In The News
The long-term risk of suicide is three times higher for adults who have suffered from a concussion during the workweek, compared to the general population, according to a new study published in the Canadian Medical Association Journal (CMAJ).
The risk for suicide was even greater if the concussion occurred on a weekend, which may suggest people are more prone to severe concussions through recreational accidents rather than accidents at work.
“Given the quick usual resolution of symptoms, physicians may underestimate the adverse effects of concussion and its relevance in a patient’s history,” said Dr. Donald Redelmeier, senior core scientist at the Institute for Clinical Evaluative Sciences (ICES) and a physician at Sunnybrook Health Sciences Centre, Toronto, Ontario.
“Greater attention to the long-term implications of a concussion might save lives because deaths from suicide can be prevented.”
In 2010, there were 38,364 deaths from suicide in the United States and 3,951 in Canada. Concussion is the most common brain injury in adults. Each year, there are about four million cases of concussions in the United States and about 400,000 in Canada.
“The link between concussion and suicide is not confined to professional athletes or military veterans,” said Michael Fralick, a coauthor and medical trainee at the University of Toronto.
For the study, researchers looked at anonymized records for 235,110 patients with concussion over a 20-year period in Ontario, Canada, using diagnostic codes from the health insurance database.
The investigators specifically compared concussions that occurred on a weekend or a weekday to distinguish between recreational and occupational injuries. The mean age of the patients was 41 years, about half were men, and the majority lived in cities. Most had no prior suicide attempt, hospitalization or past psychiatric disorder.
After a follow-up period of nearly nine and a half years, the researchers found that there had been 667 suicides. Patients diagnosed with a concussion on weekdays accounted for 519 suicides and an absolute suicide risk three times the population norm (29 suicides per 100,000 people a year).
Patients who had suffered from a concussion on weekends accounted for 148 suicides and an absolute suicide risk four times that of the population norm (39 per 100,000 a year).
The mean time from concussion to subsequent suicide was 5.7 years. Additional concussions were linked to a greater risk of suicide. Most of the patients had visited their family physician in the month before suicide. The most common mechanism was a drug overdose, and the average age at death was 44 years.
Previous research has shown an association between concussion and suicide. However, “no past study, to our knowledge, has focused on concussions and tested the potential difference between weekends and weekdays,” write the authors.
“The increased long-term risk of suicide observed in this study persisted among those who had no psychiatric risk factors and was distinctly larger than among patients after an ankle sprain.”
The researchers hope these findings will help doctors and patients better understand the risks of concussion and prevent possible suicides.
While considerable attention has been directed toward reducing bullying of lesbian, gay, bisexual, and transgender (LGBT) teens, a new Northwestern Medicine study has found that most adolescents would agree that it does, in fact, get better. But not all.
Discrimination, harassment, and assault of LGBT youths is still very much a problem for about a third of adolescents, the study found. What’s more, it’s often very severe, ongoing and leads to lasting mental health problems such as major depression and post-traumatic stress disorder (PTSD).
“We tend to think that society is evolving but we can’t just accept this narrative that ‘it gets better’ and think it gets better for everyone,” said Dr. Brian Mustanski, an associate professor in medical social sciences at Northwestern University Feinberg School of Medicine.
Mustanski was happy to see that the majority of the 248 youths in the study (84.6 percent) experienced decreasing levels of victimization over the four years.
Unfortunately, 10.3 percent of teens experienced significant increases in bullying, and 5.1 percent maintained high levels of victimization over the four years. While doing the research, Mustanski was struck by just how severe the treatment was.
“With bullying, I think people often assume ‘that’s just kids teasing kids,’ and that’s not true,” Mustanski said.
“If these incidents, which might include physical and sexual assaults, weren’t happening in schools, people would be calling the police. These are criminal offenses.”
Mustanski is the lead author of the study published in The American Journal of Public Health. The study is innovative because it looked at not only the number of victimizations teens were experiencing but how severe they were and how they changed over time.
“You can’t equate someone giving you a dirty look with someone physically assaulting you,” Mustanski said.
“Victimizations that are more severe are going to have bigger effects. We scored them in a way that represented that, and we saw they had a profound effect on mental health rates over time.”
Two specific scenarios appear to place LGBT youths at the highest risk for mental health problems. The first is when a youth experienced moderate harassment (i.e. having something thrown at them) that increased over time or adolescents.
The second is when a youth continually experiences high levels of victimization (i.e. physical or sexual assault) over the prolonged course of time (for example, over four years).
This accumulation of victimizations was the key difference in Mustanski’s study from previous research that focused on a single period of time. While a single incident can have an impact on a young person, Mustanski’s study found that an adolescent’s depression and PTSD was exacerbated when these assaults built up over time.
And even youths who began high school getting severely bullied but were lucky enough to see that lessen over time were still at a higher risk for PTSD.
“Some of the symptoms someone needed to get a PTSD diagnosis were re-imagining or having flashbacks to a traumatic event,” Mustanski said, citing a hypothetical example of an LGBT youth who was repeatedly assaulted for his sexual orientation over time.
“If that’s your experience for several years of high school, you can imagine how scarring that would be,” Mustanski said.
The study in 2007 began examining Chicago youths who identified as LGBT or reported having same-sex attraction. It assessed the teens’ mental health at baseline and in seven interviews over four years and found that females were more likely to be in the group that was getting victimized less over time than men. Boys experienced physical and verbal assault more than girls, Mustanski said.
“We were happy to see that for most kids, the levels of victimization were lower overall or decreasing over time. But we were struck by how severe it was for some of these kids who were getting highly victimized over their four years of high school,” Mustanski said.
