Extracts from the "Other" Journals relating to Children, Youth and
Families
in the fields of health, substance abuse, education, psychology, science
...
November 2007
Smoking youth more prone to drug use
Young people who smoke are much more likely to abuse alcohol and use illegal drugs than non-smoking youth, according to a new report released Wednesday by the Canadian Centre on Substance Abuse. The research report used data from the 2004 Canadian Addiction Survey and examined the association between tobacco use by 15- to 19-year-olds and the use of alcohol, marijuana and other drugs.
The study found that the association is "very
strong." For example, 31 per cent of smoking youth under 20 reported
using hard drugs such as cocaine, heroin, amphetamine, ecstasy or
hallucinogens compared with only 3.5 per cent of non-smoking youth. Some
of the report's other key findings include:
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nearly 98 per cent of smoking youth also reported consuming alcohol in the past year, compared to 75 per cent of non-smoking youth;
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60 per cent of smoking youth met the criteria for hazardous drinking as defined by the World Health Organization, compared with 23.7 per cent of non-smoking youth;
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91 per cent of smoking youth reported using cannabis in the past year, compared with 28.8 per cent of non-smoking youth.
The report does not say whether smoking necessarily leads to other drug or alcohol use. In other words, the study did not determine whether tobacco is a "gateway drug," but it warns parents to be aware of the link between smoking and substance abuse.
"This research clearly shows that tobacco use among youth age 15 to 19 is a powerful and effective marker of other substance use and a good indication that these youth are engaging in other risky behaviour, such as hazardous drinking," Rita Notarandrea, CCSA's deputy chief executive office and director of research and policy, said in a release. She recommended that parents and educators start a dialogue with young smokers about their use of other drugs and drinking.
A little more than a quarter - 26.7 per cent - age 15 to 19 reported that they had smoked cigarettes at least occasionally in the year before the survey.
Meagan Fitzpatrick
23 November 2007
http://www.canada.com/montrealgazette/story.html?id=f33a2d6b-89e1-4f78-bec5-157a4a649fc2
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IRELAND
Homeless strategy 'failing children'
The Government's homeless strategy is failing vulnerable young people, a senior Trinity College academic claimed today. Dr Paula Mayock, who documented the lives of 40 young homeless Dubliners over the last three years, warned many felt criminalised when asking gardai for a bed or shelter. All were aged between 12 and 22 and most began using heroin after ending up on the streets.
Dr Mayock noted homeless people seeking emergency shelter in the evenings must report to a Garda station and wait, at times several hours, for an out-of-hours social worker. But she said this often left young, vulnerable people feeling intimidated and criminalised. "They don't see law enforcement as a place they would get respite. Young people see these places as punishment rather than a place for care," she said.
The research detailed in 'Lives in Crisis: Homeless Young People' was compiled by Dr Mayock and Dr Eoin O'Sullivan of Trinity College. It found young homeless people suffered traumatic childhoods - dealing with parental illness, death, family conflict, drug or alcohol misuse and violence or abuse.
Most of the 40 homeless people grew up in poor neighbourhoods and experienced hardship and instability at home. Sixteen had a history of living in state care or residential settings for young offenders. Nine reported persistent disagreement and conflict with parents or caregivers during their early to mid-teenage years as a result of drink, drugs and everyday troubles such as staying out late. The study found they were extremely vulnerable to ill health including asthma, bronchitis and pneumonia and injuries such as broken bones. And drug use was extremely high with half using heroin.
Dr Mayock said the Government's Youth Homeless Strategy had a heavy emphasis on prevention but early insufficient focus on early intervention. She said there was evidence suggesting some of the existing interventions may lead to a descent into a subculture of homelessness. She said the lack of provision for 18-25 year olds is a particular problem and called for the Government to consider providing city-wide accommodation with training schemes linked to FAS.
22 November 2007
http://www.ireland.com/newspaper/breaking/2007/1122/breaking65.htm
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U.N. slashes AIDS estimates in latest report
The United Nations has slashed its estimates of how many people are infected with the AIDS virus, from nearly 40 million to 33 million. In a report to be issued on Tuesday, the U.N. says revised estimates on HIV in India account for a large part of the decrease.
The agency admitted it overestimated how many people are infected with the incurable virus, and said better methods of collecting data show it is not quite a common as feared. "The single biggest reason for this reduction was the intensive exercise to assess India's HIV epidemic, which resulted in a major revision of that country's estimates," the report said.
