthritis & Rheumatism, March 2007, (DOI: 10.1002/art.22419).
Contact: Amy Molnar
John Wiley & Sons, Inc.
View drug information on Prozac Weekly.
To investigate how an autoantibody could stimulate behavioral changes by interaction with the brain, researchers at Tel Aviv University set out to induce depressive hallmarks in mice. Their findings, presented in the March 2007 issue of Arthritis & Rheumatism, shed light on the brain pathways of depression in general and in central nervous system dysfunction in SLE in particular.
Healthy female mice received injections, directly into the brain, of human anti-ribosomal P antibodies extracted from the blood sample of an SLE patient. For control purposes, equal numbers of mice were injected with normal human immunoglobin G. All the mice were then subjected to a series of tests: a forced swimming test in a glass beaker partially filled water to evaluate escape-oriented behaviors, such as rearing and jumping; rotarod and grip strength tests to gauge motor function; a staircase test; a swim T-maze test to assess cognitive function; and a passive avoidance test to measure the ability of mice to remember a foot shock delivered 24-hours earlier.
Depression-like behavior was strongly observed in the performance of anti-ribosomal P antibody-injected mice on the forced swimming test. The immobility time of these mice was twice as high as that of the control group, indicating a state of despair. In the remaining tests of cognitive and motor functions, there were no significant differences detected between the mice in each group, ruling out neurological damage.
In an additional experiment, the "depressed" mice were randomly divided into treatment groups. Some mice were treated with fluoxetine, the antidepressant marketed as Prozac, and some mice were treated with haloperidol, a psychotropic drug used to treat anxiety, addiction, and depression. To determine the effectiveness of each therapy, mice were subjected to repeating the forced swimming, staircase, and rotarod tests. Depression-like behavior was significantly blocked by long-term treatment with fluoxetine, but not by short- or long-term treatment with haloperidol.
At the culmination of the experiments, the brains of mice were sectioned and scrutinized through immunostaining. The staining pattern delineated the limbic system, which regulates the automatic nervous system's response to stress. It also highlighted areas of the brain associated with the sense of smell.
These findings provide a novel line of research into the mechanisms underlying the limbic and olfactory pathways in depression. Imaging studies both in patients with clinical depression and patients with SLE could help determine whether these pathways are similarly affected in humans.
"The relevance of the results to the involvement of the central nervous system in SLE is another intriguing aspect of the present study," notes its leading author, Yehuda Shoenfeld, M.D., while emphasizing the need for further investigation through large-scale clinical studies. "Elucidating the mechanisms by which anti-ribosomal P induces behavioral changes may lead to novel therapeutic advances for SLE patients with depression," Dr. Shoenfeld reflects.
Article: "Induction of Autoimmune Depression in Mice by Anti-Ribosomal P Antibodies via the Limbic System," Aviva Katzav, Inna Solodeev, Ori Brodsky, Joab Chapman, Chaim G. Pick, Miri Blank, Wei Zhang, Morris Reichin, and Yehuda Shoenfeld, Arthritis & Rheumatism, March 2007, (DOI: 10.1002/art.22419).
Contact: Amy Molnar
John Wiley & Sons, Inc.
View drug information on Prozac Weekly.
Surviving Suicide - A Moving Documentary For Sport Relief, BBC
For this year's Sport Relief, the BBC and Comic Relief bring viewers Surviving Suicide, a sensitive and moving documentary for BBC One which explores the issues affecting those whose lives have been touched by suicide.
Every year nearly 6,000 people in the UK take their own lives. The film features stories from everyday people; people who have attempted suicide and people who have been bereaved. Importantly the film shows how people can embark on a journey of recovery.
One contributor is Neil "Twink" Tinning, who was the official photographer for The Jam at the height of their popularity. Twink has tried to kill himself four times in the last 12 years and says: "Sometimes when you are in that phase, suicide seems the only logical step."
The documentary also features commentary from celebrities Trisha Goddard and Melinda Messenger.
Melinda felt suicidal as a result of severe post-natal depression but has now recovered thanks to support from the medical profession and her family.
Trisha has had first hand experiences of suicide and mental health problems in the family. Trisha said: "You get to a situation where you just want peace. It's a struggle to come back but you can do it."
