Author Archives: Rauh

Depression, ADHD, Anxiety Medications Not Overprescribed in Children, Study Shows

Psychiatric medications—especially stimulants and antidepressants—do not appear to be overprescribed to children and adolescents, according to a report published Monday in the Journal of Child and Adolescent Psychopharmacology.

“Among young people, the population level prescribing rates as well as age and sex distributions [of children who received stimulant and antidepressant prescriptions] are broadly consistent with known epidemiologic patterns of their established indications for ADHD, anxiety, and depression,” wrote lead author Ryan Sultan, M.D, of Columbia University and colleagues.

The researchers analyzed data contained in the 2008 IMS LifeLink LRx Longitudinal Prescription database on U.S. youth aged 3 to 24 years of age who had filled at least one prescription for stimulants, antidepressants, or antipsychotics during the study year. In total, the 2008 IMS LRx database included 131,291 younger children (aged 3 to 5), 2,140,289 older children (6 to 12), 2,163,202 adolescents (13 to 18), and 1,916,700 young adults (19 to 24) who filled at least one stimulant, antidepressant, or antipsychotic prescription.

The analysis revealed that 4.6% of older children and 3.8% of adolescents were prescribed stimulants; this is well below published national community ADHD prevalence estimates of 8.6%. Similarly, just 2.8% of adolescents, 1% of older children, and 0.1% of younger children received a prescription for an antidepressant; yet the prevalence rates for depression among adolescents alone range from 4% to 5%, while the prevalence rates for anxiety disorders in children and adolescents range from 15% to 20%.

Although annual antipsychotic prescription percentages were lower than antidepressant or stimulant percentages for all age groups, with a peak in adolescence (age 16 = 1.3%), it remains unclear whether antipsychotic prescribing is above or below prevalence rates of the disorders for which these medications are prescribed. “Patterns of antipsychotics are more complex and may reflect the heterogeneity of the approved and off-label conditions and disorders treated with this medication class,” the authors wrote.

“Overall, the findings provide some reassurance regarding population level prescribing patterns of psychotropic medications in youth in relation to the epidemiologic distribution of major child and adolescent mental disorders,” they wrote. “However, we should continue to monitor psychotropic medication prescriptions over time to assess whether U.S. prescribing practices remain broadly consistent with underlying disorder prevalence.”

For related information, see the Psychiatric News article “Prescribing for Mentally Ill Children Generally in Line With Best Practices.”

© 2019 American Psychiatric Association

We Need to Talk About Kids and Smartphones

Markham Heid

Updated: Oct 10, 2017 8:24 AM ET
TIME Health  ©, Copyright 2019 Meredith Corporation
For more, visit TIME Health.

Nina Langton had no right to be depressed. At least, that’s how she saw it.

She had a great group of friends, lived in a prosperous neighborhood, and was close with her parents. Like most 16-year-olds at her Connecticut high school, Nina spent much of her free time on her smartphone. But unlike many of her classmates, she was never “targeted” on social media—her word for the bullying and criticism that took place daily on sites like Snapchat. “Part of what made my depression so difficult was that I didn’t understand why I was feeling so sad,” she says.

Later, after her attempted suicide and during her stay at a rehabilitation facility, Nina and her therapist identified body image insecurity as the foundation of her woe. “I was spending a lot of time stalking models on Instagram, and I worried a lot about how I looked,” says Nina, who is now 17. She’d stay up late in her bedroom, looking at social media on her phone, and poor sleep—coupled with an eating disorder—gradually snowballed until suicide felt like her only option. “I didn’t totally want to be gone,” she says. “I just wanted help and didn’t know how else to get it.”

Nina’s mom, Christine Langton, has a degree in public health and works at a children’s hospital. Despite her professional background, she says she was “completely caught off guard” by her daughter’s suicide attempt. “Nina was funny, athletic, smart, personable . . . depression was just not on my radar,” she says.

Nina, TIME Magazine

In hindsight, Langton says she wishes she had done more to moderate her daughter’s smartphone use. “It didn’t occur to me not to let her have the phone in her room at night,” she says. “I just wasn’t thinking about the impact of the phone on her self-esteem or self-image until after everything happened.”

It seems like every generation of parents has a collective freak-out when it comes to kids and new technologies; television and video games each inspired widespread hand-wringing among grown-ups. But the inescapability of today’s mobile devices—coupled with the personal allure of social media—seems to separate smartphones from older screen-based media. Parents, teens and researchers agree smartphones are having a profound impact on the way adolescents today communicate with one another and spend their free time. And while some experts say it’s too soon to ring alarm bells about smartphones, others argue we understand enough about young people’s emotional and developmental vulnerabilities to recommend restricting kids’ escalating phone habit.

The latest statistics on teen mental health underscore the urgency of this debate.

Between 2010 and 2016, the number of adolescents who experienced at least one major depressive episode leapt by 60%, according to a nationwide survey conducted by the U.S. Department of Health and Human Services. The 2016 survey of 17,000 kids found that about 13% of them had a major depressive episode, compared to 8% of the kids surveyed in 2010. Suicide deaths among people age 10 to 19 have also risen sharply, according to the latest data from the Centers for Disease Control and Prevention. Young women are suffering most; a CDC report released earlier this year showed suicide among teen girls has reached 40-year highs. All this followed a period during the late-1990s and early 2000s when rates of adolescent depression and suicide mostly held steady or declined.