After originally estimating some 5.7 million people were infected in India, the U.N. more than halved that estimate, to 2.5 million. But the numbers nonetheless show the epidemic is overwhelming and that efforts to fight HIV must still be stepped up, said officials at the U.N. AIDS agency UNAIDS. "These improved data present us with a clearer picture of the AIDS epidemic, one that reveals both challenges and opportunities," UNAIDS Executive Director Dr. Peter Piot said in a statement.
"Unquestionably, we are beginning to see a return on investment – new HIV infections and mortality are declining and the prevalence of HIV leveling. But with more than 6,800 new infections and over 5,700 deaths each day due to AIDS, we must expand our efforts in order to significantly reduce the impact of AIDS worldwide."
The new numbers suggest that some 33.2 million people are infected with the human immunodeficiency virus – about 30.8 million adults and 2.5 million children.
Doubling in Asia
UNAIDS estimated that 1.7 million people became newly infected
in sub-Saharan Africa this year, a significant reduction since 2001. But
Africa remains by far the continent hardest hit by AIDS, with 22.5
million people infected with HIV. "Eight countries in this region now
account for almost one-third of all new HIV infections and AIDS deaths
globally," said UNAIDS.
"In Asia, the estimated number of people living with HIV in Vietnam has more than doubled between 2000 and 2005 and Indonesia has the fastest growing epidemic."
The report gives two reasons for the downward revisions – one is better data and the other is an actual decrease in the number of new infections. "UNAIDS and (the World Health Organization) are now working with better information from many more countries," UNAIDS said.
The number of new HIV infections each year likely peaked in the late 1990s at 3 million and was estimated at 2.5 million for 2007, UNAIDS said. "This reflects natural trends in the epidemic, as well as the result of HIV prevention efforts. Of the total difference in the estimates published in 2006 and 2007, 70 percent are due to changes in six countries: Angola, India, Kenya, Mozambique, Nigeria, and Zimbabwe," the report said. "In both Kenya and Zimbabwe, there is increasing evidence that a proportion of the declines is due to a reduction of the number of new infections which is, in part due to a reduction in risky behaviors."
The U.N also changed its estimate on how long it takes to die of AIDS if not treated from 9 years to 11 years.
19 November 2007
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Gender identity and the chemical delay of puberty: A call for more clinics and treatment for children at an early stage in their growth
After agonizing for most of his 48 years over who he really was, Steven Stanton began the process of becoming a woman two years ago. Six thousand miles away in Germany, a 12-year-old boy named Kim has started hormonal therapy in preparation for surgery to make him a girl. He may be the youngest person to begin this treatment.
Stanton and Kim represent the small proportion of gender-variant individuals who wish to change the body in which they were born to conform to the person they believe themselves to be. In the nomenclature of the American Psychiatric Association, both individuals would be said to be suffering from Gender Identity Disorder.
Though the public is becoming more aware of gender variance in children, there is still a lot of misunderstanding about what exactly it means to be transgender. Most people who ultimately live their lives as the other gender have felt they were given the wrong body since very early childhood. Most parents of children like Kim, plus a growing number of professionals who have experience with these children, recognize two things:
First, the children who see themselves as of the other gender are born with this belief. It is "hard wired," emerging at around 2 to 2 1/2 years of age, just about the time other children begin to recognize themselves as being a boy or a girl. And second, although these children are unhappy about the body they inhabit, they are otherwise normal, often endearing and creative. However, there is still a common assumption that these children suffer from a disorder and should be treated to alter their internal sense of gender to align with their biological sex.
In response to this damaging reparative approach, clinics in support of cross-gendered children have sprung up. And a growing number of professionals are working to support younger children and their families despite the opprobrium of colleagues and ethical challenges to their stance. The endocrinologists and surgeons who support beginning the process of gender reassignment sooner often have arrived at their conclusion after seeing adults such as Stanton come to doctors so late to seek bodily change that the process is much more difficult.
Many transgender people reach desperate psychological straits not only because of the reflection they see of themselves in the public at large, but also because of professional indifference or refusal to help them when they are younger. Child psychologists and therapists generally arrive at a more appropriate stance when they see the variety of children and families who come in for advice – and who do not fit the stereotypical perceptions or psychodynamic explanations of family pathology common in the field.
In a peer-run support group for parents of children whom we prefer to call gender-variant, most of the children reflect the bias we see in a child psychiatry clinic – that is, many more boys who want to dress, play like and be with girls. Girls who have gender-variant preferences do not attract much concern or attention, and those whose parents come to the group are the ones who actually insist that they are boys.