The documentary is part of an ongoing effort by Comic Relief to reduce stigma and negative attitudes towards mental health, as well as to encourage people to seek help before they reach crisis point.
Surviving Suicide, 10.40pm, Wednesday 5 March 2008, BBC One
Rise to the challenge for Sport Relief by running the Sainsbury's Sport Relief Mile.
There are 23 flagship Miles to choose from: Belfast Custom House Square; Birmingham Centenary Square; Brighton & Hove Madeira Drive; Bristol Harbourside; Cardiff Bay; Coventry The Whittle Arches; Edinburgh West Princes Street Gardens; Gateshead Saltwell Park; Glasgow Green; Hull Queen Victoria Square; Ipswich Portman Road; Leeds Roundhay Park; Liverpool Waterfront; London Victoria Embankment; Manchester Albert Square; Middlesbrough Centre Square and MIMA; Milton Keynes Midsummer Boulevard; Norwich St Peters Street; Nottingham Victoria Embankment; Plymouth Plymouth Hoe; Sheffield Millennium Square; Southampton Palmerston Road; and Swansea National Waterfront Museum.
The Sport Relief Mile takes place on Sunday 16 March.
Sign up for your nearest Mile at sportrelief.
To make a donation, call 08457 910 910 (calls cost no more than 4p per minute from BT landlines. Minimum call charge 6p. Other operator and mobile rates may vary).
Since its launch in 2002, almost ??50million has been raised through Sport Relief.
Comic Relief spends the money raised to help vulnerable people living incredibly tough lives both at home in the UK and across the world's poorest countries.
Sport Relief is an initiative of Comic Relief, registered with the charity commission No. 326568.
Surviving Suicide - a moving documentary for Sport Relief (BBC)
Every year nearly 6,000 people in the UK take their own lives. The film features stories from everyday people; people who have attempted suicide and people who have been bereaved. Importantly the film shows how people can embark on a journey of recovery.
One contributor is Neil "Twink" Tinning, who was the official photographer for The Jam at the height of their popularity. Twink has tried to kill himself four times in the last 12 years and says: "Sometimes when you are in that phase, suicide seems the only logical step."
The documentary also features commentary from celebrities Trisha Goddard and Melinda Messenger.
Melinda felt suicidal as a result of severe post-natal depression but has now recovered thanks to support from the medical profession and her family.
Trisha has had first hand experiences of suicide and mental health problems in the family. Trisha said: "You get to a situation where you just want peace. It's a struggle to come back but you can do it."
The documentary is part of an ongoing effort by Comic Relief to reduce stigma and negative attitudes towards mental health, as well as to encourage people to seek help before they reach crisis point.
Surviving Suicide, 10.40pm, Wednesday 5 March 2008, BBC One
Rise to the challenge for Sport Relief by running the Sainsbury's Sport Relief Mile.
There are 23 flagship Miles to choose from: Belfast Custom House Square; Birmingham Centenary Square; Brighton & Hove Madeira Drive; Bristol Harbourside; Cardiff Bay; Coventry The Whittle Arches; Edinburgh West Princes Street Gardens; Gateshead Saltwell Park; Glasgow Green; Hull Queen Victoria Square; Ipswich Portman Road; Leeds Roundhay Park; Liverpool Waterfront; London Victoria Embankment; Manchester Albert Square; Middlesbrough Centre Square and MIMA; Milton Keynes Midsummer Boulevard; Norwich St Peters Street; Nottingham Victoria Embankment; Plymouth Plymouth Hoe; Sheffield Millennium Square; Southampton Palmerston Road; and Swansea National Waterfront Museum.
The Sport Relief Mile takes place on Sunday 16 March.
Sign up for your nearest Mile at sportrelief.
To make a donation, call 08457 910 910 (calls cost no more than 4p per minute from BT landlines. Minimum call charge 6p. Other operator and mobile rates may vary).
Since its launch in 2002, almost ??50million has been raised through Sport Relief.
Comic Relief spends the money raised to help vulnerable people living incredibly tough lives both at home in the UK and across the world's poorest countries.
Sport Relief is an initiative of Comic Relief, registered with the charity commission No. 326568.
Surviving Suicide - a moving documentary for Sport Relief (BBC)
News From The American Academy Of Family Physicians, July/August 2010
American Academy of Family Physicians - Coca-Cola Alliance, Conflict of Interest or Ethical Relationship?