“These increases are huge—possibly unprecedented,” says Jean Twenge, a professor of psychology at San Diego State University and author of iGen, which examines how today’s super-connected teens may be less happy and less prepared for adulthood than past generations. In a peer-reviewed study that will appear later this year in the journal Clinical Psychological Science, Twenge shows that, after 2010, teens who spent more time on new media were more likely to report mental health issues than those who spent time on non-screen activities.

Using data collected between 2010 and 2015 from more than 500,000 adolescents nationwide, Twenge’s study found kids who spent three hours or more a day on smartphones or other electronic devices were 34% more likely to suffer at least one suicide-related outcome—including feeling hopeless or seriously considering suicide—than kids who used devices two hours a day or less. Among kids who used electronic devices five or more hours a day, 48% had at least one suicide-related outcome.

Twenge also found that kids who used social media daily were 13% more likely to report high levels of depressive symptoms than those who used social less frequently. Overall, kids in the study who spent low amounts of time engaged in in-person social interaction, but high amounts of time on social media, were the most likely to be depressed.

Twenge is quick to acknowledge that her research does not prove a cause-and-effect relationship exists between smartphones and depression. “It’s possible that depressed kids are just more likely to spend time on their devices,” she says. “But that doesn’t answer the question of what caused this sudden upswing in teen depression and suicide.”

Some experts have pointed to the aftermath of the Great Recession, or rising student workloads, as possible non-device explanations for young people’s recent struggles. “But when you look at the economic or homework data, it doesn’t line up with the rise in teen suicide or depression,” Twenge says. Youth smartphone ownership does. “I’m open to exploring other factors, but I think the more we learn about kids and smartphones, the more we’re going to see that limiting their exposure is a good idea.”

Others agree it’s time to approach adolescent device use with greater caution. “What this generation is going through right now with technology is a giant experiment, and we don’t know what’s going to happen,” says Frances Jensen, chair of neurology at the University of Pennsylvania’s Perelman School of Medicine. While the science on kids and technology is incomplete, Jensen says what we already know about the minds of tweens and teens suggests giving a young person all-the-time access to an Internet-connected device “may be playing with fire.”

The teenage brain

To understand how device use may be affecting a young person’s mental health, it’s important to recognize the complex changes occurring in an adolescent’s still-developing brain.

For one thing, that brain is incredibly plastic and able to adapt—that is, physically change—in response to novel activities or environmental cues, says UPenn’s Jensen, who is the author of The Teenage Brain.

Some research has already linked media multitasking—texting, using social media and rapidly switching among smartphone-based apps—with lower gray-matter volume in the brain’s anterior cingulate cortex (ACC), a region involved in emotion processing and decision making. More research has associated lower ACC volumes with depression and addiction disorders.

“We know for a fact teens have very underdeveloped impulse control and empathy and judgment compared to adults,” Jensen says. This may lead them to disturbing online content or encounters—stuff a more mature mind would know to avoid. Teens also have a hyperactive risk-reward system that allows them to learn—but also to become addicted—much more quickly than grown-ups, she says. Research has linked social media and other phone-based activities with an uptick in feel-good neurochemicals like dopamine, which could drive compulsive device use and promote feelings of distraction, fatigue, or irritability when kids are separated from their phones.

Even if smartphones aren’t the root cause of a teen’s anxiety or other issues, Jensen adds, they may turn out to be an accelerant—the gasoline that turns a flicker of adolescent angst into a blaze.

Another area of the brain—the prefrontal cortex—is critical for focus and interpreting human emotion, and doesn’t fully develop until a person’s mid-20s, says Paul Atchley, a professor of psychology at the University of Kansas. “During our teenage years, it’s important to train that prefrontal cortex not to be easily distracted,” he says. “What we’re seeing in our work is that young people are constantly distracted, and also less sensitive to the emotions of others.”

While the research on smartphones is preliminary, Atchley says he believes studies will eventually show a clearer connection between the negative trends in teen mental health and rising smartphone use. But some scientists contend there isn’t enough cause-and-effect evidence to condemn smartphones.

“I see the rise in depression, especially among girls, and I understand why people are making these connections with new technologies,” says Candice Odgers, a professor of psychology and neuroscience at Duke University who has published research on teens and tech. “But so far, we have very little data to suggest mobile technologies are causing anxiety or social impairments.” She points to evidence that some young people, particularly marginalized groups like LGBT youth, can derive benefits from online communication through supportive exchanges with friends and family.

Odgers adds that jumping to conclusions and vilifying smartphones may lead us away from factors that may turn out to be more significant—a worry raised by other experts. “This is such a serious and polarizing issue that I think we need to set aside our assumptions until we have stronger data,” she says. At the same time, she doesn’t condone unrestricted smartphone access at any age. “I’m certainly not advocating giving an 8-year-old a smartphone,” she says. “But if you ask me what age is appropriate, or how much use is safe, I don’t think the existing evidence provides those answers.”

As researchers debate appropriate public health messaging, kids are receiving their first smartphone at ever-younger ages—the average is 10, according to one recent estimate—and they’re spending more and more time on their devices.