Thus we see a wider range of anatomical boys – more who have a female gender expression and a few who have a female gender identity. The preponderance of anatomical boys in the group is likely because it is much less troublesome to the world at large for a girl to engage in boy behavior. Though most gender-variant children do not end up being transgender, many do go on to prefer same-sex partners, indicating that the gender variance may have been part of their sexual orientation and not necessarily their core gender identity.
Uniform to the parents in our group is the anguish they experience as their kids enter kindergarten and increasingly appear "different" to their peers in a way that invites teasing and worse. Taking a leap of faith, some parents have supported their child's reidentified gender identity, not their biologically given sex. The results are frequently astounding; once anxious and depressed children, some even expressing suicidal thoughts at very tender ages, make dramatic psychological turnarounds for the better.
In the group, two children under 12 have begun therapy that delays the middle and late states of puberty for three to four years. Both have been living as boys for several years. This treatment is reversible should the child change his/her mind, but it prevents the development of secondary sexual characteristics (such as Adam's apple, deepening voice, breasts) that are more difficult to deal with should the children go on to surgery following the future administration of "opposite sex" hormones. This may partially account for the positive outcomes reported thus far in young starters compared to those such as Stanton who start as adults. The suppression of puberty is seen as a diagnostic aid that allows therapists and patients to evaluate problems under less time pressure.
At the Amsterdam Gender Clinic in Holland, it has become clear that the earlier the decision is made to start the process, the better off the child. After administering the medications to delay puberty, the doctors – if all goes well – provide opposite sex-hormonal treatment in children at age 16, the age when children are able to give medical consent in Europe. With this process in place, doctors have had not one child regret the change after surgery. While much is known about the effects of delaying puberty on the body, less is known about its effects on the brain, and both continue to be carefully evaluated.
Definitive studies are not yet in that demonstrate that these children's understanding of themselves stems from a particular biological process, but for those of us who have worked with these children and their families for years, it is overwhelmingly apparent that family dynamics cannot explain the dysphoria these children feel at such an early age. On the contrary, while researchers 50 years ago felt strongly that gender was malleable and could be assigned, current studies find the opposite to be true. When various therapies for gender-variant children aimed at "realigning them according to their biological sex" were studied, there was little to suggest any "success."
One such study was a behavioral approach that in therapy sessions grabbed dolls away from boys and replaced them with tanks and such, telling the children that these were the toys boys played with. New research is showing that family acceptance or rejection of these children has a major impact on their health and mental well-being.
Watching the parents in our group suffer over the treatment their children receive in the earliest grades, and anticipating the truly horrendous scenes that many will face as adolescents, even in the Bay Area, it is no wonder that many of these parents have turned to advocacy and activism for their children. This includes meetings with grade-school teachers, bringing in experts to the schools, developing reading material for the kids and curricula for schools starting in the very early grades, and presenting programs aimed at the education of pediatricians, many of whom are not well versed in the current research on these issues.
But for the minority of gender-variant children who are truly transgender, the issues for the parents are so much greater. Parents of these children fear that if they force their child to endure puberty in the "wrong" body, they might altogether lose their children. This is not an exaggeration: Current statistics reveal that an astoundingly high percentage of transgender teenagers attempt suicide. So for these parents, the decision to delay puberty medically for their children becomes a difficult if obvious choice. The treatment appears to be effective and completely reversible. But when and how do you decide to start such a course of treatment?
In the Netherlands, the children must meet certain criteria of wanting to be the opposite sex from an early age. Then they are evaluated by more than one psychiatrist or psychologist experienced with such children. The children must be reasonably free of serious mental illness, which does not include anxiety and/or the dysphoria of living in the wrong body. Such children are then candidates for delaying advanced puberty – and a two-year trial period in which they must live out life as the opposite sex. The length of the trial period gives them time to reflect on their decision. (Our British colleagues object to the fact that because the trial period delays the development of secondary sexual characteristics, it does not provide a child the opportunity to live in the advanced adolescent body of their biological sex.)
However, when this procedure is followed, the Dutch have not had one case of surgical regret in more than 25 cases published in peer-reviewed journals. One clinic in Germany will start the hormonal treatment as young as 12. Though treatment at age 16 is now possible at the Dutch clinic and from some American endocrinologists, such an age is still seen by some as too young.