In an essay addressing the recent controversy over the American Academy of Family Physicians accepting a large corporate donation from The Coca-Cola Company to fund patient education materials on obesity prevention, family physician and AAFP member Howard Brody, M.D., Ph.D., argues that accepting funds from commercial sources that seek to influence physician organization behavior in a direction that could run counter to the public health constitutes a conflict of interest. He asserts that many of the defenses offered by AAFP leadership are rationalizations rather than sound ethical counterarguments. He concludes that medical organizations, as the public face of medicine and as formulators of codes of ethics for their physician members, have special obligations to adhere to high ethical standards, and he raises concern about the development of a corporate culture within a medical professional society. Family physicians, he concludes, have demonstrated a commitment to putting the health needs of their patients ahead of personal financial gain. As such, they deserve to be represented nationally by an organization that fully reflects those high ethical commitments and standards.
In response to the editorial by Howard Brody, M.D., Ph.D., AAFP President, Lori Heim, M.D., F.A.A.F.P., counters in a separate essay that the AAFP's new consumer alliance agreement with The Coca-Cola Company illustrated the AAFP's adherence to its ethical foundation, demonstrated the AAFP's commitment to serving physicians and the public, and maintained the trust Americans put in their family physicians and the organization that represents them. She contends that throughout the development of the program, the AAFP consistently addressed possible conflicts of interest openly and directly, sharing with its members and the public exactly what measures it was taking to ensure that no unethical conduct or breach of trust would occur. The AAFP saw a public health and education need that was both unmet and undermined by the barrage of marketing messages and confusing information and acted to fill that need by developing unbiased educational materials to help patients make good nutrition decisions. In so doing, she concludes, the AAFP hewed to its high ethical standards, its core values, and its mission in the decisions made and the actions that followed.
Professional Medical Organizations and Commercial Conflicts of Interest: Ethical Issues
By Howard Brody, M.D., Ph.D.
Institute for the Medical Humanities, University of Texas Medical Branch, Galveston
Identifying and Addressing Potential Conflict of Interest: A Professional Medical Organization's Code of Ethics
By Lori Heim, M.D., F.A.A.F.P.
American Academy of Family Physicians, Leawood, Kan.
Cholesterol Screening Rates Low Among Young Adults Despite Prevalence of Cardiovascular Risk Factors
Approximately two-thirds of all young adults have one or more risk factors for coronary heart disease, yet less than 50 percent are screened for high cholesterol. Analyzing nationally representative data for 2,587 young adults from the National Health and Nutrition Examination Surveys, researchers found about 59 percent of young adults had CHD or CHD equivalents, or one or more risk factors (high blood pressure, smoking, family history or obesity). The prevalence of high cholesterol levels increased with the number of CHD risk factors, yet no significant difference in screening for cholesterol was observed among those with one or two or more risk factors for CHD compared with those with no risk factors. High cholesterol levels were observed in 65 percent of young adults with CHD or CHD equivalents, 26 percent of young adults with two or more risk factors, 12 percent of young adults with one risk factor and 7 percent with no risk factors. The authors call for the improvement of risk assessment and management for cardiovascular disease among young adults.
Prevalence of Coronary Heart Disease Risk Factors and Screening for High Cholesterol Levels Among Young Adults, United States, 1999-2006
By Elena V. Kuklina, M.D., Ph.D., et al
Centers for Disease Control and Prevention, Atlanta, Ga.
New Method for Estimating Complexity of Patient Visits Finds Family Medicine Is More Complex Than Cardiology
As primary care physicians continue to fight for a system of compensation that recognizes the complexity of the primary care encounter, researchers elucidate a new approach for calculating the complexity of patient visits. The method estimates complexity based on the amount of care provided weighted by its diversity and variability. Analyzing data from the 2000 National Ambulatory Medical Care Survey using this method, researchers find that when adjusted for duration of visit, family medicine has a greater complexity density per hour (167) than either cardiology (125) or psychiatry (31). An accompanying editorial draws out the implications of this work, asserting that complex systems models describe important phenomena in primary care not adequately described by complicated linear models and deliver answers that differ from those of linear models in meaningful ways. Estimates of clinical complexity, the authors assert, could have broad use for interspecialty, interpractice, and interphysician comparisons as well as longitudinal applications.
