March 31, 20094:25 pm
posted by Aric Thorpe, MHR
Multiple births equal increased postpartum depression risk
New light is being shed on the connection between multiple births and postpartum risk, a greatly understudied topic. According to findings published in the April issue of Pediatrics, mothers that give birth to twins, triplets, and beyond, are at an increased risk of postpartum depression. According to Yoonjoung Choi, Dr.P.H., of Johns Hopkins University, and colleagues, mothers who birthed multiple babies have a 43% increase in risk for depressive symptoms nine months post delivery. Multiple birth rates have increased rapidly over the last couple of decades. However, alarmingly, only about a quarter of multiple birth mothers indicated that they spoke with a mental health professional about symptoms of depression; there is no excuse for this occurrence. “Mothers of multiple births have more regular contact with healthcare providers throughout the pre-pregnancy, prenatal, and postpartum periods, which allows ample opportunities for healthcare providers to educate women about depression,” the authors of the study stated. Click here to read an article from CNN that discusses the study more.
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March 27, 20097:25 am
posted by Aric Thorpe, MHR
Inherited depression associated with brain structure abnormalities
Here is an interesting piece that lends new perspective to previous studies that have associated the limbic system with inherited depression risk. According to findings from a study recently published online in the Proceedings of the National Academy of Sciences inherited depression risk is evident through brain structure abnormalities. Hereditary markers for depression may be denoted by a thinning of a region of the brain that processes social and emotional stimulus. Specifically, the researchers found a 28% decrease in thickness of gray matter in the right cerebral hemisphere compared to normal brains. According to Bradley Peterson, M.D. of the Columbia University Medical Center and New York State Psychiatric Institute, and colleagues, the result was “remarkable for its magnitude and spatial extent” outdoing bio-structural irregularities of major neuropsychiatric disorders such as Alzheimer’s and schizophrenia. The researchers commented stating, “These findings strongly suggest that the predisposition to familial depression derives from disturbances of cortical gray matter in the right cerebral hemisphere.” Click here to read more about this discovery from Reuters, UK.
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March 26, 20095:15 pm
posted by Aric Thorpe, MHR
FDA approves SSRI for major depressive disorder in teens
A great deal of legal debate has surrounded the SSRI escitalopram oxalate in relationship to its potential use in children and teens, perhaps because of its black box warning regarding possible risk of suicidal thoughts; it may be, however, that this legal debate will subside due to recent events. Lexapro (escitalopram oxalate) has now been approved by the FDA for major depressive disorder in teens ages 12 to 17. The approval comes shortly after the Justice Department filed a complaint against Forest Laboratories, the maker of the drug, saying that the company was promoting off-label use of excitalopram in children; Forest Laboratories denied any involvement in such activities.
Lexapro was approved for treatment of major depressive disorder after two placebo-controlled trials, one which examined the effects of escitalopram in patients ages 12 to 17 and another that examined the effects of citalopram in patients ages 7 to 17. The drugs were found to cause statistically significant greater improvement than placebo alone. Click here to read an article from Health.com that discusses the drug’s approval.
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March 24, 20092:22 pm
posted by Aric Thorpe, MHR
Patients with serious mental illness placed in nursing homes along side the elderly
According to stats from the Centers for Medicare and Medicaid Services young and middle-aged patients with serious mental illness are being housed along side the elderly increasingly in nursing homes across the United States. From 2002 to 2008 there was a 41% increase in the number of patients with mental illness placed in nursing homes (according to data obtained from the Associated Press under the Freedom of Information Act). This increase may be due to the closing of several state funded psychiatric institutions and the increasing number of vacancies in nursing homes. This trend is likely to continue if economic conditions do not shift as Medicaid will continue to pay nursing homes to house patients with mental illness as long as the census in a given facility reflects less than 50% of patients that possess a mental illness. The following is an excerpt of an article from Medpage Today that discusses how this trend is in many ways problematic:
About 125,000 mentally ill people are now living in long-term care facilities, 9% of the total nursing home population, according to the CMS data.