Frustration continues for American parents of transgender children, as it can be difficult to find care providers who are willing to medically delay puberty and then to provide cross-hormones at or before 16 years of age so that children can experience the puberty of their gender identity. Psychological support and evaluation is usually available only in a few specialized clinics. And it is very difficult to find an insurance company that will cover all of these treatments. In a system that can afford the plethora of expensive surgical procedures for advanced cardiac disease in people of well-advanced age, we surely can afford more clinics to evaluate and treat these children, and not condemn them to psychological morbidity at an early age.
Stephanie Brill,Herbert Schreier
18 November 2007
http://www.sfgate.com/cgi-bin/article.cgi?f=/c/a/2007/11/18/INVMT7C9C.DTL
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Less than 9 hours sleep linked to obesity in children
Elementary school children who don't get enough sleep in third grade are more likely than their peers to be overweight in sixth grade, according to a large study believed to be the first to examine the relationship between excess fat and sleep in children. Studies of adults have found a similar association between sleep duration and excess weight.
Researchers led by pediatrician Julie C. Lumeng at the University of Michigan reported last week in the journal Pediatrics that children ages 9 to 12 who routinely got less than nine hours of sleep per night were at increased risk of being overweight, regardless of their sex, race, socioeconomic status or the level of chaos in the home. Lumeng and her colleagues also found no association between sleep problems, such as trouble falling asleep or staying in bed, and excess weight.
Using data from a large federally funded study of youth development, researchers found that among sixth-graders, for every additional hour of sleep beyond nine hours, a child was 20 percent less likely to be overweight. Half of the nearly 800 children in the study were boys, and 81 percent were white. Overall, 18 percent were overweight; boys were more likely to be overweight than girls.
The authors write that the findings suggest "a biological link between sleep duration and obesity" possibly caused by alterations in metabolism and the secretion of hormones that help control weight. Regardless of the mechanism, they conclude that their findings provide "an additional reason to ensure that children are receiving adequate sleep, primarily through enforcing an age-appropriate bedtime."
The National Sleep Foundation recommends that elementary school students sleep 10 to 12 hours per night.
Source: Pediatrics
14 November 2007
http://www.startribune.com/1244/story/1551590.html
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'Delay' in ADHD children's brains
The brains of children with Attention Deficit Hyperactivity Disorder (ADHD) do not mature at the same rate as their peers, a US study says. Researchers looked at 450 children – half of whom had ADHD – and found an average delay of three years in the development of the cortex. This, the brain's outer mantle, is key for both attention and planning.
Researchers say the Proceedings of the National Academy of Sciences study may pave the way for new treatments. The team from the National Institute of Mental Health (NIMH) looked at when and where the brain reached peak "thickness", a marker of maturity. Among the 223 youngsters with ADHD, half of 40,000 cortex sites examined reached peak thickness at 10.5, compared to age 7.5 in a matched group without the disorder.
But the researchers did find that despite the delay, the brain does follow a normal pattern of development. "Finding a normal pattern of cortex maturation, albeit delayed, in children with ADHD should be reassuring to families and could help to explain why many youth eventually seem to grow out of the disorder," said Philip Shaw, the lead researcher.
Finding out why
Future studies will now look into why the delay happens, and
examine ways of boosting recovery.
However UK experts warned that the findings do not indicate that children with ADHD "catch up" after the three year delay, as the brains of children without the disorder will continue to advance. "During these later stages of development the cortex of the brain gets thinner due to a process called pruning which occurs as the brain refines its connections and becomes more organized," said Dr David Coghill of the University of Dundee.
"So what will be happening is that whilst the children with ADHD's brains are still growing, the brains of the children without ADHD are starting this process of pruning." This, he added, meant "adolescents with ADHD remain behind on many of the important skills like memory, impulse control and planning".
Professor Anita Thapar of Cardiff University School of Medicine said the findings were "interesting and useful". "But it will be a long time before we see the implications of their findings for clinical practice".
13 November 2007
http://news.bbc.co.uk/2/hi/health/7090602.stm
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New findings could lessen concerns about disruptive children
Educators and psychologists have long feared that children entering school with behavior problems were doomed to fall behind in the upper grades. But two new studies suggest that those fears are exaggerated.
One concluded that kindergartners who are identified as troubled do as well academically as their peers in elementary school. The other found that children with attention deficit disorders suffer primarily from a delay in brain development, not from a deficit or flaw.
