October 2005
Abortion doesn't raise depression risk: study
Among women with an unwanted pregnancy, those who carry the pregnancy to term are more likely to experience later depression than those who terminate the pregnancy with an abortion, new study findings suggest.
Well-designed studies have generally shown that abortion does not contribute to an increased risk of depression, Dr. Sarah Schmiege and Dr. Nancy Felipe Russo note in their report in BMJ Online First, published October 28.
However, one previous study examining these associations among women with an unwanted first pregnancy found that induced abortion was associated with a higher risk of depression than a pregnancy carried to term.
But Schmiege, from the University of Colorado in Boulder, and Russo, from Arizona State University in Tempe, believe this analysis was flawed.
For their study, they identified a large group of women ages 14 to 21 in 1979 who had an unwanted pregnancy between 1970 and 1992 and for whom personal and outcome data were available. The women were interviewed over several years to examine the relation between pregnancy outcome and later depression.
The authors found that terminating compared to delivering an unwanted first pregnancy was not directly related to risk of depression. Instead, women who delivered before 1980 had a much higher risk of depression than all other groups.
These findings "directly contradict the claim that terminating an unwanted first pregnancy puts women at higher risk of subsequent depression, particularly for younger women," Schmiege and Russo contend.
Their analysis also showed that women who had aborted a pregnancy had significantly higher mean education attainment and income and lower total family size. These factors could explain the higher risk of depression among women who don't abort an unwanted pregnancy.
"This suggests that if the goal is to reduce women's risk for depression, research should focus on how to prevent and ameliorate the effect of unwanted childbearing, particularly for younger women," the authors conclude.
SOURCE: BMJ Online First 2005.
October 28 2005
Liberia: Youth Not Putting HIV Prevention Lessons Into Practice
First the good news. Young Liberians know about AIDS, how they might contract the disease and what they can do to protect themselves. Now the bad news. They are not putting that knowledge into practice.
A study commissioned by the United Nations Children's Fund (UNICEF) found while nine out of 10 respondents knew HIV could spread through sexual intercourse, and six out of 10 knew a condom would protect them, only one in 10 used it the first time they had sex.
"Despite high knowledge rates, the sexual practices of too many Liberian youths include high rates of unprotected sex," said Angela Kearney, UNICEF's representative for Liberia.
"This contradiction is profoundly disturbing and requires all of us to redouble our efforts to effectively communicate with young people about the very real threat of HIV/AIDS," she added.
Almost 1,500 children aged between 10 and 25 were surveyed across the West African nation whose health infrastructure is struggling to rebuild after 14 years of civil war, which sent professionals fleeing and left hospitals peppered by mortar rounds and bullets, and stripped of any equipment.
Everyone agrees that the fight against HIV/AIDS is important in a country where the prevalence rate is estimated at 8.2 percent, according to the study.
But Liberia is in such a ruined state that aid agencies and the government are having to focus on restoring the most basic of health facilities before thinking about rolling out testing centres and antiretroviral (ARV) drugs.
The UNICEF study takes a look at the prevention side of the conundrum. Conscious of the fact that more than half of Liberia's population is aged under 18, it tries to pinpoint attitudes and knowledge about the disease.
"Young persons should be a priority because they are at the centre of the HIV epidemic in terms of transmission, vulnerability, impact and potential for change," the study said.
One of the main conclusions to emerge from the survey - carried out during the first five months of the year and published this week - is that work must be done on getting young people to use condoms.
"There is an urgent need to use innovative tactics to promote both the male and female condom use among young persons," it said. "To be used widely, a specific brand of condom must fulfil three "Ps", namely price, place and promotion."
Weak spots
While the health experts praised the generally good level of
understanding about HIV/AIDS nationwide, there were weak spots.
In the northernmost county of Lofa, for example, more than a third of those surveyed said they had not heard of AIDS, whereas everyone in Montserrado county, which includes the coastal capital Monrovia, said they had heard of it.
"This may be due to the fact that this area was less accessible to NGOs working on HIV/AIDS prevention during the civil war," the study said.
Lofa, a heavily-forested county wedged between Guinea and Sierra Leone, was nearly emptied of its civilian population during the latter years of the war, when it served as the headquarters for the main rebel group.
"Priority attention must be given to citizens from this area when intervention programmes are being planned for young persons in the country," the study said.