“I am probably on my phone 10 hours a day,” says Santi Potočnik Senarighi, a 16-year-old eleventh grader in Denver. Even when he’s not actively using his phone, Santi says it’s always with him, and he never considers taking a break. “This is part of my life and part of my work, and [that] means I need to be in constant contact.”

Santi’s dad, Billy Potočnik, says he worries about his son’s phone habit, as Santi is struggling in school. But every one of Santi’s friends has a smartphone and uses it constantly, and so Potočnik says confiscating his son’s phone feels oppressive. “If I try to take it away from him, he tells me he’s not doing anything bad on it,” which Potočnik says is usually true, “and it turns into a struggle.”

He and other parents say enduring that struggle day after day feels overwhelming. And to complicate matters, many schools and after-school groups now use social media or online platforms to coordinate events, or to post grades and homework. “It’s not as simple as saying, okay, time to take a break from your phone,” Potočnik says.

How teens ‘talk’

Colleen Nisbet has been a high school guidance counselor for more than two decades. One of her duties at Connecticut’s Granby Memorial High School is to monitor students during their lunch periods. “Lunch was always a very social time when students were interacting and letting out some energy,” she says. “Now they sit with their phones out and barely talk to each other.”

This scene—of kids collecting in parks or at one another’s houses only to sit silently and stare at screens—comes up over and over again when talking with parents and kids. “When you’re with people you don’t know well or there’s nothing to talk about, phones are out more because it’s awkward,” says Shannon Ohannessian, a 17-year-old senior at Farmington High School in Connecticut.

That avoidance of face-to-face interaction worries Brian Primack, director of the University of Pittsburgh’s Center for Research on Media, Technology, and Health. “Human beings are social animals,” he says. “We evolved over millions of years to respond to eye contact and touch and shared laughter and real things right in front of us.” There’s strong research linking isolation to depression, and time spent socializing with improved mood and well-being. If smartphones are getting between an adolescent and her ability to engage in and enjoy face-to-face interaction—and some studies suggest that’s happening—that’s a big deal, Primack says.

But while they’re not always speaking out loud, kids today are talking to each other—and about each other. They’re just doing it on their phones. Not all that talk is friendly. “They tell me they’re making comments or criticizing each other to friends while they’re all sitting together,” says Nisbet, the guidance counselor. Something about the phone just seems to “take the filter off,” she adds.

Backbiting and mean-girl gossip are nothing new, of course. But research suggests that, even among adults, the Internet has a disinhibition effect that leads people to speak in coarser, crueler ways then they would offline.

Maryellen Pachler, a Yale-trained nurse practitioner who specializes in the treatment of adolescent anxiety disorders, says her job used to involve convincing her patients that their fears were largely irrational. “Now I don’t think they’re irrational at all,” she says. “If you raise your hand in class or say something silly, I think it’s likely your classmates will be texting or posting something about it.”

She says the glamor and gleam of social media is also fueling a rise in teen anxiety. “My patients see their friends’ Snapchat or Instagram photos where they look so happy, and they feel like they’re the only ones who are faking it,” she says, referencing what researchers call the highlight reel effect of social media. “I want to tell them, listen, this girl you’re jealous of—she was in here with me yesterday!”

Teens agree social-media whitewashing is the rule, not the exception. “No one’s going to post something that makes them look bad,” Ohannessian says. “I know that, but it’s still hard to separate what you see on social media from real life.”

What’s next for teens and phones

There are doubtless many factors contributing to teen depression. Parents say kids today are busier than ever before—their lives increasingly crammed with the extracurriculars required to gain admission to a good college. But even those researchers who aren’t ready to slam smartphones say it’s important to restrict an adolescent’s device habit, and that too much social media or media multitasking is likely harmful.

“I don’t think these devices are the main cause, but I think they contribute to a lot of the things we worry about,” says David Hill, director of the American Academy of Pediatrics (AAP) Council on Communications and Media. “I speak to parents who are very concerned, and my take is to be much more rigid about setting limits—especially when it comes to phones in the bedroom at night.”

But the AAP’s current guidelines do not offer specifics when it comes to appropriate smartphone limits for children older than 6, and public health officials generally say parents should decide what is right for their kids, without offering specifics.

Educators are also grappling with smartphone-related dilemmas. Most schools allow smartphone use between classes and during free periods, but teachers say keeping students off their phones during class has become a tremendous burden.

Gina Spiers, an English teacher at San Lorenzo High School near Oakland, Calif., says she used to confiscate phones, but students would panic and cause a disruption in class. She and her school are fighting back—with encouraging results.

Starting this fall, San Lorenzo High joined several schools nationwide in working with a company called Yondr to restrict smartphone access during school hours. Yondr makes small, lockable phone pouches that students keep with them, but that can’t be opened until the end of the day.

“The changes have already been profound,” says Allison Silvestri, San Lorenzo’s principal. Kids are more focused and engaged during class, and student journals suggest the high schoolers are feeling less anxious and more relaxed. Silvestri says fewer fights have broken out this semester—a benefit she attributes to the absence of social media. “They have to look each other in the eye to make conflict happen,” she says. “There’s so much more joy and interaction, and I can’t count the number of parents who have asked me, ‘How do I buy this for my home?’”