Experts say the findings of the two studies, being published today in separate journals, could change the way scientists, teachers and parents understand and manage children who are disruptive or emotionally withdrawn in the early years of school. The studies might even prompt a reassessment of the possible causes of disruptive behavior in some children. "I think these may become landmark findings, forcing us to ask whether these acting-out kinds of problems are secondary to the inappropriate maturity expectations that some educators place on young children as soon as they enter classrooms," said Sharon Landesman Ramey, director of the Georgetown University Center on Health and Education, who was not connected with either study.
In one study, an international team of researchers analyzed measures of social and intellectual development from more than 16,000 children and found that disruptive or antisocial behaviors in kindergarten did not correlate with academic success at the end of elementary school. Kindergartners who interrupted the teacher, defied instructions and even picked fights were performing as well in reading and math as well-behaved children of the same abilities when both groups reached fifth grade, the study found.
Other researchers cautioned that the findings, being reported in the journal Developmental Psychology, did not imply that emotional problems were trivial or could not derail academic success in the years before or after elementary school.
In the other study, researchers from the National Institute of Mental Health and McGill University, using imaging techniques, found that the brains of children with attention-deficit hyperactivity disorder developed normally but more slowly in some areas than the brains of children without the disorder. The disorder, also known as ADHD, is by far the most common psychiatric diagnosis given to disruptive young children; 3 percent to 5 percent of school-age children are thought to be affected. Researchers have long debated whether it was due to a brain deficit or to a delay in development.
Doctors said the report, being published in The Proceedings of the National Academy of Sciences, helps to explain why so many children grow out of the diagnosis in middle school or later, often after taking stimulant medications to improve concentration in earlier grades. About 80 percent of those with attention problems were taking or had taken stimulant drugs, and the researchers did not know the effect of the medications on brain development. Doctors consider stimulant drugs a reliable way to improve attention in the short term; the new study is not likely to change that attitude.
But the greatest delays in brain maturation were found in areas of the cerebral cortex most involved in attention and motor control, said the lead author of the study, Philip Shaw, a psychiatrist at the National Institute of Mental Health.
The new findings suggest that searching for a clear abnormality or flaw is the wrong approach, at least for attention problems. "The basic sequence of development in the brains of these kids with ADHD was intact, absolutely normal," Shaw said. "I think this is pretty strong evidence we're talking about a delay, and not an abnormal brain."
About three in four children do grow out of the problem by early adulthood, he said.
Benedict Carey, New York Times
13 November 2007
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Alcohol can do permanent harm to youthful brains
One brain has to last a lifetime. But a kid who drinks too much alcohol too soon in his life may cause damage to his brain that he may not be able to recover from later on, according to experts.
"Recent studies show that alcohol consumption has the potential to trigger long-term biological changes that may have detrimental effects on the developing brain, including neurocognitive impairment," acting Surgeon General Kenneth P. Moritsugu wrote in "Call to Action to Prevent and Reduce Underage Drinking," a report released in March.
Other consequences of drinking before the legal age of 21 – such as youth getting into fights, unwanted sexual encounters and automobile accidents – have long been common knowledge. New research, however, points to another consequence – one to the brain, said David Rosenbloom, professor of public health at Boston University's School of Public Health and director of Join Together, an organization that supports drug and alcohol treatment and prevention programs in communities.
"Alcohol affects many portions of the brain," he said in an interview. "The portion of the brain which is related to exercising judgment and caution is the last part of the brain to develop and changes rapidly during adolescence. There is some evidence that alcohol affects that part of the brain negatively."
Although some view underage drinking as a right of passage that users can recover from, the opposite is true, according to the American Medical Association. Damage from alcohol can be long-term and irreversible, the AMA says. During adolescence, the brain goes through changes, and alcohol use during that time can damage long- and short-term growth processes, according to the AMA.
An AMA report titled "Harmful Consequences of Alcohol Use on the Brains of Children, Adolescents and College Students" notes that the area of the brain that handles memory and learning, called the hippocampus, is about 10 percent smaller in youths between the ages of 14 and 21 who drink than in youths that age who do not drink. The report also states that those drinkers scored lower on vocabulary, visual-spatial and memory tests and were more likely to perform poorly in school, fall behind and experience social problems, depression, suicidal thoughts and violence.
The findings indicate that adults would have to drink twice as much alcohol to suffer the same damage as adolescents and that occasional heavy drinking injures young brains.