Overall, he said it is important to note that the majority of targeted LGBT youths are doing well and are “resilient,” but for the group of adolescents getting severely victimized, something drastic needs to be done.
He hopes the study’s findings will help schools clearly see these patterns of LGBT bullying so they can intervene with policies and programs to help prevent the behavior and provide coping mechanisms for those who are being targeted.
Source: Northwestern University
New research suggests infant girls at risk for autism pay more attention to social cues in faces than infant boys. This innate ability may reduce the risk or lower the severity of autism in high risk children.
The Yale School of Medicine study is the first to prospectively examine sex-related social differences in at-risk infants. Researchers believe the difference in observational skills could help protect female siblings of children with autism from developing the disorder themselves.
Study findings appear in the Journal of the American Academy of Child & Adolescent Psychiatry.
Lead author Dr. Katarzyna Chawarska, an associate professor in the Yale Child Study Center, and her colleagues measured social attention in 101 infants between the ages of six and 12 months who have older siblings with autism.
The team also studied 61 infants with no risk of autism. Chawarska said high-risk siblings are about 15 to 20 times more likely to have autism than those without a history of autism in the family.
The infants were all shown a video of a woman smiling and cooing at them, while she was doing other activities like pointing to toys in different parts of the screen, and preparing a sandwich. The team tracked where the infants focused their gazes, and for how long.
“We found that the girls in the high-risk group displayed more attention to people and their faces than all other infants,” said Chawarska, who is also director of the Early Social Cognition Laboratory at Yale.
“This increased access to social experiences during a highly formative developmental period predicted fewer social impairments at two years of age. It is important to note however, that this may not prevent ASD in high-risk females, but could mitigate the severity of autism symptoms.”
Chawarska’s lab is now pursuing several leads they hope will help reveal the mechanisms underlying this attentional advantage in girls.
Source: Yale University/EurekAlert
A new animal study from the University of Guelph in Canada provides new insights on the internal workings of the brain, specifically regions involved in recognizing and remembering objects.
The research appears in the Journal of Neuroscience.
“Our study suggests that past experience with an object alters the brain circuitry responsible for object recognition,” said researcher Dr. Boyer Winters. “It has significant implications for our understanding of multisensory information processing.”
Multisensory integration is an important part of memory, Winters said. For example, if you hold something while blindfolded, chances are you can recognize it by touch if you have seen it before. But how?
Specialized areas of the brain mediate information for sight and touch, Winters said. Some researchers say those regions “talk” to each other, enabling better recognition of an object.
Others believe that the brain integrates information from the senses and stores it in a separate place entirely, and then taps into that area to aid object recognition.
Winters and his team set out to test which model is correct using rat models.
They let some rats briefly explore an object’s tactile and visual characteristics. The next day, the researchers showed the object to the same animals, and compared their responses to rats seeing the object for the first time.
Rats exploring the objects for the first time appeared to use multiple specialized brain regions to recognize the object, while rats with previous exposure tapped into a separate part of their brains to perform the same memory task.
“Knowing what an object looks like enables them to assimilate information in a way that doesn’t happen when there is no pre-exposure,” Winters said.
“Our study suggests there is an assigned region of the brain for memory based on previous experience with objects.”
The more exposure to an object, the more information about it is stored in dedicated parts of the brain, leading to more efficient behavioral responses, Winters said.
Investigators believe the new knowledge may help in developing therapies for people with dementia and other brain disorders who cannot recognize highly familiar objects or people, he said.
The research appears in the Journal of Neuroscience.
Source: University of Guelph
New research looks at whether differences in people’s movements influence coordination of group actions. That is, does matching participants based on their movement rates improve group performance?
The answer is yes, according to Canadian researchers from McGill University. Investigators believe the finding may help us predict for each person how successful they will be in a group task.
Study results will be published in the Journal of Experimental Psychology: Human Perception and Performance.
“We found that pairs of musicians (pianists) with similar rates of solo music performance are better at synchronizing the timing of tone onsets during piano duets than partners with different solo performance rates,” said McGill psychology professor Dr. Caroline Palmer.
“We think this could extend to interpersonal synchrony in other fields, such as recreational activities like jogging, where health benefits may be greatest when partners are matched for rates; or in education, when teachers and students are matched in conversational speech rates; and especially in sports, such as tennis doubles, pairs skating, or team rowing,” explains Palmer.
McGill researchers found that solo rates are a stable predictor of coordination between individuals.
There were no group differences in other factors known to influence coordination, such as years of musical training and age at which pianists started musical training. This suggests that solo rates are the only difference in partners’ duet coordination between matched and mismatched pairs.
“These findings suggest that coordination of timing with a partner is facilitated by similarity of partners’ individual movement speeds,” said Anna Zamm, a Ph.D student at McGill and the study’s first author.
Therefore, the performance of a group could be improved by matching participants with similar internal rhythms.
“Success on group tasks is linked to how well pair members match up, a bit like rowers in a boat. The boat will move straight ahead if both people are matched in the force with which they row,” said Palmer.
“It does not matter whether each individual is strong or weak — it’s the match in force that matters.”
Source: McGill University
For many children with attention deficit hyperactivity disorder (ADHD), symptoms decrease as they age. For some children, however, the symptoms persist, and a new study implicates persistent parental criticism.
“Why ADHD symptoms decline in some children as they reach adolescence and not for others is an important phenomenon to be better understood. The finding here is that children with ADHD whose parents regularly expressed high levels of criticism over time were less likely to experience this decline in symptoms,” said Erica Musser, Ph.D., assistant professor of psychology at Florida International University and lead author of the study.