More than 80 percent of respondents nationwide said they would be willing to take an HIV test but that is easier said than done.
Of the 30 voluntary testing centres operational since the end of civil war in 2003, all but one are in the capital Monrovia, according to the government-run National AIDS Control Programme.
"Use of VCT (Voluntary Counselling and Testing) services needs to be promoted since many young persons had positive disposition towards it," the study said.
But it is difficult for doctors to test people, if there are no drugs to offer them.
"The government, together with its partners, needs to increase access to affordable ARV drugs," the report said. "Because ARV drugs are currently not readily available in the country, the promotion of VCT must be done with some caution."
Another problem that came to light in the survey was discrimination against people living with HIV/AIDS, with some youngsters saying they should be "isolated, killed, or treated in AIDS camps".
The report suggested that more training be offered not only to health workers, but also to traditional leaders, religious leaders and parents. It also advocated people living with AIDS be involved in education campaigns to reinforce the fact that HIV is an infection for which there is treatment.
UN Integrated Regional Information
Networks
October 27, 2005
http://allafrica.com/stories/200510270524.html
Stress makes quarter of kids hurt themselves: survey
Of 875 middle school-age children who were polled recently on how they handle stress, one quarter admitted to having hurt themselves on purpose when stressed or upset. The 9- to 13-year-olds who admitted to having hurt themselves when stressed said things like -- "I banged my head against the wall on purpose" or "I pinched myself really really hard."
"What this means to me," Dr. D'Arcy Lyness told Reuters Health, "is that emotion can be so strong that it is overwhelming and kids don't know how to handle it and they sometimes blame themselves. Hurting themselves is a way to take it out on them."
"Obviously, this is not a healthy coping mechanism but it certainly seems to be happening in a pretty significant amount of kids," said Lyness, a licensed child and adolescent psychologist and behavioral health editor at KidsHealth (www.kidshealth.org) in Wilmington, Delaware, the organization that conducted the poll.
Kids who admitted to hurting themselves on purpose when stressed were also more likely than those who did not to say they lose their temper, keep their troubles to themselves, feel bad about themselves, and were less likely to try to work things out. This suggests, Lyness said, that certain teens and 'tweens have a tendency toward poorer coping skills in general and need extra help developing more effective ways to cope with stress and manage their emotions.
What makes 9- to 13-year-olds feel stressed? "Not surprisingly, things that are important in their lives," Lyness said. Top responses included grades, school and homework, followed by family issues such as getting along with siblings and worries about what's going on at home, followed closely by peer group issues like being bullied and making and having friends.
The "good news" from the KidsHealth KidsPoll, Lyness said, is that most of the children had more than one "pretty decent way" of handling stress or reacting to it.
The most common coping skills were the distracter type responses -- watching TV or playing a video game ranked highest on the list. "These are really good coping skills for brief minor stressors like losing a big game for example," said Lyness. "It's really good for kids to be able to distract themselves and shift their mood. It helps them get past the stressor instead of dwelling on it."
What can parents do to help kids when they are stressed or upset? Most of the kids polled ranked "talk with them about it" as the number one thing parents can do to help, even though kids ranked "talk to a parent" as one of the least likely actions they initiated when stressed.
"This is an important finding," Lyness said. "I think parents assume that kids will come to them when they are stressed or upset. But many times stress is something that kids keep to themselves. They don't necessarily speak up about it even though they really want parents to bring it up, to notice when they are feeling stressed and upset."
Lyness also encourages parents to "put names to the emotions, label the emotions their children are having. This can help children recognize the emotions and muddle through those emotions."
Megan Rauscher
26 October 2005
Sleeping pills for the young?
In a recent investigation, researchers have discovered an enormous increase, over the past four years, in prescribed sleeping pills for children and young adults aged 10 to 19.
The managed-care pharmacy benefits company Medco Health Solutions studied utilization of 2.4 million customers, and found that among the youth age cohort, prescriptions have increased by an amazing 85 percent.
Although the frequency of sleeping aid use continues to be highest among the elderly population, authorities fear the scheduled introduction of new medicines for sleep disorders will drive use of prescription drugs even higher.
Both over-the counter and prescription medications are used for treatment of sleep disorders - in 2004 alone, more than 35 million prescriptions were filled with Americans spending more that $2.1 billion on these medications.