"Our brains go through important transformations during adolescence," Sandra Brown, chief of psychology services at the Veterans Affairs Medical Center in San Diego, said in the report summary. Brown's research was included in the study. "This study shows that alcohol use during the adolescent years is associated with damage to memory and learning capabilities as well as to the decision-making and reasoning areas in the brain," she said in the report summary.
Lauren Kidd
11 November 2007
http://www.app.com/apps/pbcs.dll/article?AID=/20071111/NEWS/711110441/1001/DWEK01
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"Excessive" PC game-time impairs sleep, memory
Adolescent boys who "relax" in the evening after doing their homework by playing a heart-pounding computer game may have trouble sleeping and remembering what they just learned, new research hints. "The impact of media on children's health and well-being is widely recognized and considered a serious problem," note the investigators. "Our results provide supplementary evidence for a negative influence of excessive media consumption on children's sleep, health, and performance," they say.
The study, described in the journal Pediatrics this month, involved 11 healthy 12- to 14-year-old boys with no sleep complaints and who were taking no medications. On two different experiment days, the boys played an age-appropriate interactive racing computer game called Need for Speed for 60 minutes or watched an exciting video on TV, such as a Harry Potter or Star Trek movie. They did this in the evening, 2 to 3 hours before bedtime.
As part of their experiments, Dr. Markus Dworak and colleagues from German Sport University Cologne performed overnight sleep studies, and before and after visual and verbal memory tests. The results showed that after playing the interactive computer game, the boys took longer to fall asleep, spent less time in slow-wave sleep – the type that helps a person form factual memories – and spent more time in stage 2 non-REM sleep – the stage of sleep first crops up right after the initial, "drifting-off" phase of sleep, and precedes deep, slow-wave sleep.
Studies in children have shown that playing interactive video games can lead to significant increases in heart rate, blood pressure and respiratory rate, "and thus a higher arousal state of the central nervous system," the investigators note. Pre- and post-computer game cognitive tests also showed a decline in verbal memory performance after playing the hour-long computer game session.
This is an "interesting" finding, the researchers say, one that suggests that strong emotional experiences, such as playing a computer game or watching a thrilling movie, could decisively impact the learning process. "Because recently acquired knowledge," they explain, "is very sensitive in the subsequent consolidation period, emotional experiences within the hours after learning could influence memory consolidation considerably."
Watching the movie did not affect memory performance or overall sleep patterns, but it did significantly reduce "sleep efficiency" – actual time spent sleeping versus the total time spent in bed. It's possible, the investigators say, that they picked the wrong movies for the experiment, as none of the boys judged the chosen films as very thrilling to watch.
Source: Pediatrics, November 2007.
9 November 2007
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Dutch want cannabis registered as regular medicine
The Dutch government said on Wednesday it wants to promote the development of cannabis-based medicine and will extend the drug's availability in pharmacies by five years to allow more scientific research.
In 2003, the Netherlands became the world's first country to make cannabis available as a prescription drug in pharmacies to treat chronic pain, nausea and loss of appetite in cancer, HIV and multiple sclerosis (MS) patients. "Medicinal cannabis must become a regular registered medicine," Health Minister Ab Klink said in a statement, adding he wanted to give the development of a cannabis-based medicine by a Dutch company a serious chance.
The Netherlands, where prostitution and the sale of cannabis for recreational use in coffee shops are regulated by the government, has a history of pioneering social reforms. It was also the first country to legalize euthanasia.
The Dutch government regulates the growing of special strains of cannabis in laboratory-style conditions to supply pharmacies, but also hopes for progress on a cannabis-based drug by Dutch firm Echo Pharmaceuticals, the Health Ministry said. "The development path, that could take several years, can deliver scientific details and insight into the balance between the efficacy and safety of medicinal cannabis," it said.
A ministry spokesman said several thousand patients were prescribed cannabis in the Netherlands and up to 15,000 people used it for medicinal purposes, although many bought their supply at coffee shops rather than pharmacies.
Echo Pharmaceuticals said in September it was launching a tablet containing the active ingredient in cannabis that doctors can prescribe.
In 2005, Canada became the first country in the world to approve a cannabis-based medicine produced by Britain's GW Pharmaceuticals Plc as a treatment for MS patients. U.S. regulators granted approval last year for a clinical trial for GW's under-the-tongue spray called Sativex, but the company announced in July that European regulators had requested a further clinical study before approval.