The smartphone experiment at San Lorenzo doesn’t meet the standards of the scientific method. But it’s one more piece of evidence linking mobile devices with the troubles today’s teen are facing. While there are no doubt helpful and healthy ways young people could use smartphones to enrich their lives, it’s becoming harder to argue that the status quo—near-ubiquitous teen smartphone ownership, coupled with more-or-less unfettered Internet access—is doing kids good.

A few months after her suicide attempt, Nina Langton addressed her high school classmates and spoke openly about her depression. She described the stigma of mental illness, and lamented the fact that, while many teens experience depression, very few are willing to talk about it or ask for help. “I was worried for so long about opening up about my struggles because I thought I would be judged,” she said.

After she gave the speech, “so many people my age reached out to me about their own experiences with technology and depression and therapy,” she says. “I think this is a big problem that needs to be talked about more.”

SOURCE: http://time.com/4974863/kids-smartphones-depression/

Resistance Exercise Linked to Reduced Anxiety

The Effects of Resistance Exercise Training on Anxiety_ A Meta-Analysis and Meta-Regression Analysis of Randomized Controlled Trials _ SpringerLink (1)

Resistance Exercise Linked to Reduced Anxiety

By Lisa Rapaport

People who do resistance exercises like weight lifting may experience less anxiety than people who don’t work out, a research review suggests.

Researchers analyzed data from 16 previously published studies with a total of 922 participants who were randomly assigned to do resistance training or be inactive. The study was published in Sports Medicine, online August 17.

Resistance workouts were associated with a reduction in anxiety symptoms whether or not participants had a mental health disorder, though the effect was more pronounced in healthy people who didn’t report any physical or psychological problems.

“The positive effects of exercise training on mental health are well established; however, the majority of this knowledge is based on studies involving aerobic-based training,” said lead study author Brett Gordon, a physical education and sports researcher at the University of Limerick in Ireland.

“RET (resistance exercise training) significantly reduced anxiety in both healthy participants and those with a physical or mental illness, and the effect size of these reductions is comparable to that of frontline treatments such as medication and psychotherapy,” Gordon said by email. “RET is a low-cost behavior with minimal risk, and can be an effective tool to reduce anxiety for healthy and ill alike.”

Because the analysis only focused on resistance training, the results can’t show whether this type of activity might be better or worse than aerobic or other types of exercise for easing anxiety symptoms.

While the effects of resistance exercise on the brain are not as well understood as the impact of aerobic workouts, emerging research has also linked resistance training to less shrinkage of white matter in the brain, said Dianna Purvis Jaffin of the Brain Performance Institute at the University of Texas at Dallas.

White matter is composed of nerve fibers that connect neurons in different parts of the brain. Changes in white matter can occur with age, and are thought to be involved in cognitive and behavioral problems.

It’s possible that exercise might help ease anxiety simply by distracting people from how they’re feeling and giving them something else to focus on, Jaffin, who wasn’t involved in the current study, said by email.

“Exercise generally requires some level of concentration on the activity and may serve as a distraction, and at least acutely (meaning – during that bout of exercise and a bit after) interrupt rumination and obsessive worrying,” Jaffin said.

“Finally, since people with anxiety tend to have uncertainty about their future, they may obsessively worry and lack confidence,” Jaffin added. “Exercise can improve self-efficacy, the belief that one can succeed in particular situations, which may make someone feel more empowered.”

While the amount of exercise may influence the impact of workouts on mental health, there isn’t enough evidence available yet to prescribe a specific amount of activity, said Steven Petruzzello, a body mechanics researcher at the University of Illinois Urbana-Champaign who wasn’t involved in the study.

Absent this sort of prescription, choosing an enjoyable workout makes sense, Petruzzello said by email.

In the current analysis, people did resistance exercises on two to five days per week for an average of 11 weeks.

“The best advice at the present time is to ‘just do it’ – it being whatever the person finds enjoyable or at least tolerable,” Petruzzello said. “For some that might mean going for a walk, for others it might entail more vigorous forms of activity.”

SOURCE: http://bit.ly/2yvBptq

Sports Med 2017.

(c) Copyright Thomson Reuters 2017. Click For Restrictions - http://about.reuters.com/fulllegal.asp

Probiotic May Ease Depression

Probiotic May Ease Depression in IBS Patients

Alan R. Jacobs, MD

DISCLOSURES

August 18, 2017
This is the Medscape Neurology Minute. I’m Dr Alan Jacobs.
Researchers from McMaster University in Canada have published a randomized, double-blind, placebo-controlled study investigating the effects of probiotics on anxiety and depression in patients with irritable bowel syndrome (IBS).[1] Forty-four adults with IBS or a mixed-stool pattern, and mild-to-moderate anxiety and/or depression, were randomly assigned to taking daily probiotic Bifidobacterium longum NCC3001 or placebo for 6 weeks.
At week 6, twice as many patients who received the probiotic had reductions in depression scores, while there was no effect on anxiety or IBS symptoms. Patients in the probiotic group also had mean increases in quality-of-life scores and decreases in fMRI-measured responses to negative emotional stimuli in multiple brain regions, including the amygdala and frontolimbic regions, compared with placebo. At 10 weeks, depression scores were reduced in patients given probiotic versus placebo.