The escalation in use of sleep pharmacology comes with warnings.
The American Academy of Family Physicians cautions that long-term use of prescription sleep aids may cause adverse reactions and may make a return to a normal sleep strategy difficult. The Academy advises that a combination of medication and behavioral interventions is often more effective than either approach alone for those with chronic insomnia.
Medco also performed a supplemental analysis and found a correlation between use of prescription sleeping aid medications and drugs used to treat attention deficit/antihyperactivity disorder (ADHD).
According to Dr. Robert Epstein, chief medical officer for Medco, "One of the potential side-effects of drugs to treat ADHD is insomnia. Therefore, for some, the additional use of medications to assist in sleeping is something one might anticipate."
24 October 2005
http://www.mydna.com/resources/meds/news/resources/news/200510/news_20051024_smeds.html
Faulty gene may identify those at risk of schizophrenia
Scientists believe they have discovered a genetic defect which could help explain the biological basis of schizophrenia. Schizophrenia is the most common severe mental illness in Britain, and the findings could result in earlier diagnosis in children and young people, and lead to the development of new drugs and better treatment.
A study by scientists at Stanford University in California, has found that a genetic defect in some people can trigger a dangerous increase in levels of a natural brain chemical called dopamine, which may lead to schizophrenia.
At present they think the discovery probably only applies to a small proportion of people who develop the illness, but the scientists believe it could result in a fundamental change in the understanding of the condition.
Dr Allan Reiss, who carried out the study, says it is hoped that they will one day be able to identify the highest-risk groups and intervene early to prevent a lifetime of problems and suffering.
Reiss says as a better understanding of such disorders is gained, treatments can be designed that are more specific and effective.
Approximately one in 100 people will suffer from schizophrenia at some time in their lives and the annual cost to the nation in health care is estimated at more than £2.6bn.
The illness is characterised by changes in thoughts, perception and behaviour, and often strikes people in their 20s or early 30s.
Although one in five sufferers fully recover, an equal number need expensive, long-term treatment.
The remainder partly recover but may suffer relapses.
Although scientists do not know what causes schizophrenia they say there is strong evidence suggesting a biological or genetic basis.
The general population has a 1 per cent chance of developing the illness, and that risk increases to 10 per cent for the close relatives of a patient, and rises for identical twins, to 47 per cent if one is already diagnosed.
The study investigated 24 children who suffered from a genetic mutation known as a deletion on one chromosome.
It is known that about one-third of children with this deletion to part of chromosome 22 will develop schizophrenia.
The deletion occurs in one in 4,000 births.
Dr Reiss says they have strong evidence that this deletion is a major risk factor for the development of schizophrenia or related psychotic conditions.
The study found one of the genes on the part of the chromosome that is missing is responsible for a protein that degrades dopamine, a critical chemical messenger, or "neurotransmitter", in the brain.
Children with the deletion suffer higher-than-normal levels of dopamine, interfering with what scientists call the "Goldilocks effect", when it is important not to have too much or too little, but just enough dopamine.
The scientists followed the children for five years, and as expected, about one-third developed schizophrenia in that time.
Dr Reiss says although this deletion probably causes less than 5 per cent of schizophrenia cases, it is the only well-defined genetic risk factor they have right now.
The study is published in the journal Nature Neuroscience.
Medical Study News
24-Oct-2005
http://www.news-medical.net/?id=13989
Mental health professionals need to be watchful of mental health problems beyond depression in order to prevent youth suicide
Mental health professionals need to be watchful of mental health problems beyond depression in order to prevent youth suicide, according to new research from the World Health Organization (WHO). WHO researchers examine which mental disorders or combinations of disorders may be most responsible for youth suicide in a new study being released in the October issue of the American Journal of Orthopsychiatry, published by the American Psychological Association (APA).
Researchers from the WHO in Geneva, Switzerland and from the Christchurch School of Medicine in New Zealand reviewed the English language research from 1982 to 2001 to re-examine the occurrence and distribution of mental disorders in 894 cases of completed suicides among young people worldwide. The majority of the cases (89 percent) had at least one diagnosis of a mental disorder. Mood disorders were the most frequently diagnosed (42 percent) followed by substance-related disorders (40 percent) and then disruptive disorders (20 percent).