Cannabis has a long history of medicinal use. It was used as a Chinese herbal remedy around 5,000 years ago, while Britain's Queen Victoria is said to have taken cannabis tincture for menstrual pains. But it fell out of favor because of a lack of standardized preparations and the development of more potent synthetic drugs.
Critics argue that it has not undergone sufficient scientific scrutiny and some doctors say it increases the risk of depression and schizophrenia.
Emma Thomasson
7 November 2007
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Brain-boosting drugs spark ethical debate
A rise in healthy people popping pills to boost performance in exams or work, raises long-term ethical and safety concerns about the effects of such treatments, British doctors said on Thursday. The British Medical Association (BMA) wants a public debate about the risks and benefits of using drugs to improve memory and concentration, sometimes called "cognitive enhancement".
The ability of prescription drugs and medical procedures to improve intellectual performance is likely to increase significantly in the next 20 to 30 years as technology advances. "We know that there is likely to be a demand by healthy individuals for this treatment," Dr Tony Calland, chairman of the BMA's Medical Ethics Committee said at the launch of a discussion paper on the issue. "However, given that no drug or invasive medical procedure is risk free, is it ethical to make them available to people who are not ill?"
Surreptitious use of brain-boosting prescription drugs is particularly common in the United States and likely to increase in Britain, the BMA said. "There is a growing expectation that the use of these so-called cognitive enhancers in the UK is both imminent and inevitable," the BMA said.
Today, the use of pharmaceutical aids to boost performance is mainly confined to certain groups – notably students cramming for exams. Popular choices include drugs for attention deficit hyperactivity disorder, such as Ritalin, or methylphenidate, made by Novartis AG and others. Another favorite is modafinil, the active ingredient in Cephalon Inc's narcolepsy medicine Provigil.
Such drugs are widely available to buy online.
Botox for the brain
In the future scientists may be able to provide more permanent
fixes for bad memory or poor concentration through brain stimulation and
neurotechnology. This would involve techniques such as transcranial
magnetic stimulation – sometimes referred to as "botox for the brain"
– where magnetic pulses are used to stimulate particular brain regions,
and deep brain stimulation, where electrodes are inserted into the brain
to transmit tiny electrical currents.
These and future medical interventions could
benefit individuals and, potentially, wider society, if they increase
the competitiveness of the workforce. But "over-enhancement" of the
brain's cognitive functions could have damaging side-effects. It may,
for instance, impair a normal brain's ability to selectively filter out
trivial or traumatic information, resulting in the individual being
plagued by unwanted or traumatic memories.
Ben Hirschler
8 nOVEMBER 2007
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Marijuana more addictive for youth
Young people can easily become dependent on marijuana because their brain is still developing, says an expert on youth substance abuse. ``Kids can get addicted really quickly, like six months,'' said Kathy Szirtes, who spoke Thursday at a public forum in Ottawa on problematic marijuana use among youth. ``An adult may take two years, but kids can take six months because their bodies are still soft and growing. The teen brain really isn't done growing.''
For young people who use marijuana to deal with anxiety or to get to sleep, the drug "can literally become hard-wired into them in terms of a dependency,'' she added. "You see this in adults who say, `Oh I need a few drinks before I'm going to dance.' The same thing happens with kids who use weed and say, `I can't relax in a movie for that long unless I'm stoned. A lot of it is psychological,'' said Szirtes.
It is a myth that marijuana use is not harmful, said Szirtes, a specialist in youth mental health and substance abuse who works in Victoria, B.C. "We're seeing massive numbers of kids who can't use weed safely. And so you get these frustrated parents who might be saying, `Why can't you just use on the weekend. Come on, we used to.''' Marijuana can be "very addictive both psychologically and physiologically,'' she said, adding that "it has a little bit gentler withdrawal effects than other drugs.''
The debate on decriminalization and legalization of marijuana has been misinterpreted by many young people who believe the drug is not harmful, added Szirtes. "I do know a lot of kids have taken that message and just only read the piece that says it's probably not harmful. It's not harmful to everyone, but in fact it's harmful to a lot of people,'' she said, noting when young people get into marijuana dependency cycles, it causes behaviour changes. "You start wrecking relationships with family, with teachers, your memory goes, you can't sleep properly unless you have a toke before bed and on it goes. We're certainly seeing a rise in problems in the high schools. Because marijuana interferes with sleep, "kids are at school and they're exhausted,'' added Szirtes.