The study appears in the Journal of Abnormal Psychology.
Musser and her colleagues studied a sample of 388 children with ADHD and 127 without, as well as their families, over three years. Of the children with ADHD, 69 percent were male, 79 percent were white, and 75 percent came from two-parent households.
The researchers measured change in ADHD symptoms over that period and measured the parents’ levels of criticism and emotional involvement.
Parents were asked to talk about their relationship with their child uninterrupted for five minutes. Audio recordings of these sessions were then rated by experts for levels of criticism (harsh, negative statements about the child, rather than the child’s behavior) and emotional over-involvement (overprotective feelings toward the child).
Measurements were taken on two occasions one year apart.
Only sustained parental criticism (high levels at both measurements, not just one) was associated with the continuance of ADHD symptoms in the children who had been diagnosed with ADHD.
“The novel finding here is that children with ADHD whose families continued to express high levels of criticism over time failed to experience the usual decline in symptoms with age and instead maintained persistent, high levels of ADHD symptoms,” said Musser.
While the findings indicate an association between sustained parental criticism and ADHD symptoms over time, this doesn’t mean one thing causes the other, said Musser.
“We cannot say, from our data, that criticism is the cause of the sustained symptoms,” she said. That is, a cause-and-effect relationship between a hypercritical parent and the extension of ADHD symptoms can not be inferred from the current study.
Nevertheless, improved parenting behavior as well as other interventions to reduce symptoms may be beneficial.
“Interventions to reduce parental criticism could lead to a reduction in ADHD symptoms, but other efforts to improve the severe symptoms of children with ADHD could also lead to a reduction in parental criticism, creating greater well-being in the family over time.”
New clinical practice guidelines advise physicians that cognitive behavioral therapy (CBT) and second-generation antidepressants (SGAs), are equally effective treatments for major depressive disorder (MDD) in adults.
The American College of Physicians (ACP) recommendation appears in the Annals of Internal Medicine.
“Patients are frequently treated for depression by primary care physicians, who often initially prescribe SGAs,” said ACP President Wayne J. Riley, M.D., M.P.H., M.B.A., M.A.C.P.
“However, CBT is a reasonable approach for initial treatment and should be strongly considered as an alternative treatment to SGAs where available, and after discussing treatment effects, adverse effect profiles, costs, accessibility, and preferences with patients.”
Major depression is a medical condition causing sadness that interferes with daily life, not a normal reaction to life situations such as the death of a loved one or the loss of a job.
Symptoms associated with depression include lack of energy and loss of interest in things previously enjoyed.
The American College of Physicians developed the guideline to summarize and grade the evidence on the comparative effectiveness and safety of non-drug treatments and commonly used medications, alone or in combination for major adult depression.
SSRIs are antidepressants that generally have fewer side effects than older antidepressants. Common SSRIs are citalopram (Celexa), escitalopram (Lexapro), fluoxetine (Prozac), fluvoxamine (Luvox), paroxetine (Paxil), and sertraline (Zoloft). SNRIs are newer medications such as venlafaxine and duloxetine.
Researchers evaluated outcomes including response, remission, functional capacity, quality of life, reduction of suicidality or hospitalizations, and harms.
Researchers report that moderate-quality evidence showed that CBT and SGAs are similarly effective treatments for MDD and that discontinuation rates are similar for CBT and SGAs.
Moderate quality evidence means that the authors are confident in the research finding but acknowledge that further research may change the conclusions.
Low-quality evidence showed no difference in effectiveness or adverse effects between first line treatment using SGAs compared to non-drug treatments (complementary and alternative medicines, or exercise monotherapies or combination therapies).
Lower quality research means that the research is uncertain and future studies are likely to change the findings.
Researchers discovered adverse effects commonly associated with SGAs include constipation, diarrhea, dizziness, headache, insomnia, nausea, sexual adverse events, and drowsiness.
For second line treatment after treatment failure with SGAs, low-quality evidence showed that strategies to switch to or augment with another drug or non-drug therapy are similarly effective.
Low-quality evidence showed that St John’s wort may be as effective as SGAs for treating MDD, and moderate-quality evidence showed that St John’s wort was better tolerated than SGAs.
However, St. John’s wort is not currently regulated by the Food and Drug Administration in the U.S. Because no standard is in place regarding the contents and potency of the medication, patients in the U.S. may not be able to get quality-controlled St John’s wort or reliably obtain preparations with similar effectiveness as those used in the included studies.
A new military study finds that patients with post-traumatic stress disorder (PTSD) and obstructive sleep apnea (OSA) experience reduced quality of life, more sleepiness, and do not respond as well to positive airway pressure (PAP) therapy.
Investigators used a case-controlled study at the Sleep Disorders Center at the San Antonio Military Medical Center in Fort Sam Houston, Texas, to investigate the interactions.
For the investigation, researchers performed sleep studies on 200 military medical patients with PTSD and found that over half were diagnosed with OSA. These patients were compared with 50 matched patients with OSA but not PTSD and with another 50 patients without PTSD or OSA controls.
This study showed that compared with the other groups, patients with both PTSD and OSA had worse quality of life measurements, more sleepiness, and less adherence and response to treatment.
The results point out that patients with PTSD are also at high risk of having OSA and should be evaluated accordingly.
A significant finding from the study is that PAP therapy is not as effective if an individual has both PTSD and OSA. As such, these patients should also be followed especially closely for adherence and response to PAP treatment.
The complete study appears in the journal CHEST.
