Vitamin D and Depression

Highlights     vit-d-download

  • •There is adequate evidence for a positive association between vitamin D deficiency and depression.
  • •If a depressed individual is deficient, Vitamin D supplementation/augmentation can be an effective treatment.
  • •The current evidence base is limited by methodological flaws.
  • •There is a need for further randomised controlled longitudinal studies.

Abstract

Objective

To examine whether vitamin D deficiency or insufficiency is associated with depression and whether vitamin D supplementation is an effective treatment for depression.

Method

Empirical papers published in recent years were identified using three search engines and online databases – PubMed, Google Scholar and Cochrane Database. Specific search terms used were ‘vitamin D’, ‘depression’ and ‘treatment’ and articles were selected that examined the association between vitamin D deficiency/insufficiency and depression, vitamin D supplementation and Vitamin D as a treatment for depression. Our review weighted more recent studies (from 2011), although also considered earlier publications.

Results

Empirical studies appear to provide increasing evidence for an association between vitamin D insufficiency and depression, and for vitamin D supplementation and augmentation in those with clinical depression who are vitamin D deficient. Methodological limitations associated with many of the studies are detailed.

Limitations

Articles were restricted to those in the English language while publication bias may have weighted studies with positive findings.

Conclusions

There remains a need for empirical studies to move beyond cross-sectional designs to undertake more randomised controlled longitudinal trials so as to clarify the role of vitamin D in the pathogenesis of depression and its management, as well as to establish whether currently suggested associations are clinically significant and distinctive.

SOURCE:  http://www.jad-journal.com/article/S0165-0327(16)30892-8/abstract

Adolescent Assault Victim Needs

Abstract

Task Force on Adolescent Assault Victim Needs.

For many years, it has been routine to treat victims of child abuse, suicide attempts, and sexual assault via multidisciplinary care protocols. Although violently injured adolescents have become commonplace in our nation’s emergency departments, no care guidelines exist that address the unique needs of these patients. The convened a task force to develop such guidelines for providers of hospital-based pediatric emergency and trauma care. The work of the task force was guided by the premise that comprehensive care of violently injured adolescents must address their psycho-social needs as well as their physical injuries.

This task force report summarizes the epidemiology of violent injury in adolescence and its physical and emotional consequences (“Part I”), and it outlines appropriate care for the victims from their arrival in the emergency department to their discharge from the hospital (“Part II”). Care of violently injured adolescents that follows these guidelines is likely to promote full recovery and to reduce the risks of reinjury and reactive perpetration.

SOURCE: AAP Gateway;  http://pediatrics.aappublications.org/content/98/5/991.abstract

Early Signs Of Schizophrenia: The Warning Symptoms To Understand

The early signs of schizophrenia typically happen in the late teen years, and or in someone’s early adulthood. In many cases, they are pretty tough to spot unless you are very familiar with the illness. Another reason that it can be difficult to spot early warning signs of the illness has to do with the fact that teenagers experience a variety of mood swings and eccentric behavior.  CAS-Neurological-Soft-Signs-Schizophrenia-2zzzlljpf1a2y8bo86aups

In general, men tend to show warning signs of schizophrenia earlier than women, but there’s really no set age for illness onset. The period before actual symptoms of schizophrenia symptoms appear is known as the “prodromal” phase. During this time a doctor or professional may diagnose someone as exhibiting signs of “premorbid” schizophrenia if they think that the condition may develop.

Sometimes an anti psychotic medication may be prescribed in order to delay the onset of symptoms. The prodromal phase typically lasts anywhere from 2 to 5 years before full blown schizophrenia develops. In men these signs typically appear from age 20 to 25 and in women from age 25 to 30.  Unfortunately although we do not know what causes schizophrenia, there is documentation of many common early signs that someone may be developing this illness.

Early Signs of Schizophrenia: The Warning Symptoms

It should be noted that many of these symptoms can be indicators of something as simple as major depression. However, when odd behaviors are coupled with isolation, preoccupation with religion, and the person drops out of all normal societal functions, this is a red flag for the possible development of schizophrenia.