Marijuana cravings for young people often look like Attention-Deficit Hyperactivity Disorder symptoms. Other signs include changes in friends, sleep disturbances, and mood swings. "I think the average parent should be as concerned about marijuana as they would be about any other hard drug,'' said Szirtes. "While marijuana is not necessarily immediately detrimental to the system, because of its long-term effects it is overall just as harmful as any other hard drug.''
A new Centre for Addiction and Mental Health drug use survey shows that about one in four Ontario high school students have used marijuana at least once in the past year, and that one in 12 report symptoms of dependence. After alcohol, marijuana has become the drug of choice in Ontario high schools.
Bruce Ward,
6 November 2007
http://www.canada.com/reginaleaderpost/story.html?id=748cad2e-2e93-4b70-be0b-cb99bd9e6626
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Depressed Youth Respond Best to Combination Therapy
Adding Cognitive Behavioral Therapy to fluoxetine treatment appears to provide depressed adolescents with the benefits of both quick-acting and longer-duration treatments. Combining medication and psychotherapy provides adolescents with depression the treatment advantages of both a sprint and a marathon.
The combination of the antidepressant medication fluoxetine (Prozac) and cognitive-behavioral therapy (CBT) appears more effective than either strategy alone for the long-term treatment of adolescents with depression, according to the latest report from the Treatment for Adolescents With Depression Study (TADS) in the October Archives of General Psychiatry.
The report lengthens observations in the TADS from the 12 weeks reported earlier this year (Psychiatric News, March 2) to 36 weeks.
The benefit of combination therapy derives from the swifter initial action of the drug linked with the longer term effects of CBT, said lead author John March, M.D., M.P.H., professor and chief of child and adolescent psychiatry in the Department of Psychiatry and Behavioral Science at Duke University. All three treatments proved equally successful at the end of the trial, but the response rate at that point is not the only standard to use, said March in an interview with Psychiatric News. "There are a lot of things we can do to get a patient better, but faster is important too," he said. "Three months in the life of a depressed kid is a long time."
The longer trial period is a more clinically relevant time frame, said Stan Kutcher, M.D., the Sun Life Financial Chair in Adolescent Mental Health in the Department of Psychiatry at Dalhousie University in Halifax, Nova Scotia. "Nobody treats depression for just 12 weeks," Kutcher told Psychiatric News. "This is the best information we have to date about treating this disorder in young people."
Dawn Duarte and Aaron Levin
Full story: http://pn.psychiatryonline.org/cgi/content/full/42/21/14
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Emerging psychosis in young people - New guidance launched
Guidance to help front line practitioners achieve earlier diagnosis of psychosis in young people has been launched by the Royal College of General Practitioners (RCGP) and the Royal College of Psychiatrists (RCPsych).
The guidance, designed to support practitioners from primary care, relevant community agencies and specialist mental health services, was formulated following a report commissioned by the National Institute for Mental Health in England (NIMHE). The report highlighted a growing evidence base that early symptom recognition can reduce progression to psychosis, and in some cases prevent the onset of a disabling psychotic illness.
The likelihood of developing psychosis is three in one hundred; with 80 per cent of cases starting between the ages of 16-30, and five per cent aged 15 or less. It is one of the most serious conditions that can affect a young person - there is a ten per cent lifetime risk of suicide and 12 per cent of those who suffer from it end up with no job. However, with early intervention, suicide risk is halved and over 50 per cent will go on to find employment.
Containing advice for GPs and listing key symptoms which may signal the onset of psychosis, the guidance aims to create a smoother pathway between primary care practitioners and mental health specialists to ensure early detection and provide vital support for young people with psychosis, and their families.
Dr Huw Lloyd, Chair of the RCGP Mental Health Group, says: "This guidance sets out a different dynamic between generalists and specialists in which earlier GP recognition supports different access routes to a specialist assessment and treatment service - in this case a youth-orientated specialist assessment and psychological treatment service."
Dr Roger Banks, Vice President of the Royal
College of Psychiatrists with a remit for developing the College's links
with primary care, says: "This vital initiative, firmly and
enthusiastically supported by the Royal College of Psychiatrists, is
indicative of a developing and strongly collaborative approach and the
erosion of artificial boundaries between primary and secondary, or more
aptly, generalist and specialist mental health care."
The report 'Early Detection in Psychosis', and guidance, can be
downloaded from:
http://www.earlydetection.csip.org.uk
http://www.nimhe.csip.org.uk/~earlydetection
1 November 2007