People who survived the Holocaust faced a significantly greater risk for developing schizophrenia compared to those who were indirectly affected, according to a new comprehensive study conducted at the University of Haifa in Israel. Among all survivors, the highest rates of schizophrenia were found in those who had been born into the Holocaust.
“The exposure to protracted multiple maximal physical, social, and psychological adversities of the Holocaust increased the risk of survivors developing schizophrenia,” said researcher Stephen Levine, Ph.D.
Holocaust researchers have long documented how survivors were at greater risk of emotional distress and various psychiatric disorders, such as sleeping disorders. However, until now no study has examined the effect of Holocaust exposure on the risk of developing schizophrenia.
For the study, the researchers examined comprehensive population-based data on 113,932 European Jews from nations where the Holocaust occurred. The population was split into two groups.
The first group included those who were indirectly exposed to the Holocaust. Although they had immigrated to Israel before the Holocaust began in their country of origin, they still had relatives, friends, or colleagues who were exposed to it.
The second group included those who were directly exposed to the Holocaust. These individuals did not immigrate to Israel until after the end of the Second World War.
The findings reveal that individuals with direct exposure to the Holocaust had a 27 percent higher chance of developing schizophrenia than those who were not directly exposed to it.
Furthermore, within the directly exposed group, people with the highest risk of developing schizophrenia were those born during the Holocaust and who continued to experience it afterward. This group’s risk of developing schizophrenia was 41 percent higher than the group with indirect Holocaust exposure.
The researchers note that the disruption of normal neurological development in childhood most likely increased the risk of developing schizophrenia. This would support the hypothesis that neurological development in young children is a critical period for subsequent development later in life.
“The study results are not entirely intuitive, as scholars disagree as to the consequences of Holocaust exposure,” Levine said. “Some researchers claim that Holocaust survivors were stronger and healthier. Selective mortality induced by the Nazis systematically murdered more vulnerable people, leaving the fittest to survive. This school of thought would anticipate that survivors would be at a reduced risk of developing schizophrenia.
“Conversely, other scholars have argued that irrespective of the fact that the strongest survived, protracted exposure to extreme trauma made Holocaust survivors vulnerable to developing schizophrenia. This study is consistent with the latter argument.”
Substance use disorders related to prescription opioid pain medicines have become a public health epidemic in the U.S. as they affect an estimated 1.9 million people.
New health policy initiatives call for $1.1 billion in federal money to combat problems linked to prescription drug abuse and heroin, including more treatment for people addicted to painkilling opioids such as OxyContin and hydrocodone.
A new study, however, finds there are no easy answers when physicians drug screen their patients to discover drug use. In fact, doctors who treat patients suffering from chronic pain are often placed in a difficult Catch-22.
Researchers from from the University of Houston (UH) and the University of Texas Medical Branch (UTMB) discovered monitoring patients through urine drug screenings — part of the standard protocol to ensure patient safety — is associated with an increase in the odds that the patients won’t return for future treatment.
The study, published in journal Pain Physician, deals with an issue drawing increasing public attention.
Reducing prescription drug use requires monitoring of patients treated with those drugs. Researchers found, however, that monitoring may have some unintended consequences.
They discovered almost one-fourth of chronic pain patients — 23.75 percent — who were given a urine drug screening test on their first visit failed to show up for their next appointment. That compares to just more than 10 percent of patients who were not screened. The trend applied even to patients whose drug screening indicated they had followed clinic rules.
“It is a balancing act,” said Partha Krishnamurthy, a marketing professor and director of the Institute for Health Care Marketing at UH’s Bauer College of Business. “On one hand, concerns about patient safety and public health necessitate the monitoring of patients on opioid medications. On the other hand, aggressive monitoring may interfere with the therapeutic alliance.”
Krishnamurthy was lead author for the study along with co-authors Drs. Govindaraj Ranganathan, Courtney Williams and Gulshan Doulatram, all UTMB physicians who are board certified in pain management.
Drug screenings offer clues to patient behavior but also signal the patient that the doctor is watching.
“When you give a signal to the patient, it is likely to affect their decision making,” Krishnamurthy said. He also has an appointment to UTMB, as an adjunct assistant professor in the Department of Anesthesiology and Pain Medicine.
The researchers found that 34.57 percent of patients who tested positive failed to show up for their next appointment; 21.74 percent of those whose screening tests were negative also failed to show up. About 10 percent of those who weren’t tested skipped a follow-up appointment.
Those no-shows have implications for public health, as well as for individual patients, Krishnamurthy said, citing research showing prescribed opioid medications can be a precursor to heroin use or sold for recreational use. If these findings hold up in future controlled studies, he said, the big question will be “if monitoring patients makes them disengage from the clinic, where are they going?”
“While there is considerable research on the value of (urine drug screening) to the physician, there is little research on how it influences patient behavior,” the researchers wrote. “The post-screening behavior of those receiving a (urine drug screening) was markedly different from those who did not.”
Even patients who tested negative for illicit substances were more likely to skip a subsequent appointment than those who were not tested.
“This raises concerns that the (screenings) administered early in the doctor-patient relationship might have an inadvertent impact on injuring patient expectations of trust,” according to the study.
The researchers did not recommend the screenings be stopped or delayed but emphasized the need to understand the impact of drug screening and how to mitigate any potential unintended effects.
The study drew upon the electronic medical records of 4,448 clinic encounters involving 723 patients between April 2009 and January 2012. Identifying information had been retracted.