  • Bizarre Behavior: Unusual behavior: The person may exhibit “odd” or “unusual” behaviors that may make no sense. For example they may wear their pajamas backwards to work. They will do things that make zero logical sense and just seem weird.
  • Cognitive Decline: It will be noted that the person experiences significant decline in mental performance. They may not be able to concentrate, cope with problems, and may drop out of school or life. They may also experience a significant degree of confusion and may easily lose things.
  • Depression: The person typically displays significant signs of depression before the disease develops. The individual may appear emotionless and/or in a state of deep despair.
  • Drug Abuse: Many people with schizophrenia turn to drugs to alleviate their mental pain. In some ways this is viewed as self-medicating. However, it should be noted that in some cases illicit drug abuse could cause or exacerbate psychotic symptoms.
  • Flat Affect: The person may talk or appear emotionally flat – as if they have zero emotion or life. They may also gaze at you as though they are lost or clueless. They may not be able to cry or express any form of happiness or excitement. This flat emotion may contribute to an odd, flat speech as well.
  • Hearing Voices: Most people that have schizophrenia experience auditory hallucinations at some point. Although hearing voices in your head does not always indicate mental illness, if these voices are destructive in nature and encouraging self-harm or dangerous behavior, they are a likely indicator of this illness.
  • Inappropriate Emotion: For example during a time of sadness or someone’s death a person with this condition may laugh or chuckle. They may express inappropriate emotions at times that clearly do not fit their reaction.
  • Magical Thinking: This is when someone thinks that they have special or supernatural powers. They may assume that other people are jealous of their supernatural “powers.” This shows a gross disconnect with reality.
  • Paranoia: The person may believe that others are talking behind their back. They may also develop intricate theories about others trying to poison them or hack their thoughts. Many people with paranoia believe they are being followed by government officials or that people are plotting against them.
  • Poor Hygiene: The individual’s personal hygiene may go downhill fast. They may no longer shower, trim their hair, brush their teeth, or take care of themselves. They may totally neglect their personal hygiene and appearance for long periods of time.
  • Preoccupied with Religion or Occult: One major early sign of schizophrenia is if the person becomes obsessed with religion and/or the occult. If you notice this behavior, it is important to definitely take note.
  • Relationship Deterioration: Social relationships will significantly deteriorate – the person may not socialize at all and may prefer to be alone.
  • Social Isolation: The person will withdraw from social activities and isolate themselves from society. They may skip school, work, and/or other activities that involve talking to other people.
  • Sleep Changes: The person may sleep excessively or be unable to sleep for very long.
  • Suicidal Behavior: The person may self-harm and/or be involved with accidents that cause damage to their body. A common example could be cutting oneself. The person may also exhibit suicidal thinking.

It should be noted that many of these symptoms listed are not necessarily indicators of schizophrenia alone. There are many people that withdraw from social activities, become depressed, and sleep a lot because they are anxious, have depression, or another mental illness. However, if you experience many of these symptoms together, it is a likely indicator of schizophrenia.

What to do if you see early signs of schizophrenia in someone?

If you see someone else exhibiting early signs of schizophrenia, you may want to recommend that they get in for proper psychological evaluation. If they do have schizophrenia or some other condition, most professionals will be able to tell what is going on.

Treatment for the condition as soon as possible is associated with better functioning in society and a more favorable prognosis. If the individual has a family history of schizophrenia and they are showing the early warning signs and symptoms, it is likely that they are developing the same condition as there is a genetic link.

Most people with the early warning signs of schizophrenia are not aware of their condition. It typically takes outside intervention for someone to realize that what they are experiencing is in fact a mental illness. This is because all the symptoms that they are experiencing seem so real to them. Although the onset of these symptoms may be sudden or abrupt, the majority of people show a slow, gradual onset of these early signs.

SOURCE:  Mental Health Daily,  http://mentalhealthdaily.com/2014/03/27/early-signs-of-schizophrenia-the-warning-symptoms-to-understand/

 

Teens Who Suffer from Anxiety

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University of Texas at Arlington researchers have found that low attention control in early adolescence is related to a genetic risk factor for four different anxiety disorders. Young teens who suffer from anxiety are also more vulnerable to additional problems like depression, drug dependence, suicidal behavior and educational underachievement.    

The National Institutes of Mental Health reports that 8 per cent of teens ages 13 to 18 have an anxiety disorder, with anxiety-related problems often peaking during this time. Most adults diagnosed with anxiety or mood disorders also report the presence of symptoms earlier in their lives.

“Appropriate and earlier intervention could really assist these patients and improve their outlooks on the long-term,” said Jeffrey Gagne, UTA assistant professor of psychology and lead author of the study. “Having a visible marker like low attention control, which usually appears and can be identified before anxiety, could improve the treatment of these disorders.”