The authors concluded that the probiotic Bifidobacterium longum reduces depression and increases quality of life in patients with IBS, and that this reduction is associated with reduced limbic reactivity in the brain.Donald Rauh

Donald Rauh M.D., Ph.D., FAPA
Diplomate of the American Board of Psychiatry & Neurology
Board Certified in General Psychiatry and in  Child & Adolescent Psychiatry

Childhood Anxiety Disorder

Childhood Anxiety Disorders

Generalized Anxiety Disorder

If your child has generalized anxiety disorder, or GAD, he or she will worry excessively about a variety of things such as grades, family issues, relationships with peers, and performance in sports.  Learn more about GAD.

Children with GAD tend to be very hard on themselves and strive for perfection. They may also seek constant approval or reassurance from others.

Panic Disorder

Panic disorder is diagnosed if your child suffers at least two unexpected panic or anxiety attacks—which means they come on suddenly and for no reason—followed by at least one month of concern over having another attack, losing control, or “going crazy.”  Learn more about panic disorder and panic attacks.

Separation Anxiety Disorder

Many children experience separation anxiety between 18 months and three years old, when it is normal to feel some anxiety when a parent leaves the room or goes out of sight. Usually children can be distracted from these feelings.

It’s also common for your child to cry when first being left at daycare or pre-school, and crying usually subsides after becoming engaged in the new environment.

If your child is slightly older and unable to leave you or another family member, or takes longer to calm down after you leave than other children, then the problem could be separation anxiety disorder, which affects 4 percent of children. This disorder is most common in kids ages seven to nine.

When separation anxiety disorder occurs, a child experiences excessive anxiety away from home or when separated from parents or caregivers. Extreme homesickness and feelings of misery at not being with loved ones are common.

Other symptoms include refusing to go to school, camp, or a sleepover, and demanding that someone stay with them at bedtime. Children with separation anxiety commonly worry about bad things happening to their parents or caregivers or may have a vague sense of something terrible occurring while they are apart.

Social Anxiety Disorder

Social anxiety disorder, or social phobia, is characterized by an intense fear of social and performance situations and activities such as being called on in class or starting a conversation with a peer. Learn more about social anxiety disorder.

This can significantly impair your child’s school performance and attendance, as well as his or her ability to socialize with peers and develop and maintain relationships.

  • Watch this VIDEO: Rose, a teen, speaks about her social anxiety and how cognitive-behavioral therapy (CBT) helped her.

Selective Mutism

Children who refuse to speak in situations where talking is expected or necessary, to the extent that their refusal interferes with school and making friends, may suffer from selective mutism.

Children suffering from selective mutism may stand motionless and expressionless, turn their heads, chew or twirl hair, avoid eye contact, or withdraw into a corner to avoid talking.

These children can be very talkative and display normal behaviors at home or in another place where they feel comfortable. Parents are sometimes surprised to learn from a teacher that their child refuses to speak at school.

The average age of diagnosis is around 5 years old, or around the time a child enters school.

Specific Phobias

A specific phobia is the intense, irrational fear of a specific object, such as a dog, or a situation, such as flying. Common childhood phobias include animals, storms, heights, water, blood, the dark, and medical procedures.

Children will avoid situations or things that they fear, or endure them with anxious feelings, which can manifest as crying, tantrums, clinging, avoidance, headaches, and stomachaches. Unlike adults, they do not usually recognize that their fear is irrational. Learn more about phobias.

 


Obsessive-compulsive disorder (OCD) and posttraumatic stress disorder (PTSD) are closely related to anxiety disorders, which some may experience at the same time, along with depression.

Obsessive-Compulsive Disorder (OCD)

OCD is characterized by unwanted and intrusive thoughts (obsessions) and feeling compelled to repeatedly perform rituals and routines (compulsions) to try and ease anxiety.  Learn more about OCD.

Most children with OCD are diagnosed around age 10, although the disorder can strike children as young as two or three. Boys are more likely to develop OCD before puberty, while girls tend to develop it during adolescence.

Posttraumatic Stress Disorder (PTSD)

Children with posttraumatic stress disorder, or PTSD, may have intense fear and anxiety, become emotionally numb or easily irritable, or avoid places, people, or activities after experiencing or witnessing a traumatic or life-threatening event.  Learn more about PTSD.

Not every child who experiences or hears about a traumatic event will develop PTSD. It is normal to be fearful, sad, or apprehensive after such events, and many children will recover from these feelings in a short time.

Children most at risk for PTSD are those who directly witnessed a traumatic event, who suffered directly (such as injury or the death of a parent), had mental health problems before the event, and who lack a strong support network. Violence at home also increases a child’s risk of developing PTSD after a traumatic event.