A Method for Estimating Relative Complexity of Ambulatory Care
By David A. Katerndahl, M.D., M.A., et al
University of Texas Health Science Center at San Antonio, Texas
The Implications of Measuring Complexity
By Lee A. Green, M.D., M.P.H.,
University of Michigan Medical School, Ann Arbor
Personal Doctoring Alive and Well in America
In a moving essay, two family physicians reflect on their experience witnessing a community share the life and loss of their family doctor of 33 years at a memorial service held in the town's high school gymnasium. They relate how, in public reflections on their personal doctor, people revealed how their friend had seen needs, understood fears, and partnered with them to create futures. The authors assert that these stories are compelling evidence that personal doctoring, practiced with compassion in the context of families and community, is alive and well and held deeply in the heart of America. The experience, they conclude, renewed their resolve that as we work for health care reform, system change and practice redesign, innovation must empower personal doctoring. No computer, no insurance company, no hospital system can replace the personal doctor.
A Public Celebration of a Personal Doctor
By William R. Phillips, M.D., M.P.H. and Larry A. Green, M.D.
University of Washington, Seattle and University of Colorado, Denver
Education Program Doubles Health Care Workers' Influenza Vaccination Rates
A simple promotional and educational intervention program can substantially increase the low influenza vaccination rate among primary care workers, a high-priority group because of their proximity to patients. The study of 344 staff members in 27 primary care clinics in Jerusalem, Israel, found that an intervention consisting of a lecture session by a family physician, literature distributed by e-mail, and solicitation by a key figure from the local staff resulted in a doubling of the immunization rate in intervention clinics compared with control clinics. Specifically, the immunization rate was 53 percent in the intervention group compared with 27 percent in the control group. When compared with the previous season, the absolute increase in the immunization rate was 26 percent in the intervention clinics and only 7 percent in the control clinics. The authors conclude that the program, which requires little investment of time and resources, could be easily replicated in other clinics with low immunization rates. They hypothesize that the program's success was due to its multifaceted approach involving respected and familiar family physicians and including a local staff member. They call for future research to determine whether this or a similar intervention program aimed at increasing staff influenza immunization rates may also substantially increase patient immunization.
Randomized Trial of a Program to Increase Staff Influenza Vaccination in Primary Care Clinics
By Zvi Howard Abramson, M.D., M.P.H., et al
Hebrew University-Hadassah Medical School, Jerusalem, Israel
Disparities in Colorectal Cancer Screening Persist Despite Medicare's Expansion of Coverage
Despite the 2001 Medicare expansion of colorectal cancer screening coverage, Medicare enrollees who do not have supplemental health insurance or a usual place of health care have disproportionately lower rates of testing. Analyzing Medicare Current Beneficiary Survey data on 8,330 enrollees who participated in the survey in 2000, 7,889 enrollees who participated in 2003 and 7,614 enrollees who participated in 2005, researchers found that those who received regular care from primary care physicians had the highest rates of testing and had increasing rates of recent endoscopy and decreasing rates of fecal occult blood test use over time. In contrast, those who did not have a usual place of health care had the lowest rates of testing: 21 percent had a recent endoscopy in 2000, 18 percent in 2003, and 21 percent in 2005, and the proportion of unscreened increased during the study period. Medicare beneficiaries who did not have additional insurance to supplement Medicare Part B had lower rates for colonoscopy or sigmoidoscopy than those with supplemental insurance. Among beneficiaries with supplemental insurance plans, the use of endoscopy to test for colorectal cancer increased while FOBT use decreased over the 6-year period. The authors assert these findings suggest that expanding health insurance benefits without additional targeted efforts to improve utilization of appropriate health care services will not eliminate disparities. Moreover, they reinforce the important role of primary care and a medical home in the delivery of screening services. The authors conclude that outreach programs that include efforts to encourage enrollees to have regular visits with a primary care physician and to undergo an annual preventive health examination, as well as reminder systems for patients and primary care physicians to carefully consider all screening options, including FOBT, may further increase colorectal cancer screening rates and mitigate disparities for vulnerable populations.