Gagne and UTA graduate student Catherine Spann recently published their research as “The Shared Etiology of Attentional Control and Anxiety: An Adolescent Twin Study” in the Journal of Research on Adolescence. Deirdre O’Sullivan, Nicole Schmidt and H. Hill Goldsmith, all of the University of Wisconsin-Madison, also participated in the study, which was supported by several grants from the National Institute of Mental Health including a Silvio O. Conte Center for Neuroscience grant.

This research constitutes the first twin study-based examination of genetic and environmental factors that contribute to both low attention control and four distinct anxiety symptoms in early adolescence.

The researchers used a combination of self-ratings and mother ratings to assess scores for obsessive, social, separation and generalized anxiety symptoms in 446 twin pairs with a mean age of 13.6 years, all enrolled in the Wisconsin Twin Project.

They then explored the extent to which links between low levels of attention and anxiety symptoms are genetically and environmentally mediated in adolescence.

Non-shared environmental influences were significant across attention control and all anxiety variables. Genetic correlations ranged from 36 to 47 per cent, a pattern that suggests that low attention can be considered a phenotypic and genetic risk factor for anxiety.

Risk level varied, however, depending on the specific type of disorder, with the highest correlations being for generalized and separation anxieties, and the lowest for obsessive-compulsive disorder.

Perry Fuchs, chair of UTA’s department of Psychology in the College of Science, emphasized the importance of this work in the context of the university’s increasing focus on health and the human condition within the Strategic Plan 2020: Bold Solutions|Global Impact.

“Adolescence is clearly an important development period,” Fuchs said. “Better assessment of teens’ ability to concentrate could facilitate the identification of those at risk of anxiety and could also inform molecular genetic studies, which would be the logical next stage for research.”

If you believe that your teenager may be experiencing forms of anxiety, call our office.  Dr. Rauh’s extensive experience in this field can help.  The sooner he/she is diagnosed, the better their chances are to improve their long term overall mental health.  (215).860.6101

Story Source:  The above post is reprinted from materials provided by University of Texas at Arlington.

Journal Source: http://onlinelibrary.wiley.com/doi/10.1111/jora.12260/abstract;jsessionid=D82A226EBD011613D6FF4B18CD9F80C1.f02t04

ADHD and the Impact on Quality of Life

                Social and Emotional Impairment in Children and Adolescents with ADHD  and the Impact on QUALITY OF LIFE

ADHD is associated with impairment of psychosocial functioning that goes beyond the core symptoms of attention-deficit, hyperactivity, and impulsivity.

Children and adolescents with ADHD have problems with peer relationships, lack friendships, or have limitations in their activities with friends if they do have friends. They often interact with their peers in a self-centered, impulsive, intrusive, commanding, and hostile behavior. As a result, up to 70% of these children with ADHD may have no close friends by third grade. They also tend to express their anger and frustration, especially when provoked, more than others and show reduced empathy and guilt.

The emotional impairments of children and adolescents with ADHD may include poor self-regulation of emotion, greater excessive emotional expression, especially anger and aggression, greater problems coping with frustration, reduced empathy, and decreased arousal to stimulation, while anxiety or depression are also common comorbid disorders of ADHD.  Relationships within the family can be impaired as well. However, there is increasing evidence that quality of life improves with effective treatment.

Another common class of comorbid disorders associated with ADHD are learning disabilities which may result in lowered self-esteem. These as well as other impairments affect the quality of life (QoL) of both patients and their families.

READ MORE:   [WORDdoc.format/(you may need to check your download folder)]  Social and Emotional Impairment in Children and Adolescents with ADHD and the Impact on Quality of Life

Journal of Adolescent Health 46 (2010) 209–217

All authors contributed equally to this work.

© 2010 Society for Adolescent Medicine. Published by Elsevier Inc. All rights reserved.

To make sure that you are diagnosed and treated professionally contact Dr. Donald A. Rauh

ADHD 101

The Basics of ADHD

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Attention Deficit Hyperactivity Disorder (ADHD) affects nearly 8% of all children in the U.S. But we’re not the only ones.  Climate seems to be the only ameliorating factor. Incidence of ADHD is lowest in areas with a higher solar index, that is, a sunny climate.  This applies both inside and outside the U.S.

The frequency of diagnosis as well as the prevalence of American research has led to the assumption that Attention Deficit Hyperkinetic Disorder is largely an “American disorder,” stemming from behaviors and cultural norms not found in other cultures.  But in a study of the “Worldwide prevalence of ADHD” published in 2003, Stephen V. Faraone and his investigative team conclude that this is not the case.

After identifying 50 studies of ADHD worldwide (20 based on U.S. populations and 30 based on non-U.S. populations), Faraone et al conclude that the prevalence of ADHD is at least as high in many non-US children as in US children with the highest prevalence being seen when the DSM-IV diagnoses are used.