The large data set allowed researchers to discover a correlation between urine drug screening tests and a patient’s risk of skipping future appointments. But, the data did not clearly establish that the tests caused the patients to drop out. About 70 percent of patients were screened at their initial visit.
The findings held up through a variety of analytical models, but Krishnamurthy said the next step will be a controlled study, where patients are randomly assigned to be screened or not. Ultimately, he said, the goal is to balance use of opioid medications with patient safety and well-being.
A new study finds that first-time expectant fathers may be unduly influenced by television shows that portray dads in an unfavorable light.
The University of Michigan study found some dads watch a heavy dose of television featuring incompetent dads and many came to believe that men were unimportant in their children’s lives.
“Our findings show that within the broader social context that under-prepares men for fatherhood, men are especially vulnerable to negative media messages about fathers,” said Patty Kuo, the study’s lead author and graduate student in the University of Michigan Department of Psychology.
Television content has been documented to portray a limited range of gender roles, and to frequently depict fathers as emotionally available, but also bumbling and incompetent, she said.
Kuo and co-author L. Monique Ward, the Arthur F. Thurnau Professor of Psychology, explored whether first-time expectant parents’ beliefs about gendered family roles and the importance of fathers to child development was related to their TV use.
The study appear in the journal Psychology of Men and Masculinity.
Researchers reviewed responses from 201 first-time expectant parents who completed an online survey on their daily viewing habits. Respondents averaged more than 30 hours of TV per week, including 25 percent who said their viewing habits exceeded 49 hours.
For the study, the TV listing involved 30 shows: 10 dramas (“The Walking Dead,” “Parenthood”), 13 sitcoms (“Modern Family,” “Raising Hope”), two comedy-dramas (“Louie,” “Shameless”), four animated programs (“Family Guy,” “The Simpsons”), and one reality show (“Teen Mom”).
Men watched more TV, especially shows that prominently featured fathers, than women, the study showed. In general, men perceived TV to be more realistic, which contributed to their beliefs about weakened importance for fathers.
The researchers theorize that men are not solely affected by bumbling father tropes, but there are other more attractive aspects of dad characters that may be appealing.
For example, Walter White (“Breaking Bad”) and Tony Soprano (“The Sopranos”) may not be sensitive fathers, but they are formidable and powerful men. Phil Dunphy and Jay Pritchett from “Modern Family” may not be competent fathers, but they are married to beautiful wives and adored by their families.
“Although the portrayals of these men as fathers are negative, the overall portrayals of these fathers as men are attractive because they portray these men as powerful, dominant, or sexually virile,” the researchers wrote.
The unattractive portrayals of fathers are counter to expectant mothers’ desires for an involved and equal partner.
“Therefore, women may not rely as much on these (TV) images for forming their beliefs about fathers’ roles in families,” Kuo said.
Source: University of Michigan
Benzodiazepines are a common class of medication used for anxiety and sleep problems. New research finds that although the drugs do not increase the risk of dementia, health professionals are advised to avoid their use in older adults.
Common benzodiazepines are clonazepam (Klonopin), lorazepam (Ativan), diazepam (Valium), and alprazolam (Xanax).
Although research published in the British Medical Journal (BMJ) did not find a cause and effect increased dementia risk, the use of benzodiazepines among older adults may lead to adverse health outcomes.
Benzodiazepines are widely prescribed among older adults to manage sleep, anxiety, and depressive disorders. The new study sought to resolve conflicting findings on whether benzodiazepines could increase risk of dementia.
A team of US researchers at the University of Washington (UW) and Group Health in Seattle, led by UW Professor of Pharmacy Shelly Gray, designed the study to determine whether higher cumulative use of benzodiazepines is associated with a higher risk of dementia or more rapid cognitive decline.
Their study involved 3,434 participants at Group Health aged 65 and older without dementia at study entry, who were followed for an average of seven years. Cognitive screening was carried out when participants entered the study and again every two years.
Benzodiazepine use was assessed using computerised pharmacy data over a 10 year period. Factors such as age, sex, and presence of other conditions were recorded and participants were asked about smoking, exercise, and self-rated health.
Longitudinal observational studies, such as this, do not show cause and effect, but can be used to explore the relationship between benzodiazepine use and risk of dementia over time.
During follow-up, 797 participants (23 percent) developed dementia, of whom 637 (80 percent) developed Alzheimer’s disease.
The team found no association between the highest level of benzodiazepine use (the median level of use in this group was equivalent to about one year of daily use) and dementia or cognitive decline.
Contrary to expectations, they found a small increased risk for dementia in people with low (up to one month) or moderate (one to four months) use. However, suggest this could represent treatment of prodromal [early] symptoms.”
They also point to some study limitations and say they were unable to completely rule out potential bias that could have affected their results.
“Overall, our results do not support a causal association between benzodiazepine use and dementia,” they write.
Nonetheless, given the mixed evidence regarding benzodiazepines and risk of dementia and that these drugs are associated with many adverse events, “healthcare providers are still advised to avoid benzodiazepines in older adults to prevent important adverse health outcomes, withdrawal and dependence,” they conclude.
In 2015, this same team published findings showing a link between the heavy use of medications with anticholinergic activity (including some over the counter sleep aids and allergy medications, and tricyclic antidepressants) and dementia.
Source: British Medical Journal
Emerging research suggests there may be a genetic connection between some mental health disorders and type II diabetes.
In a new report scientists show that a gene called “DISC1,” which is believed to play a role in mental health disorders such as schizophrenia, bipolar disorder, and some forms of depression, influences the function of pancreatic beta cells which produce insulin to maintain normal blood glucose levels.