SOURCE: https://adaa.org/living-with-anxiety/children/childhood-anxiety-disorders ,  ADDA

 

Vitamin D

Vitamin D Insufficiency and FL Outcomes

Blood Cancer J; ePub 2017 Aug 25; Tracy, et al

August 30, 2017

Indolent Lymphoma for July/August 2017

  1. Vitamin D Insufficiency and FL Outcomes
  2. Grade 3 Follicular Lymphoma Outcomes Evaluated

There appears to be a link between vitamin D insufficiency (VDI) and early clinical failure in patients with follicular lymphoma, according to an observational prospective cohort study involving 642 individuals. Participants had follicular lymphoma that was diagnosed at a median of 60 years of age between 2002 and 2012. Investigators looked at whether VDI was linked with adverse outcomes. Among the results:

  • At a median follow-up of ~5 years, 46% of patients experienced either an event or treatment failure.
  • 7% had a lymphoma-related death.
  • Overall, patients with VDI were more than twice as likely to experience inferior event-free survival at 1 year; the same was true for overall survival.
  • They were nearly 3 times more likely to experience inferior lymphoma-specific survival.
  • Among patients treated with immunochemotherapy, those with VDI were ~3 times more likely to experience inferior event-free survival; the same was true for overall survival.
  • They were nearly 6 times more likely to experience inferior lymphoma-specific survival.

Citation:Tracy S, Maurer M, Witzig T, et al. Vitamin D insufficiency is associated with an increased risk of early clinical failure in follicular lymphoma. [Published online ahead of print August 25, 2017]. Blood Cancer J. doi:10.1038/bcj.2017.70.

 

Study Rebuts Popular Claim Against Antidepressant Effectiveness

The antidepressants paroxetine and citalopram distinctly outperformed placebo among patients who experienced no adverse effects from the drugs in US Food and Drug Administration (FDA)-registered, placebo-controlled trials, according to a new mega-analysis published online in Molecular Psychiatry.

The findings reject a widely disseminated theory, reported on in media outlets including Newsweek and 60 Minutes, that such medications exert no actual antidepressant effect.

“It has been suggested that the superiority of antidepressants over placebo in controlled trials is merely a consequence of side effects enhancing the expectation of improvement by making the patient realize that he/she is not on placebo,” wrote researchers from the University of Gothenburg, Sweden. “We explored this hypothesis in a patient-level post hoc analysis.”

Donald Rauh M.D., Ph.D., FAPA
Diplomate of the American Board of Psychiatry & Neurology
Board Certified in General Psychiatry and in  Child & Adolescent Psychiatry

Nuts

Association of Nut Consumption with Total and Cause-Specific Mortality

Ying Bao, M.D., Sc.D., Jiali Han, Ph.D., Frank B. Hu, M.D., Ph.D., Edward L. Giovannucci, M.D., Sc.D., Meir J. Stampfer, M.D., Dr.P.H., Walter C. Willett, M.D., Dr.P.H., and Charles S. Fuchs, M.D., M.P.H.

N Engl J Med 2013; 369:2001-2011November 21, 2013DOI: 10.1056/NEJMoa1307352

BACKGROUND

Increased nut consumption has been associated with a reduced risk of major chronic diseases, including cardiovascular disease and type 2 diabetes mellitus. However, the association between nut consumption and mortality remains unclear.

METHODS

We examined the association between nut consumption and subsequent total and cause-specific mortality among 76,464 women in the Nurses’ Health Study (1980–2010) and 42,498 men in the Health Professionals Follow-up Study (1986–2010). Participants with a history of cancer, heart disease, or stroke were excluded. Nut consumption was assessed at baseline and updated every 2 to 4 years.

RESULTS

During 3,038,853 person-years of follow-up, 16,200 women and 11,229 men died. Nut consumption was inversely associated with total mortality among both women and men, after adjustment for other known or suspected risk factors. The pooled multivariate hazard ratios for death among participants who ate nuts, as compared with those who did not, were 0.93 (95% confidence interval [CI], 0.90 to 0.96) for the consumption of nuts less than once per week, 0.89 (95% CI, 0.86 to 0.93) for once per week, 0.87 (95% CI, 0.83 to 0.90) for two to four times per week, 0.85 (95% CI, 0.79 to 0.91) for five or six times per week, and 0.80 (95% CI, 0.73 to 0.86) for seven or more times per week (P<0.001 for trend). Significant inverse associations were also observed between nut consumption and deaths due to cancer, heart disease, and respiratory disease.

In two large, independent cohorts of nurses and other health professionals, the frequency of nut consumption was inversely associated with total and cause-specific mortality, independently of other predictors of death. (Funded by the National Institutes of Health and the International Tree Nut Council Nutrition Research and Education Foundation.)

Source:  http://www.nejm.org/doi/full/10.1056/NEJMoa1307352

Intense Moods, Bipolar Disorder

Bipolar Disorder – going through intense moods

Do you go through intense moods?  Do you feel very happy and energized some days, and very sad and depressed on other days? Do these moods last for a week or more? Do your mood changes make it hard to sleep, stay focused, or go to work?

Some people with these symptoms have bipolar disorder, a serious mental illness. This brochure will give you more information.

What is bipolar disorder?

Bipolar disorder is a serious brain illness. It is also called manic-depressive illness or manic depression. People with bipolar disorder go through unusual mood changes. Sometimes they feel very happy and “up,” and are much more energetic and active than usual. This is called a manic episode. Sometimes people with bipolar disorder feel very sad and “down,” have low energy, and are much less active. This is called depression or a depressive episode.