We may be hearing about it now in record proportions but ADHD is not new.  The first case of what appears to be ADHD was reported by the Scottish physician Sir Alexander Crichton in 1798. Earlier descriptions may be lost to us simply because mental issues were not discussed from a physiological perspective prior to the 19th century.  Even today the connection between mental and physical health is not always fully understood or appreciated.

Self control in children has long been associated with obedience, an aspect of morality that grows with the child’s perception of the rights of others and the importance of societal norms.  In 1844 the German physician Heinrich Hoffmann created the character of “Fidgety Phil” as a cautionary tale about a little boy who can’t sit still and brings the dinner table down on himself and his family. His book was meant to entertain and instruct but the underlying message is clear. Fidgeting means trouble for you and your family: Get over it!

Today we recognize that many children just can’t get over it.  Medical Resonance Imaging (MRI) has added greatly to our understanding of brain structure and function. Because MRI does not involve exposure to ionizing radiation, it enables us to see and study the developmental differences between the typical and the ADHD brain. These images indicate that, in addition to improving behavior, psycho-stimulant medications can help normalize brain development.

Won’t They Outgrow It?  Children are naturally active, even hyperactive. Some mature more slowly than others.  Why not let nature take its course and wait for so-called “hyperactives” to catch up with their peers?

But what if they don’t?  Some children do outgrow ADHD.  Their symptoms recede in late adolescence, but the effects of the disorder remain, both physically and psychologically.  It doesn’t take a lot of imagination to realize that the experience of being the “class clown,” the kid who can’t sit still, will affect the child’s self image and travel with him into adulthood. For example see:  Social-and-Emotional-Impairment-in-Children-and-Adolescents-with-ADHD-and-the-Impact-on-Quality-of-Life

The long-term physical effects are still being explored.  Untreated, the ADHD brain grows and develops more slowly ending with a decreased volume of grey matter.  Psycho-stimulants can restore the deficit. Recent studies suggest that these medications improve behavior by normalizing the chemistry of the brain by increasing dopamine and, in some cases, norepinephrine in the synapse.  The normalized chemistry results in near normal amounts of grey matter . Researchers believe that these brain effects parallel and underlie the widespread clinical benefits.

Not Just Kids’ Stuff.  ADHD can persist to adulthood as well. Estimates vary widely –from 35-85% with estimates being highest for those who were not treated in childhood.  In adulthood symptoms change from hyperactivity to more sophisticated issues of attention and impulse control. Inattentiveness, misplacing items, and procrastination can substantively impair performance and reduce earing power recently estimated at between roughly $90 Billion and $140 Billion per year.  This issue has become substantial enough to generate commentary in the Wall Street Journal (Young Workers With Dyslexia, ADD Find Office Less Accommodating Than School October 12, 2006; Page D1 Sue Shellenbarger).  Currently ADHD is believed to affect 10% of children and 5% of adults worldwide.

Safety:  For many years physicians and opinionated members of the media and some social organizations debated the effects of potential cardiovascular effects of stimulants.  Many of the studies were small and frequently repudiated by major medical organizations.  Finally, the FDA decided to conduct a thorough investigation.  Note that the studies were not sponsored by industry.  They conducted two studies, one in children and young adults  and one in Adults  Both studies showed that the use of stimulants did not increase the risk of serious cardiovascular events compared to non-users.  In fact, when the incidence of events in non-users was normed to 1, the incidence in users was 0.75 in the first study and 0.81 in the second.  That is the incidence in those using stimulants was lower than that in those not using stimulants.  These were huge studies with the first comprising about 2.5 million patient-years and the second about 800,000 patient-years.

 

To Fish or Not to Fish

A recent study on the relationship of  EPA DHA  fish oils to increased Prostate Cancer risk has raised alarm and created confusion.

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I am reprinting here a statement by my esteemed colleague Dr. Robert Rountree, MD, Chief Medical Officer at Thorne Research which helps us to clearly understand how to interpret the results that have been sensationalized and distorted. Dr. Rountree concludes, …it would be premature to stop eating fish or to discontinue taking omega-3 nutritional supplements on the basis of this study. The first line of the study actually states “Studies of dietary Omega 3 fatty acid intake and prostate cancer risk are inconsistent.” The bottom line here is that this study shows NO CAUSE AND EFFECT relationship.                                                                                                                                               For more information see:  http://www.integrativecanceranswers.com/do-fish-oils-really-cause-prostate-cancer/