Mood disorders include major and minor depressive disorder, dysthymia, mania, hypomania, bipolar disorder and non-specific mood disorders. Substance-related disorders include drug abuse and alcohol dependency/abuse. Disruptive disorders include conduct disorder, attention deficit disorder, oppositional disorder and identity disorder.
The cases included subjects who were under 20 years of age - 72 percent. Twelve percent were between the ages of 20 - 29 and 15.5 percent were 15-29 years old. Studies that met the criteria for this review originated mostly from Europe and North America. Hence, caution is necessary in application of findings from that region to program development in Asian, African, South American or developing countries.
From the limited information available, lead author Alexandra Fleischmann, Ph.D., and co-authors suggest that comprehensive suicide prevention strategies for young people target mental disorders as a whole rather than just look for depression. Even though mood disorders were tied to suicide the most, these disorders were lower than expected, according to the study.
The authors add that beyond diagnosable mental disorders, other components, such as a person's predisposition, social and environmental conditions, psychosocial risk factors, and culture should be considered to prevent suicide among youth from escalating.
Medical study news
23 October 2005
http://www.news-medical.net/?id=13967
Serve more food and they will eat it : US studies
If you eat too much fattening food one day, don't count on yourself to be good the next day and eat less.
People offered large meals will eat them day after day, according to a study released on Wednesday at a conference of North American obesity researchers in Vancouver.
Health experts have pointed to large food portions, such as "supersized" fast-food meals, as a culprit in the dramatic rise in obesity rates in the United States.
Sixty four percent of Americans are considered to be either overweight or obese.
"I think it's quite obvious we need innovative strategies to limit the impact of portion size on intake," said Barbara Rolls of Penn State University, who conducted the study.
The researchers tracked the eating habits and energy intake of nearly two dozen men and women over 11 days, making it one of the longest studies of its kind.
People would consistently eat more when offered large meals, except in the case of vegetables, according to the study.
"As someone who had been pushing fruits and vegetables for weight reduction I find this quite discouraging," Rolls said.
Another study presented to the annual meeting of North American Association for the Study of Obesity (NAASO) on Wednesday found that for snack food it may not be the size of the bag that determines how much people eat.
Researchers who compared consumption of normal and larger amounts of snacks such as potato chips found that people would eat the larger amount available if it was presented in one large serving or smaller individual increments.
"If we give people a greater amount of food, a greater amount is consumed," Hollie Raynor of Brown University in Rhode Island told the Vancouver convention.
A third study released on Wednesday found the link between overeating and availability of larger amounts of food in a meal may start in children as young as age 2.
But the researchers said they also found that children who tended to eat too much were less likely to do it when allowed to serve the food to themselves.
Experts say it is difficult to convince Americans to limit how much they eat, because of the convenience of large portions at fast food outlets and the financial attraction of buying low-priced food in bulk in stores.
"People like value. We've got to shift people away from this value way of thinking of simply getting the most calories for the least dollars, to value in terms of health," Rolls told reporters.
NAASO president Louis Aronne said the availability of larger portions is not the only thing pushing the increase in obesity.
"You start out massively over-eating because portions are larger, and things get activated in the brain and liver that fuel the upward movement in body weight," Aronne said,
A recent survey by food-service company Aramark Corp. found a majority of consumers would like restaurants to offer half-sized portions on menus and more information on the nutritional content of the meals.
Allan Dowd
20 September 2005
Ireland: Teens still see cannabis as 'safe'
While many teenagers in Ireland perceive cannabis as a safe and 'natural' substance, the drug actually contains more than 400 chemicals, the Department of Health has said. The department's health promotion unit has launched a new phase in the National Drugs Awareness campaign, in an attempt to dispel some of the myths surrounding cannabis. Figures released recently by the National Advisory Committee on Drugs revealed that almost one in four 15 - 34 years olds have used the drug at some point.
According to Esther Wolfe, education officer with the HSE's addiction services, for most young people, drug taking is not part of their daily life and those who do try drugs 'are unlikely to continue using them'.
"Experimentation with substances does not automatically lead onto regular recreational drug use or indeed, dependent use. It often stops once the initial motivating factors have been satisfied", Ms Wolfe explained.
However, she added, some individuals are more susceptible to developing problems than others, for a variety of reasons which may not be predictable.
The campaign notes that the prevailing myth is that cannabis is harmless. However it emphasises that in some cases, the drug can have psychological effects, for example, it can affect short-term memory, concentration and motor skills in young people.