Bipolar disorder is not the same as the normal ups and downs everyone goes through. The mood swings are more extreme than that and are accompanied by changes in sleep, energy level, and the ability to think clearly. Bipolar symptoms are so strong that they can damage relationships and make it hard to go to school or keep a job. They can also be dangerous. Some people with bipolar disorder try to hurt themselves or attempt suicide.

People with bipolar disorder can get treatment. With help, they can get better and lead successful lives.

Who develops bipolar disorder?

Anyone can develop bipolar disorder. It often starts in a person’s late teen or early adult years. But children and older adults can have bipolar disorder too. The illness usually lasts a lifetime.

Why does someone develop bipolar disorder?

Doctors do not know what causes bipolar disorder, but several things may contribute to the illness. Family genes may be one factor because bipolar disorder sometimes runs in families. However, it is important to know that just because someone in your family has bipolar disorder, it does not mean other members of the family will have it as well. Another factor that may lead to bipolar disorder is the brain structure or the brain function of the person with the disorder. Scientists are finding out more about the disorder by studying it. This research may help doctors do a better job of treating people. Also, this research may help doctors to predict whether a person will get bipolar disorder. One day, doctors may be able to prevent the illness in some people.

What are the symptoms of bipolar disorder?

Bipolar “mood episodes” include unusual mood changes along with unusual sleep habits, activity levels, thoughts, or behavior. People may have manic episodes, depressive episodes, or “mixed” episodes. A mixed episode has both manic and depressive symptoms. These mood episodes cause symptoms that last a week or two or sometimes longer. During an episode, the symptoms last every day for most of the day.

Mood episodes are intense. The feelings are strong and happen along with extreme changes in behavior and energy levels.

People having a manic episode may:

  • Feel very “up” or “high”
  • Feel “jumpy” or “wired”
  • Have trouble sleeping
  • Become more active than usual
  • Talk really fast about a lot of different things
  • Be agitated, irritable, or “touchy”
  • Feel like their thoughts are going very fast
  • Think they can do a lot of things at once
  • Do risky things, like spend a lot of money or have reckless sex

People having a depressive episode may:

  • Feel very “down” or sad
  • Sleep too much or too little
  • Feel like they can’t enjoy anything
  • Feel worried and empty
  • Have trouble concentrating
  • Forget things a lot
  • Eat too much or too little
  • Feel tired or “slowed down”
  • Have trouble sleeping
  • Think about death or suicide

Can someone have bipolar disorder along with other problems?

Yes. Sometimes people having very strong mood episodes may have psychotic symptoms. Psychosis affects thoughts and emotions as well as a person’s ability to know what is real and what is not. People with mania and psychotic symptoms may believe they are rich and famous, or have special powers. People with depression and psychotic symptoms may believe they have committed a crime, they have lost all of their money, or that their lives are ruined in some other way.

Sometimes behavior problems go along with mood episodes. A person may drink too much or take drugs. Some people take a lot of risks, like spending too much money or having reckless sex. These problems can damage lives and hurt relationships. Some people with bipolar disorder have trouble keeping a job or doing well in school.

Is bipolar disorder easy to diagnose?

No. Some people have bipolar disorder for years before the illness is diagnosed. This is because bipolar symptoms may seem like several different problems. Family and friends may notice the symptoms but not realize they are part of a bigger problem. A doctor may think the person has a different illness, like schizophrenia or depression.

People with bipolar disorder often have other health problems as well. This may make it hard for doctors to recognize the bipolar disorder. Examples of other illnesses include substance abuse, anxiety disorders, thyroid disease, heart disease, and obesity.

How is bipolar disorder treated?

Right now, there is no cure for bipolar disorder, but treatment can help control symptoms. Most people can get help for mood changes and behavior problems. Steady, dependable treatment works better than treatment that starts and stops. Treatment options include:

1. Medication. There are several types of medication that can help. People respond to medications in different ways, so the type of medication depends on the patient. Sometimes a person needs to try different medications to see which works best.

Medications can cause side effects. Patients should always tell their doctors about these problems. Also, patients should not stop taking a medication without a doctor’s help. Stopping medication suddenly can be dangerous, and it can make bipolar symptoms worse.

2. Therapy. Different kinds of psychotherapy, or “talk” therapy, can help people with bipolar disorder. Therapy can help them change their behavior and manage their lives. It can also help patients get along better with family and friends. Sometimes therapy includes family members.

3. Other treatments. Some people do not get better with medication and therapy. These people may try electroconvulsive therapy, or ECT. This is sometimes called “shock” therapy. ECT provides a quick electric current that can sometimes correct problems in the brain.

Sometimes people take herbal and natural supplements, such as St. John’s wort or omega-3 fatty acids. Talk to your doctor before taking any supplement. Scientists aren’t sure how these products affect people with bipolar disorder. Some people may also need sleep medications during treatment.

Getting Help

If you’re not sure where to get help, call your family doctor. You can also check the phone book for mental health professionals. Hospital doctors can help in an emergency. Finally, the Substance Abuse and Mental Health Services Administration (SAMHSA) has an online tool to help you find mental health services in your area. You can find it here: https://findtreatment.samhsa.gov .

How can I help myself if I have bipolar disorder?