Primary Care, Economic Barriers to Health Care and Use of Colorectal Cancer Screening Tests Among Medicare Enrollees Over Time
By Chyke A. Doubeni, M.D., M.P.H., et al
University of Massachusetts Medical School, Worcester
Gradual EHR Implementation Delivers Positive Results for Residency Training Practice
A qualitative study examining the implementation of an electronic health record in a residency training practice finds both expected and unanticipated effects on the process of care and on relationships with patients and among practice members. The 22-month study, which included analysis of 170 clinical encounters, patient exit interviews, and focus groups and interviews with physicians and nursing staff, revealed that patient trust in the physician and security in the physician-patient relationship overrode most patients' concerns about information technology. Moreover, improved work flow and work efficiencies ameliorated staff resistance to implementation. The authors conclude that gradual EHR implementation may help support the development of beneficial physician and staff adaptations, while maintaining positive patient-physician relationships and fostering the sharing of medical information.
Gradual Electronic Health Record Implementation: New Insights on Physician and Patient Adaptation
By Ren?©e R. Shield, Ph.D., et al
Brown University, Providence, R.I.
New Model for Caring for Chronically Ill Older Patients Aids Physicians
At a time when the ranks of primary care physicians are dwindling and the number of chronically ill older patients is rapidly growing, researchers find that a new Guided Care model of support, in which a specially educated registered nurse supplements the care provided by the practice team, yields promising outcomes from the physician's point of view. This cluster-randomized trial of 14 teams of two to five physicians and their chronically ill older patients finds that Guided Care physicians are significantly more satisfied than their usual care peers with their patient/family communication and their knowledge of their patients' clinical conditions. The authors report no statistically significant effects of Guided Care on physicians' satisfaction with management of chronic care, knowledge of patients' personal circumstances, or on their ratings of the practice's care coordination activities.
Physician Satisfaction With Chronic Care Processes: A Cluster-Randomized Trial of Guided Care
By Jill Marsteller, Ph.D., M.P.P., et al
Johns Hopkins Bloomberg School of Public Health, Baltimore, Md.
PHQ-2 Useful and Time-saving Tool for Depression Screening in Primary Care
Reporting on the largest validation study of the 2- and 9-question Patient Health Questionnaires, which have been recommended for depression screening in primary care, researchers find the 2-question screen is very sensitive (proportion of positives correctly identified) for diagnosis of major depression, but the price paid for the high sensitivity was a modest specificity (proportion of negatives correctly identified) when compared with the reference standard interview. Analyzing data on 2,452 patients, researchers found the sensitivity and specificity of the PHQ-2 for diagnosing major depression were 86 percent and 78 percent, respectively, with a score of two or higher, and 61 percent and 92 percent with a score of three or higher. For the longer PHQ-9, the sensitivity and specific were 74 percent and 91 percent, respectively, with a score of 10 or higher. For the PHQ-2, a score of two or higher detected more cases of depression than a score of three or higher. A PHQ-9 score of 10 or higher appeared to detect more depressed patients than the originally described PHQ-9 scoring for major depression. The authors conclude the PHQ-2 can be a useful and time-saving tool in assisting primary care physicians with screening for depression. They call for a reevaluation of the original PHQ-9 criteria for major depression, as the simple additive score of 10 or higher identified more depressed patients than the original and more onerous method for scoring the questionnaire.
Validation of PHQ-2 and PHQ-9 to Screen for Major Depression in the Primary Care Population
By Bruce Arroll, M.B.Ch.B., Ph.D., F.R.N.Z.C.G.P., et al
University of Auckland, New Zealand
Researchers Propose New Model to Describe Diabetics' Health-Seeking Behavior
Diabetic patients make decisions about disease self-management in a nonlinear fashion based on their current needs, seeking and incorporating diverse sources not traditionally viewed as providing health information. Analyzing the transcripts of nine focus groups with 46 diabetic adults, researchers identified five themes that fill important gaps in medicine's understanding of health information seeking, receipt and use by these patients: 1) patients passively receive diabetes health information, 2) patients actively weave their own information web, 3) patients' relationships help them understand and use information, 4) health care professionals help them understand and manage information, and 5) health literacy makes a difference in patients' ability to understand and use information. Based on these findings, the researchers propose a more dynamic model of health-seeking behavior that reflects its nonlinear nature and the interplay of both active information seeking and passive receipt of information.