The closure of state-operated mental institutions in most states and rising vacancy rates in nursing homes have combined to make these facilities attractive as housing for the mentally ill.
As long as the mentally ill population in a given facility remains under 50%, Medicaid will pay to house individuals with chronic psychiatric disorders there regardless of age.
The AP report cited a series of crimes — including murder, rape, and arson — committed by younger mentally ill individuals with histories of violent behavior against elderly residents.
Click here to read the rest of this article from Medpage Today
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March 23, 200911:14 am
posted by Aric Thorpe, MHR
Combination drug approved for treatment resistant depression
A combination pill containing olanzapine and fluoxetine (Symbyax) is the first of its kind to be Okayed for treatment resistant depression. The drug is approved for adults with major depressive disorder who have already tried two separate trials of antidepressants unsuccessfully. The drug combination, which can be prescribed as a single pill or as two separate pills, showed a significant reduction in depressive symptoms compared to baseline in light of five separate studies examining the drug’s effectiveness. The combination drug was also associated with greater remission rates. The following is an excerpt of an article from Medpage Today that discusses the drug more:
Information has also been added to the labels of olanzapine (Zyprexa) and fluoxetine indicating that the two drugs can be used in combination for the acute treatment of bipolar disorder and treatment-resistant depression.
Clinicians can prescribe the single-pill option or the two drugs in separate pills.
The approval of the treatment-resistant depression indication for the combination pill was made on the basis of data from one pivotal trial, three supportive studies, and one inconclusive trial using doses ranging from 6 to 18 mg for olanzapine and 25 to 50 mg for fluoxetine, Eli Lilly said.
An analysis of all five studies together showed a significant reduction in depressive symptoms from baseline with the combination pill compared with both fluoxetine (P=0.015) and olanzapine (P=0.007) alone.
Click here to read the rest of this article from Medpage Today
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March 19, 200912:14 pm
posted by Aric Thorpe, MHR
Young Massachusetts paramedic and firefighter recruits overweight or obese?
According to a study recently published online in the journal Obesity, 75% of young Massachusetts paramedic and firefighter recruits are overweight or obese. The excuse that is often presented on the behalf of firefighters is that the added weight is from muscle mass; this is not the case according to the authors of the study. Steffanos N. Kales, M.D., M.P.H., of the Harvard School of Public Health, and colleagues, studied medical examination records of 370 firefighters and ambulance recruits that were seen during visits at two Massachusetts clinics between October 2004 and June 2007; among those seen at the clinics 43.8% were overweight (BMI of 25 to 30 kg/m2) and 33% had an even greater BMI. Researchers commenting on the findings mentioned that firefighters and emergency responders that are overweight could well put themselves in danger as well as their coworkers and the public. “We propose making BMI a vital sign during emergency responders’ medical examinations, especially as perception of ‘average weight’ is skewed higher, even among physicians,” Dr. Kales’ group said. The following is an excerpt of an article from Medpage Today that discusses the findings more:
Already in their 20s, the average 28.5 kg/m2 BMI in these emergency responder candidates exceeded that of veteran responders in their 30s and 40s, based on a review of studies from the 1980s and 1990s.
But despite common arguments that this simply reflects greater muscle mass among recruits, the researchers showed that increasing BMI was associated with cardiovascular risk factors the same as in the rest of the population, including:
* Higher blood systolic and diastolic blood pressure (both P<0.001 for trend)
* Greater likelihood of hypertension (2.4% in normal weight, 6.2% in overweight, and 16.5% in obese, P=0.001 for trend)
* Higher total cholesterol (P=0.001 for trend)
* Greater triglyceride levels (P<0.001 for trend)
* Lower exercise tolerance and higher heart rate after three-minute step test (P<0.001 and P=0.006 for trend, respectively)
These findings were particularly worrisome because cardiovascular disease and musculoskeletal injury rank high as causes of morbidity and mortality among emergency responders, the researchers noted.
“Young recruits are expected to be at or near peak career fitness,” the researchers said.