The study appears in the The FASEB Journal (Federation of American Societies For Experimental Biology).
“Studies exploring the biology of disease have increasingly identified the involvement of unanticipated proteins — DISC1 fits this category,” said Rita Bortell, Ph.D., a researcher involved in the work from the Diabetes Center of Excellence at the University of Massachusetts Medical School in Worcester, Mass.
“Our hope is that the association we’ve found linking disrupted DISC1 to both diabetes and psychiatric disorders may uncover mechanisms to improve therapies, even preventative ones, to alleviate suffering caused by both illnesses which are extraordinarily costly, very common, often quite debilitating.”
In the research, Bortell and colleagues studied the function of DISC1 by comparing two groups of mice. The first group was genetically manipulated to disrupt the DISC1 gene only in the mouse’s pancreatic beta cells. The second group of mice was normal.
The mice with disrupted DISC1 gene showed increased beta cell death, less insulin secretion and impaired glucose regulation while control mice were normal. The researchers found that DISC1 works by controlling the activity of a specific protein (GSK3β) already known to be critical for beta cell function and survival.
Inhibition of GSK3β resulted in improved beta cell survival and restored normal glucose tolerance in mice with disrupted DISC1. Alterations in the DISC1 gene were originally associated with increased risk of schizophrenia, but further studies have also found DISC1 alterations in individuals with bipolar disorder and major depression.
Experts say that although mental illness and diabetes seem to be very distinct and independent conditions, we are still learning the way genetic expression can affect the body.
“The connections between these disorders may be surprising, but we have known for a long time that a single protein or gene can play multiple roles in the body,” said Thoru Pederson, Ph.D., editor-in-chief of The FASEB Journal.
Hallucinogens such as LSD or psilocybin (the psychoactive ingredient in magic mushrooms) appear to have significant therapeutic potential for reducing intimate partner violence (IPV), according to a new study.
While some types of drugs and substance use, particularly alcohol, have been linked to increased domestic violence, hallucinogens have a completely different effect on users, causing people to behave more peacefully and compassionately.
Each year, more than 12 million people are victims of IPV in the US, according to the Centers for Disease Control and Prevention. One in every three women worldwide has experienced IPV at some point in her lifetime, according to the American Psychology Association.
Therefore, identifying both the risk and protective factors for IPV is an important goal for public health research, say the investigators.
“A body of evidence suggests that substances such as psilocybin may have a range of clinical indications,” said Associate Professor Peter S. Hendricks, Ph.D., from the School of Public Health at the University of Alabama at Birmingham.
“Although we’re attempting to better understand how or why these substances may be beneficial, one explanation is that they can transform people’s lives by providing profoundly meaningful spiritual experiences that highlight what matters most. Often, people are struck by the realization that behaving with compassion and kindness toward others is high on the list of what matters.”
Hendricks, along with researchers from the University of British Columbia, evaluated the data of 302 men ages 17-40 in the criminal justice system. Of the 56 percent of participants who reported using hallucinogens, only 27 percent were arrested for later IPV as opposed to 42 percent of the group who reported no hallucinogen use being arrested for IPV within seven years.
From the 1950s through the early 1970s, thousands of studies reported on the medical use of hallucinogens, mostly LSD. However, due to the classification of the most prominent hallucinogens as Schedule I controlled substances in 1970, research on health benefits was suspended, causing many of these studies to be abandoned and forgotten.
In recent times, however, research with hallucinogens has experienced a rebirth as their benefits are hard to ignore.
“Recent studies have shown that psilocybin and related compounds could revolutionize the mental health field,” Hendricks said. “However, additional research is needed. This study suggests that hallucinogens could be a useful avenue for reducing IPV, meaning this topic deserves further attention.”
A new Swedish study finds that after just nine weeks of Internet-delivered cognitive behavioral therapy, the brains of patients suffering from social anxiety disorder change in volume and activity — and anxiety is reduced.
Researchers noted that the brain is remarkably adaptable. For instance, previous studies have shown that juggling and video games affect brain volume. But questions remain about how brain volume and neuronal activity in specific areas may change.
In the current investigation, a group of researchers from Linköping University and other Swedish universities studied how Internet-delivered cognitive behavioral therapy (ICBT) affects brain volume and activity.
The researchers focused on patients with social anxiety disorder (SAD), one of the most common mental health problems.
For the study, magnetic resonance imaging (MRI), was performed on all study participants before and after the ICBT intervention.
The researchers found that in patients with SAD, brain volume and activity in the amygdala decrease as a result of ICBT. Study results appear in the journal Translational Psychiatry.
“The greater the improvement we saw in the patients, the smaller the size of their amygdalae. The study also suggests that the reduction in volume drives the reduction in brain activity,” said doctoral student Kristoffer NT Månsson, who led the study. Månsson teamed with Linköping colleague Dr. Gerhard Andersson and researchers from the Karolinska Institutet, Uppsala University, Umeå University and Stockholm University.
The study comprised 26 individuals treated over the Internet for nine weeks, making it a relatively small study. However, it is unique in that it investigates multiple factors at the same time: post-treatment changes in both brain volume and brain activity.
“Although we didn’t look at that many patients, this work provides some important knowledge — especially for all the sufferers. Several studies have reported that certain areas of the brain differ between patients with and without anxiety disorders,” Månsson said.
“We’ve shown that the patients can improve in nine weeks — and that this leads to structural differences in their brains.”
Månsson sees the study as a first step in a larger project. Ultimately the aim is to better understand the psychological and biological effects of treatment in order to develop more effective therapies.