Health Information Seeking, Receipt, and Use in Diabetes Self-Management
By Daniel R. Longo, Sc.D., et al
Virginia Commonwealth University School of Medicine, Richmond
In an essay addressing the recent controversy over the American Academy of Family Physicians accepting a large corporate donation from The Coca-Cola Company to fund patient education materials on obesity prevention, family physician and AAFP member Howard Brody, M.D., Ph.D., argues that accepting funds from commercial sources that seek to influence physician organization behavior in a direction that could run counter to the public health constitutes a conflict of interest. He asserts that many of the defenses offered by AAFP leadership are rationalizations rather than sound ethical counterarguments. He concludes that medical organizations, as the public face of medicine and as formulators of codes of ethics for their physician members, have special obligations to adhere to high ethical standards, and he raises concern about the development of a corporate culture within a medical professional society. Family physicians, he concludes, have demonstrated a commitment to putting the health needs of their patients ahead of personal financial gain. As such, they deserve to be represented nationally by an organization that fully reflects those high ethical commitments and standards.
In response to the editorial by Howard Brody, M.D., Ph.D., AAFP President, Lori Heim, M.D., F.A.A.F.P., counters in a separate essay that the AAFP's new consumer alliance agreement with The Coca-Cola Company illustrated the AAFP's adherence to its ethical foundation, demonstrated the AAFP's commitment to serving physicians and the public, and maintained the trust Americans put in their family physicians and the organization that represents them. She contends that throughout the development of the program, the AAFP consistently addressed possible conflicts of interest openly and directly, sharing with its members and the public exactly what measures it was taking to ensure that no unethical conduct or breach of trust would occur. The AAFP saw a public health and education need that was both unmet and undermined by the barrage of marketing messages and confusing information and acted to fill that need by developing unbiased educational materials to help patients make good nutrition decisions. In so doing, she concludes, the AAFP hewed to its high ethical standards, its core values, and its mission in the decisions made and the actions that followed.
Professional Medical Organizations and Commercial Conflicts of Interest: Ethical Issues
By Howard Brody, M.D., Ph.D.
Institute for the Medical Humanities, University of Texas Medical Branch, Galveston
Identifying and Addressing Potential Conflict of Interest: A Professional Medical Organization's Code of Ethics
By Lori Heim, M.D., F.A.A.F.P.
American Academy of Family Physicians, Leawood, Kan.
Cholesterol Screening Rates Low Among Young Adults Despite Prevalence of Cardiovascular Risk Factors
Approximately two-thirds of all young adults have one or more risk factors for coronary heart disease, yet less than 50 percent are screened for high cholesterol. Analyzing nationally representative data for 2,587 young adults from the National Health and Nutrition Examination Surveys, researchers found about 59 percent of young adults had CHD or CHD equivalents, or one or more risk factors (high blood pressure, smoking, family history or obesity). The prevalence of high cholesterol levels increased with the number of CHD risk factors, yet no significant difference in screening for cholesterol was observed among those with one or two or more risk factors for CHD compared with those with no risk factors. High cholesterol levels were observed in 65 percent of young adults with CHD or CHD equivalents, 26 percent of young adults with two or more risk factors, 12 percent of young adults with one risk factor and 7 percent with no risk factors. The authors call for the improvement of risk assessment and management for cardiovascular disease among young adults.
Prevalence of Coronary Heart Disease Risk Factors and Screening for High Cholesterol Levels Among Young Adults, United States, 1999-2006
By Elena V. Kuklina, M.D., Ph.D., et al
Centers for Disease Control and Prevention, Atlanta, Ga.
New Method for Estimating Complexity of Patient Visits Finds Family Medicine Is More Complex Than Cardiology
As primary care physicians continue to fight for a system of compensation that recognizes the complexity of the primary care encounter, researchers elucidate a new approach for calculating the complexity of patient visits. The method estimates complexity based on the amount of care provided weighted by its diversity and variability. Analyzing data from the 2000 National Ambulatory Medical Care Survey using this method, researchers find that when adjusted for duration of visit, family medicine has a greater complexity density per hour (167) than either cardiology (125) or psychiatry (31). An accompanying editorial draws out the implications of this work, asserting that complex systems models describe important phenomena in primary care not adequately described by complicated linear models and deliver answers that differ from those of linear models in meaningful ways. Estimates of clinical complexity, the authors assert, could have broad use for interspecialty, interpractice, and interphysician comparisons as well as longitudinal applications.