You can help yourself by getting treatment and sticking with it. Recovery takes time, and it’s not easy. But treatment is the best way to start feeling better. Here are some tips:

  • Talk with your doctor about your treatment.
  • Stay on your medication.
  • Keep a routine for eating and sleeping.
  • Make sure you get enough sleep.
  • Learn to recognize your mood swings.
  • Ask a friend or relative to help you stick with your treatment.
  • Be patient with yourself. Improvement takes time.

How can I help someone I know with bipolar disorder?

Help your friend or relative see a doctor to get the right diagnosis and treatment. You may need to make the appointment and go to the doctor together. Here are some helpful things you can do:

  • Be patient.
  • Encourage your friend or relative to talk, and listen carefully.
  • Be understanding about mood swings.
  • Include your friend or relative in fun activities.
  • Remind the person that getting better is possible with the right treatment.

I know someone who is in crisis. What do I do?

If you know someone who might hurt himself or herself, or if you’re thinking about hurting yourself, get help quickly. Here are some things you can do:

  • Do not leave the person alone.
  • Call your doctor.
  • Call 911 or go to the emergency room.
  • Call the National Suicide Prevention Lifeline, toll-free:
    1-800-273-TALK (8255). The TTY number is 1-800-799-4TTY (4889).

How does bipolar disorder affect friends and family?

When a friend or relative has bipolar disorder, it affects you too. Taking care of someone with bipolar disorder can be stressful. You have to cope with the mood swings and sometimes other problems, such as drinking too much. Sometimes the stress can strain your relationships with other people. Caregivers can miss work or lose free time.

If you are taking care of someone with bipolar disorder, take care of yourself too. Find someone you can talk to about your feelings. Talk with the doctor about support groups for caregivers. If you keep your stress level down, you will do a better job, and it might help your loved one stick to his or her treatment.

For More Information

National Institute of Mental Health
Office of Science Policy, Planning, and Communications
Science Writing, Press, and Dissemination Branch
6001 Executive Boulevard
Room 6200, MSC 9663
Bethesda, MD 20892-9663
Phone: 301-443-4513 or 1-866-615-NIMH (6464) toll-free
TTY: 301-443-8431 or 1-866-415-8051 toll-free
Fax: 301-443-4279
Email: nimhinfo@nih.gov
Website: http://www.nimh.nih.gov

U.S. Department of Health and Human Services
National Institutes of Health
National Institute of Mental Health

November 2015
NIH Publication Number TR 15-3679

Source:  https://www.nimh.nih.gov/health/publications/bipolar-disorder/index.shtml

STUDY FINDS LINK BETWEEN POLLUTION AND SUICIDE

Scientists at the University of Utah have found a link between short-term exposure to pollution and suicide – particularly for middle-aged men.

Examining the deaths of more than 1,500 men and women in Salt Lake City, Utah between 2000 and 2010, the findings draw an association between suicide and exposure to elements that exist in polluted air – nitrogen dioxide and fine particulate matter, small particles that can range from dust to combustible sources that float invisibly in the air.

The study, published yesterday in The American Journal of Epidemiology, was conducted by Amanda Bakian, an assistant professor of psychiatry at the university, and colleagues in the health sector.

Researchers found that there was a 20% increase in the odds of suicide in people who had short-term exposure to nitrogen dioxide in the two or three days prior to their deaths. A 5% increase in the odds was found in those who had exposure to high concentrations of fine particulate matter within that same time frame.

However, research shows that men were 25% more likely to commit suicide after being exposed to nitrogen dioxide and 6% more likely to do so after having exposure to fine particulate matter, a rate that increased by 20% for middle-aged men following nitrogen dioxide exposure, and 7% after being exposed to fine particulate matter.

“We examined the method of suicide, whether it was violent non-violent, the person’s gender, and the season in which they committed suicide,” Bakian says, “and there was a strong relationship between air pollutants and odds of suicide in men aged 36 to 64 who committed suicide in the spring time, as well as by individuals who died by violent methods.”

The reason is unclear, but Bakian says that there is potential that men in that age group have different exposure levels to air pollutants or have characteristics that are unique to them at that time in their life.

However, Bakian clearly states that research does not prove that pollution causes people to commit suicide. Rather, exposure to higher levels of pollution may increase the odds of suicide through the interaction with a variety of other factors at play.

She emphasises that suicide is complex, and believes that further research needs to be done before a definitive reason for the link can be made. “Clearly not everyone is uniformly susceptible to the effects of air pollution,” she says. “The exposure required to affect the odds varies across individuals and in some individuals, even low to moderate levels of exposure can result in poor outcomes.”

Bakian says there could be personal characteristics that increase the risk, co-occurring medical issues, lifestyle factors or a combination of different characteristics that are unique to men. Alternatively, Bakian says that men may just get more exposure to pollution than women.

According to Bakian, suicide is the eighth cause of death in Utah and the tenth in the United States.

“It is a preventable outcome,” she says. “We hope that finding out more about the correlation may help lead to its prevention, as well as interventions in public health.” Funding for the research provided in part by the university’s Program for Air Quality, Health and Society programme has been expanded to run state-wide.

Source:  BY

http://www.newsweek.com/study-finds-link-between-pollution-and-suicide-306706