The research team is now moving forward with studies on more patients. One study aims to identify the point during the treatment where the change in the brain occurs.
Experts believe the study findings will help in the development of more effective therapies for one of the most common problems in mental health.
Boys who experience the incarceration of a parent have approximately double the risk of having a heart attack in later adulthood in comparison with boys not exposed to such a childhood trauma, according to a new study by researchers at Virginia Tech and the University of Toronto.
The investigators were so surprised at the magnitude of the link that they later replicated the analyses using a second large survey.
“The strong association we found between incarceration of family members during childhood and later heart attack among men aged 50 and older remained even after adjustments for many known risk factors for heart attack such as age, race, income, education, smoking, physical activity, obesity, high alcohol consumption, diabetes, and depression,” said lead researcher Bradley White, an assistant professor with the Virginia Tech Department of Psychology and a faculty member with the College of Science.
Data came from two national surveys: a 2011 Behavioral Risk Factor Surveillance System (BRFSS) sample with approximately 15,000 adults, and a 2012 BRFSS sample with more than 22,000 respondents.
Senior co-author Esme Fuller-Thomson at the University of Toronto’s Factor-Inwentash Faculty of Social Work, reported “the findings were very consistent in the two samples indicating a strong association for men and no association for women.”
According to the data, about one in every 50 older adults in either survey reported having a parent incarcerated. The data was unable to determine exactly which family member was incarcerated; however, based on prior studies, White said the vast majority of U.S. prison inmates are men, most of whom are fathers to children under 18. Further, crime details — violent or non-violent — and length of the prison sentences were not available in the survey.
“Such factors might impact the relationship between exposure to family member incarceration and later heart attack risk,” White added.
“Previous studies have indicated that the incarceration of a parent plays havoc with the stability of housing, employment, and parental marital relationships, and result in considerable social and familial stigma,” White said.
“Parental incarceration also is associated with psychosocial maladjustment and mental disorders in children, including delinquency and conduct problems. However, less attention has been paid to the long-term physical health outcomes of the children as they grow up.”
Cortisol, the “flight or fight” hormone, has been linked to the development of cardiovascular disease in separate medical studies and warrants further research.
“Some earlier research suggests childhood adversities may change the ways individuals react to stress across the life course and this can impact the production of cortisol,” said Fuller-Thomsen.
The research was not designed to differentiate why men experience higher odds of heart attack later in life compared to women. However, the findings suggest — but do not yet confirm — reaction and life alterations may be gender-specific, said Fuller-Thomson. She adds that boys appear to be particularly sensitive to adverse childhood experiences.
She reported, “In my earlier research on the long-term consequences of childhood maltreatment, we found childhood sexual abuse was linked to heart attack for men but not women.”
She added that the psychosocial impact on boys whose fathers are incarcerated may be greater than for girls because boys and men are less likely to seek counseling following psychological traumas, and thus may have more difficulty coping.
The researchers hope that future surveys will gather more information — which family member is incarcerated, nature of the crime, and approximate timing of incarceration — to better understand the potential role of these factors in the long-term health outcomes of children with an incarcerated parent.
The findings are published in the Journal of Criminal Justice.
Source: Virginia Tech
Child playing with his mothers hand cuffs photo by shutterstock.
New research shows that a lack of sleep leads to more frequent online activity, such as incessantly checking Facebook.
“When you get less sleep, you’re more prone to distraction,” said lead researcher Gloria Mark, an informatics professor at the University of California Irvine (UCI). “If you’re being distracted, what do you do? You go to Facebook. It’s lightweight, it’s easy, and you’re tired.”
While there have been lots of studies on how human-computer interaction affects sleep, the UCI researchers say they did the opposite.
“We looked at how sleep duration influences IT usage,” said Mark.
She and her colleagues collected data from 76 UCI undergraduates — 34 males and 42 females — for seven days during the spring 2014 quarter. The study controlled for students’ gender, age, course load, and deadlines and relied on sensors to objectively gauge their behavior, activities, and stress levels, the researcher explained.
Students’ computers and smartphones were equipped with logging software, and time stamps recorded when they switched from one application window to another and when they spoke on the phone or texted. The students also were asked to fill out a sleep survey each morning and an end-of-day survey at night.
They also filled out a general questionnaire and sat for an exit interview. Periodically throughout the week, they received probing questions from researchers regarding their mood, the perceived difficulty of whatever task was at hand, and their level of engagement in their work.
Central to the study was a concept known as “sleep debt,” the accumulated difference between the amount of sleep needed and the amount experienced, the researchers noted.
Mark said the study’s findings show a direct connection among chronic lack of sleep, worsening mood, and greater reliance on Facebook browsing.
She also found that the less sleep people have, the more frequently their attention shifts among different computer screens, suggesting heightened distractibility.
The practice of meditation may help veterans reduce chronic physical pain, according to a new pilot study conducted at the Washington, D.C. Veterans Affairs Medical Center. The findings show that meditation helps an individual accept and respond to pain with less stress and negative emotion, which significantly increases coping skills.
Many veterans return home with multiple types of trauma and suffer from one of the highest rates of chronic pain of any population in the United States. Musculoskeletal pain conditions are the most frequently diagnosed medical issue among U.S. veterans, exceeding any other medical and psychological concern.
Chronic pain is also found in most combat veterans who sustained a traumatic brain injury (TBI).
A major challenge for health care providers is helping veterans safely alleviate long-term pain. Opioid medications, which are often given to individuals in severe pain, have been found to carry very negative side effects when taken long-term. Alternative practices, such as meditation, may be a light at the end of the tunnel for many patients in chronic pain.