A Method for Estimating Relative Complexity of Ambulatory Care
By David A. Katerndahl, M.D., M.A., et al
University of Texas Health Science Center at San Antonio, Texas
The Implications of Measuring Complexity
By Lee A. Green, M.D., M.P.H.,
University of Michigan Medical School, Ann Arbor
Personal Doctoring Alive and Well in America
In a moving essay, two family physicians reflect on their experience witnessing a community share the life and loss of their family doctor of 33 years at a memorial service held in the town's high school gymnasium. They relate how, in public reflections on their personal doctor, people revealed how their friend had seen needs, understood fears, and partnered with them to create futures. The authors assert that these stories are compelling evidence that personal doctoring, practiced with compassion in the context of families and community, is alive and well and held deeply in the heart of America. The experience, they conclude, renewed their resolve that as we work for health care reform, system change and practice redesign, innovation must empower personal doctoring. No computer, no insurance company, no hospital system can replace the personal doctor.
A Public Celebration of a Personal Doctor
By William R. Phillips, M.D., M.P.H. and Larry A. Green, M.D.
University of Washington, Seattle and University of Colorado, Denver
Education Program Doubles Health Care Workers' Influenza Vaccination Rates
A simple promotional and educational intervention program can substantially increase the low influenza vaccination rate among primary care workers, a high-priority group because of their proximity to patients. The study of 344 staff members in 27 primary care clinics in Jerusalem, Israel, found that an intervention consisting of a lecture session by a family physician, literature distributed by e-mail, and solicitation by a key figure from the local staff resulted in a doubling of the immunization rate in intervention clinics compared with control clinics. Specifically, the immunization rate was 53 percent in the intervention group compared with 27 percent in the control group. When compared with the previous season, the absolute increase in the immunization rate was 26 percent in the intervention clinics and only 7 percent in the control clinics. The authors conclude that the program, which requires little investment of time and resources, could be easily replicated in other clinics with low immunization rates. They hypothesize that the program's success was due to its multifaceted approach involving respected and familiar family physicians and including a local staff member. They call for future research to determine whether this or a similar intervention program aimed at increasing staff influenza immunization rates may also substantially increase patient immunization.
Randomized Trial of a Program to Increase Staff Influenza Vaccination in Primary Care Clinics
By Zvi Howard Abramson, M.D., M.P.H., et al
Hebrew University-Hadassah Medical School, Jerusalem, Israel
Disparities in Colorectal Cancer Screening Persist Despite Medicare's Expansion of Coverage
Despite the 2001 Medicare expansion of colorectal cancer screening coverage, Medicare enrollees who do not have supplemental health insurance or a usual place of health care have disproportionately lower rates of testing. Analyzing Medicare Current Beneficiary Survey data on 8,330 enrollees who participated in the survey in 2000, 7,889 enrollees who participated in 2003 and 7,614 enrollees who participated in 2005, researchers found that those who received regular care from primary care physicians had the highest rates of testing and had increasing rates of recent endoscopy and decreasing rates of fecal occult blood test use over time. In contrast, those who did not have a usual place of health care had the lowest rates of testing: 21 percent had a recent endoscopy in 2000, 18 percent in 2003, and 21 percent in 2005, and the proportion of unscreened increased during the study period. Medicare beneficiaries who did not have additional insurance to supplement Medicare Part B had lower rates for colonoscopy or sigmoidoscopy than those with supplemental insurance. Among beneficiaries with supplemental insurance plans, the use of endoscopy to test for colorectal cancer increased while FOBT use decreased over the 6-year period. The authors assert these findings suggest that expanding health insurance benefits without additional targeted efforts to improve utilization of appropriate health care services will not eliminate disparities. Moreover, they reinforce the important role of primary care and a medical home in the delivery of screening services. The authors conclude that outreach programs that include efforts to encourage enrollees to have regular visits with a primary care physician and to undergo an annual preventive health examination, as well as reminder systems for patients and primary care physicians to carefully consider all screening options, including FOBT, may further increase colorectal cancer screening rates and mitigate disparities for vulnerable populations.