But a substantial proportion of the recruits couldn’t meet the minimum exercise threshold proposed by the National Fire Protection Agency. Whereas all those of normal weight could reach 12 metabolic equivalents, 7% of those who were overweight and 42% of those who were obese failed this standard.
Notably, each unit increase in BMI reduced the likelihood of meeting this criterion by 54% (P<0.001).
Click here to read the rest of this article from Medpage Today
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March 18, 20097:01 am
posted by Aric Thorpe, MHR
Older adults don’t handle alcohol as well as they think
According to findings published in the March issue of the Journal of Studies on Alcohol and Drugs older adults may not be handling their alcohol as well as they think. According to the study, adults ages 50 to 75 that possessed the same moderate breath alcohol level as their younger counterparts were more likely to have increased psychomotor impairment and were also more likely to misjudge how impaired they were. The researchers believe that alcohol may compound slight age-related cognitive decline. Researchers commenting on the study said, “This potential disconnection between self-reported and behavioral effects of alcohol may have significant implications for public health and safety, particularly among active, older social drinkers,” The following is an excerpt of an article from Medpage Today that discusses the study more:
To see the effect of age on intoxication at the 40 mg/100 ml-breath alcohol level typical of social drinking, the researchers recruited 42 adults ages 50 to 74, along with 26 adults ages 25 to 35. All drank in moderation at least once a month.
They were randomized to chug down either a drink of lime soda mixed with one part, 100% medical-grade alcohol, or a drink of straight lime soda with a negligible amount of alcohol floating on the surface to maintain blinding.
With blood alcohol levels still on the rise at 25 minutes after administration, participants were tested for psychomotor impairment using Trail Making Tests A and B. These require subjects to connect circles labeled with letters and/or number, in order. The tests evaluate visual-motor coordination, planning, and ability to move from one thought to the next.
A booster drink at 30 minutes targeted to keep peak breath alcohol concentration at about 40 mg/100 ml for all participants was followed by repeat psychomotor testing at 75 minutes.
Despite a similar rate of rise in breath alcohol concentration between age groups, older participants thought they were less impaired than younger adults did.(P<0.001).
Click here to read the rest of this article from Medpage Today
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March 17, 20095:30 pm
posted by Aric Thorpe, MHR
Patients with high levels of religious coping more likely to receive life-saving measures at the end of life
According to findings from a study published in the March issue of the Journal of the American Medical Association individuals with high levels of religious coping were almost three times more likely to receive aggressive life-saving measures at the end of life. These patients were more likely to want their physicians to do anything they could to help them stay alive, such as using mechanical ventilation and other life-prolonging care. These same patients were also less likely to have a do-not-resuscitate order or a durable power of attorney. The authors of the study, commenting, stated “…taken together these results highlight the need for clinicians to recognize and be sensitive to the influence of religious coping on medical decisions and goals of care at the end of life.” There have been other studies that have examined the effects of religion on medical decision making; however, this is the first study to examine religion in conjunction with end-of-life medical decision making. The following is an excerpt of an article from Medpage Today that discusses the study more:
So they looked at data from 345 predominantly Christian patients with advanced cancer who were enrolled in the Coping With Cancer Study, a prospective, multicenter, longitudinal, cohort study.
The level of religious coping was assessed by questionnaire, and additional psychosocial and religious/spiritual measures, advanced care planning, and end-of-life preferences were evaluated in an interview.
More than three-quarters (78.8%) of the participants said religion helps them cope to a moderate extent, and 31.6% agreed that religion was the most important thing keeping them going.
More than half (55.9%) said they engaged in prayer, meditation, or religious study at least once a day.
Patients with a high level of religious coping were younger, less educated, less likely to be insured or married, and more likely to be black, Hispanic, or from one of the Texas study sites (P<0.001 for all).
Patients died a median of 122 days after the study began.
Those with a high level of religious coping were more likely to receive mechanical ventilation (OR 2.81, 95% CI 1.03 to 7.69) and intensive life-prolonging care during the last week of life (OR 2.90, 95% CI 1.07 to 7.89).