The new findings show that veterans who practiced meditation reported a 20 percent reduction in pain intensity (how bad pain hurts) as well as pain interference (how pain interferes with everyday aspects of life, such as sleep, mood, work). The reductions were consistent across several methods by which doctors commonly measure pain in patients.
“Meditation allows a person to accept pain and to respond to pain with less stress and emotional reactivity. Our theory is that this process increases coping skills, which in turn can help veterans to self-manage their chronic pain,” said Thomas Nassif, Ph.D., lecturer in American University’s Department of Health Studies and researcher at the D.C. Veterans Affairs Medical Center.
The form of mindfulness meditation used in the study, Integrative Restoration Yoga Nidra, or iRest, is used at Veterans Health Administration medical centers and active-duty military facilities nationwide. The Army surgeon general’s Pain Management Task Force has cited iRest as a Tier I intervention for managing pain in military and veteran populations.
The pilot study involved a total of nine male veterans, four who received iRest meditation treatment, and five who did not. All study participants served in combat and returned to the U.S. with chronic pain and moderate TBI.
The veterans attended meditation sessions twice weekly at the D.C. Veterans Affairs Medical Center and were given iRest recordings to engage in self-practice as well. By the end of eight weeks, the study participants had acquired useful mindfulness skills that empowered them to use meditation as a tool to help manage their pain, Nassif said.
“In many cases, primary care physicians are the ones expected to help individuals overcome their chronic pain,” Nassif said. “One of the most commonly used tools we have in our toolbox is opioids. Veterans in this study, and many who come to meditation sessions, find that opioid medication is a short-term solution. Meditation could be a useful tool to help veterans manage their pain over the long term.”
The findings are published in the journal Military Behavioral Health.
Source: American University
New research shows that mindfulness meditation training reduces interleukin-6, an inflammatory health biomarker, in high-stress, unemployed adults.
The biological health-related benefits occur because mindfulness meditation training alters brain network functional connectivity patterns, according to the study, which was published in Biological Psychiatry.
“We’ve now seen that mindfulness meditation training can reduce inflammatory biomarkers in several initial studies, and this new work sheds light into what mindfulness training is doing to the brain to produce these inflammatory health benefits,” said Dr. David Creswell, lead author and associate professor of psychology in the Dietrich College of Humanities and Social Sciences at Carnegie Mellon University.
For the study, 35 job-seeking, stressed adults were exposed to either an intensive three-day mindfulness meditation retreat program or a well-matched relaxation retreat program that did not have a mindfulness component.
All participants completed a five-minute resting state brain scan before and after the three-day program. They also provided blood samples right before the intervention began and at a four-month follow-up.
The brain scans showed that mindfulness meditation training increased the functional connectivity of the participants’ resting default mode network in areas important to attention and executive control, namely the dorsolateral prefrontal cortex, according to the researchers.
Participants who received the relaxation training did not show these brain changes.
Those who completed the mindfulness meditation program also had reduced IL-6 levels, the researchers said, noting the changes in brain functional connectivity coupling accounted for the lower inflammation levels.
“We think that these brain changes provide a neurobiological marker for improved executive control and stress resilience, such that mindfulness meditation training improves your brain’s ability to help you manage stress, and these changes improve a broad range of stress-related health outcomes, such as your inflammatory health,” Creswell said.
Source: Carnegie Mellon University
A new study suggests that more than one-quarter million school-age children with autism spectrum disorder (ASD) or other developmental disorders wander away from adult supervision each year.
According to researchers at Cohen Children’s Medical Center of New York (CCMC), more than 26 percent of children with special needs in the study had wandered away from a safe environment within the past 12 months.
Children are more likely to wander from public places, the researchers noted.
Children between the ages of six to 11 were more likely to wander than those ages 12 to 17, they added.
“Wandering has become a greater concern,” said Andrew Adesman, M.D., chief of developmental pediatrics at CCMC and senior investigator of the study. “Not only does it pose a significant risk to the safety and well-being of children with developmental disabilities, but fear of wandering can be a daily source of stress and anxiety for parents of affected children.”
“As the prevalence of autism spectrum disorders in the United States continues to rise, there is a need to better understand the behaviors that may compromise the safety and well-being of these children,” said Bridget Kiely, a research assistant in the division of developmental and behavioral pediatrics at CCMC and principal investigator in the study.
Using data from a 2011 Centers for Disease Control and Prevention survey of parents and guardians of more than 4,000 children ages six to 17 with special health care needs, researchers divided the children into three groups: Those with ASD only; ASD with an Intellectual Disability (ID) and/or Developmental Delay (DD); and just ID and/or DD.
Researchers found that children with ASD (with or without associated cognitive delays) were more likely to wander off than children with cognitive impairment but no ASD.
Across all groups, wanderers were more likely to not realize when they are in danger, to have difficulty distinguishing between strangers and familiar people, to show sudden mood changes, to over-react to situations and people, to get angry quickly, and to panic in new situations or if change occurs, according to the study’s findings.
“The kids who are most likely to wander are the kids who are least likely to respond appropriately to police or rescue personnel — potentially further jeopardizing their safety,” said Adesman. “First responders need to recognize that children or young adults with an autism spectrum disorder may over-react to some well-intentioned interventions and may be unresponsive to simple commands or questions”
In terms of prevention strategies, the researchers found that caregivers of children with ASD and ID/DD were more likely than those in the other two groups to use fences, locks, alarms, electronic tracking devices, or other measures to prevent wandering.
The study was published in the online scientific journal PLOS ONE.