Primary Care, Economic Barriers to Health Care and Use of Colorectal Cancer Screening Tests Among Medicare Enrollees Over Time
By Chyke A. Doubeni, M.D., M.P.H., et al
University of Massachusetts Medical School, Worcester
Gradual EHR Implementation Delivers Positive Results for Residency Training Practice
A qualitative study examining the implementation of an electronic health record in a residency training practice finds both expected and unanticipated effects on the process of care and on relationships with patients and among practice members. The 22-month study, which included analysis of 170 clinical encounters, patient exit interviews, and focus groups and interviews with physicians and nursing staff, revealed that patient trust in the physician and security in the physician-patient relationship overrode most patients' concerns about information technology. Moreover, improved work flow and work efficiencies ameliorated staff resistance to implementation. The authors conclude that gradual EHR implementation may help support the development of beneficial physician and staff adaptations, while maintaining positive patient-physician relationships and fostering the sharing of medical information.
Gradual Electronic Health Record Implementation: New Insights on Physician and Patient Adaptation
By Ren?©e R. Shield, Ph.D., et al
Brown University, Providence, R.I.
New Model for Caring for Chronically Ill Older Patients Aids Physicians
At a time when the ranks of primary care physicians are dwindling and the number of chronically ill older patients is rapidly growing, researchers find that a new Guided Care model of support, in which a specially educated registered nurse supplements the care provided by the practice team, yields promising outcomes from the physician's point of view. This cluster-randomized trial of 14 teams of two to five physicians and their chronically ill older patients finds that Guided Care physicians are significantly more satisfied than their usual care peers with their patient/family communication and their knowledge of their patients' clinical conditions. The authors report no statistically significant effects of Guided Care on physicians' satisfaction with management of chronic care, knowledge of patients' personal circumstances, or on their ratings of the practice's care coordination activities.
Physician Satisfaction With Chronic Care Processes: A Cluster-Randomized Trial of Guided Care
By Jill Marsteller, Ph.D., M.P.P., et al
Johns Hopkins Bloomberg School of Public Health, Baltimore, Md.
PHQ-2 Useful and Time-saving Tool for Depression Screening in Primary Care
Reporting on the largest validation study of the 2- and 9-question Patient Health Questionnaires, which have been recommended for depression screening in primary care, researchers find the 2-question screen is very sensitive (proportion of positives correctly identified) for diagnosis of major depression, but the price paid for the high sensitivity was a modest specificity (proportion of negatives correctly identified) when compared with the reference standard interview. Analyzing data on 2,452 patients, researchers found the sensitivity and specificity of the PHQ-2 for diagnosing major depression were 86 percent and 78 percent, respectively, with a score of two or higher, and 61 percent and 92 percent with a score of three or higher. For the longer PHQ-9, the sensitivity and specific were 74 percent and 91 percent, respectively, with a score of 10 or higher. For the PHQ-2, a score of two or higher detected more cases of depression than a score of three or higher. A PHQ-9 score of 10 or higher appeared to detect more depressed patients than the originally described PHQ-9 scoring for major depression. The authors conclude the PHQ-2 can be a useful and time-saving tool in assisting primary care physicians with screening for depression. They call for a reevaluation of the original PHQ-9 criteria for major depression, as the simple additive score of 10 or higher identified more depressed patients than the original and more onerous method for scoring the questionnaire.
Validation of PHQ-2 and PHQ-9 to Screen for Major Depression in the Primary Care Population
By Bruce Arroll, M.B.Ch.B., Ph.D., F.R.N.Z.C.G.P., et al
University of Auckland, New Zealand
Researchers Propose New Model to Describe Diabetics' Health-Seeking Behavior
Diabetic patients make decisions about disease self-management in a nonlinear fashion based on their current needs, seeking and incorporating diverse sources not traditionally viewed as providing health information. Analyzing the transcripts of nine focus groups with 46 diabetic adults, researchers identified five themes that fill important gaps in medicine's understanding of health information seeking, receipt and use by these patients: 1) patients passively receive diabetes health information, 2) patients actively weave their own information web, 3) patients' relationships help them understand and use information, 4) health care professionals help them understand and manage information, and 5) health literacy makes a difference in patients' ability to understand and use information. Based on these findings, the researchers propose a more dynamic model of health-seeking behavior that reflects its nonlinear nature and the interplay of both active information seeking and passive receipt of information.
Health Information Seeking, Receipt, and Use in Diabetes Self-Management
By Daniel R. Longo, Sc.D., et al
Virginia Commonwealth University School of Medicine, Richmond
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