Click here to read the rest of this article from Medpage Today
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March 13, 20096:45 am
posted by Aric Thorpe, MHR
NAMI again gives the nation a D
The National Alliance on Metal Illness (NAMI) began a scoring system in 2006 to judge each state’s commitment to and support systems for ensuring mental health. NAMI’s 2009 report has brought out some disappointing numbers, with the United States as a whole being ranked as a D in provisions for mental health. According to NAMI, states that have worked the hardest to improve their mental health care provisions may have their gains wiped out by the country’s poor economic health and fading resources. NAMI declared Oklahoma to be the state that had made the most improvement with its grade raised from a D in 2006 to a B this year. South Carolina, unfortunately, dropped from a B in 2006 to a D this year. The following is an excerpt of an article from BehavioralHealthcare.com that discusses NAMI’s report more:
The nation’s progress toward reforming public mental healthcare systems again has been given a “D” grade by the National Alliance on Mental Illness. NAMI first issued the Grading the States report in 2006 and released the 2009 update today, and it says those states that have worked the hardest to transform their systems could have gains wiped out as state governments face dwindling resources in the economic downturn.
NAMI says Oklahoma improved the most, with its grade rising from a D in 2006 to a B this year, and 13 other states also improved their scores. South Carolina had the greatest decline, falling from a B to a D, and 11 other states also slipped in NAMI’s rankings. Twenty-three had no change from 2006 to 2009. NAMI determines the grades based on 65 criteria. To see how your state scored, click here.
Among some of the findings in the latest report:
* SAMHSA has failed to promote uniform standards for collecting data at the state, county, and local levels;
* states are not focusing on wellness services for people with serious mental illnesses (SMI);
* states lack plans for developing and maintaining their mental healthcare workforces;
* consumers and families do not have adequate input in monitoring mental healthcare systems’ performance; and
* states are not considering the long-term housing needs of people with SMI.
Click here to read the rest of this article from BehavioralHealthcare.com
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March 12, 20093:32 pm
posted by Aric Thorpe, MHR
COPD patients who have moderate to severe depression may be at increased risk for death…
According to findings from a study published in the March issue of Chest, individuals with stabilized chronic obstructive pulmonary disease (COPD) who have moderate to severe depression are at an increased risk for death. According to the study, upon follow up with stable COPD patients with depression researchers found that they possessed nearly twice the likelihood of death from any cause. Those patients with uncontrolled COPD and moderate to severe depression were also found to have an increased mortality rate. Researchers, commenting on the study’s findings, stated “…what is needed next is explication of both the determinants of depressive symptoms and of the pathway between these symptoms and mortality.” Future studies should examine whether alleviation of depressive symptoms results in a lessening mortality rate in this population. The following is an excerpt of an article from Medpage Today that discusses the study more:
Although depression increases the risk of death in patients with COPD during or shortly after an exacerbation, conflicting data have clouded the nature of same relationship in patients with stable disease, the researchers said.
To find out, the researchers monitored 121 patients (mean age 61.5) with stable COPD (mean forced expiratory volume in one second 36.9% of predicted). They were studied from hospital admission for pulmonary rehabilitation through follow-up lasting up to 8.5 years.
All patients were clinically stable for at least six weeks before entering the study.
Depressive symptoms were measured using the Beck Depression Inventory, a 21-item self-administered survey measuring attitudes and symptoms of depression. A score of at least 19 out of 63 was used to indicate the presence of depressive symptoms.
Nearly one in five patients (19.8%) met that threshold.
Through follow-up, 63% of the patients died. Overall median survival was 5.3 years.
In a multivariate analysis, depressive symptoms were associated with all-cause death (P<0.05), independent of gender, age, and exercise capacity.
Male sex (OR 1.73, 95% CI 1.03 to 2.92) and older age (OR 1.05, 95% CI 1.02 to 1.08) were associated with an increased risk of mortality, and better exercise capacity (OR 0.98, 95% CI 0.97 to 0.99) was associated with a slightly decreased risk.
There were two possible explanations for the link between depression and mortality in patients with COPD, according to the researchers.
Click here to read the rest of this article from Medpage Today
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