Inexperienced users meanwhile, or those using a type of cannabis that is stronger than they are used to, can experience paranoia, anxiety, panic or confusion. Studies have also indicated that in a small number of vulnerable people, cannabis use can trigger schizophrenia or other psychotic illnesses, particularly where there is a family history of mental illness.
The campaign includes radio advertisements aimed at both male and female teenagers.
http://www.irishhealth.com/?level=4&id=8354
Drug for children with behavioural problems has 'unknown risks'
A controversial new drug for children with behavioural disorders is being prescribed by doctors despite the pharmaceutical company that makes it admitting it has "unknown risks".
The disclosure is included in confidential contracts being handed to children and their parents by Eli Lilly. The firm hopes to give Strattera to the youngsters as part of a study to plug the gaps in its knowledge about the drug, which is used to treat attention deficit hyperactivity disorder.
The Medicines and Healthcare products Regulatory Agency recently launched a review of the drug after it emerged that a number of British children had tried to kill themselves while taking it.
A spokesman for Eli Lilly said that throughout the study participants were given any new information so they could decide whether to continue. "The participant may withdraw from the trial at any time," he added.
Daniel Foggo
16 October 2005
'Teen mental problems not detected'
Almost 20% of Irsh secondary school students in a new study were found to be at risk of emotional, behavioural or mental health disorders.
The study also found that 15% of students screened as part of the study met the criteria for a current psychiatric disorder, including 4.5% meeting the criteria for depression or mood disorders.
It was also found that significant past suicidal ideation was experienced by nearly 2% of the students and 1.5% had a history of attempted suicide.
The research studied all 12 to 15 year olds attending eight secondary schools in North County Dublin. The students were tested for signs of a psychiatric disorder and those who tested positive were interviewed.
It was found that 3.7% of students met the criteria for anxiety disorders and 3.7% for ADHD. A total of 723 students were included in the study.
The study was carried out by a team from the Department of Child and Family Psychiatry at Dublin's Mater Hospital and the Department of Psychiatry at UCD.
One of the study authors, Prof Carol Fitzpatrick, told irishhealth.com that while the results showed that the rates of psychiatric disorders and suicidal behaviours in young Irish adolescents are similar to those of other European countries, the figures did give cause for concern.
"I think for nearly 5% of children to be identified in the study as having depressive illness, most of whom were not detected or treated , is a cause for concern."
She said there was clearly an issue with recognising mental health problems in adolescents ,who are not getting the help they need.
Prof Fitzpatrick said that as a result of the findings of the north Dublin study, 23 young people were referred on for mental health support who otherwise would not have received this support.
"We are currently working with a number of schools in north Dublin in order to increase the mental health component of the social, personal and health educational programme in the schools."
Prof Fitzpatrick said this was in line
with the recently-launched 10-year 'reach out' strategy for suicide
reduction in Ireland.
The study is published in the Journal
of Adolescence.
Niall Hunter
14 October 2005
http://www.irishhealth.com/?level=4&id=8334
Schizophrenia: early treatment improves outcome
For many years, psychiatrists have argued over whether or not early intervention after a schizophrenia patient's first episode of psychosis could improve the patient's long-term outcome. A new study concludes that early intervention can improve outcome.
Historically, the prevailing view has been that "it just doesn't matter when you treat a person because their clinical outcome is predetermined," Dr. Diana O. Perkins from the University of North Carolina at Chapel Hill explained in a UNC statement.
This view, which holds that schizophrenia is the result of altered brain development that begins before birth and that treatment will not improve long-term outcome, is often referred to as the "doomed from the womb" theory. Many psychiatrists still hold this to be true, but more recent studies, including the current one, suggest that early treatment can improve outcome.
Perkins and colleagues pooled data from 43 studies addressing the question: "Does prolonged duration of untreated psychosis influence outcome?"
They report in the American Journal of Psychiatry this month that the greater the interval between the onset of psychosis and its treatment, the greater the severity of negative symptoms.
"On average, there is a delay of over a year -- or longer -- from the time that the symptoms of schizophrenia first emerge to the time that the person first receives treatment," Perkins told Reuters Health. "The main result of this meta-analysis," she added, "is that the sooner treatment is started, the better the clinical and functional outcome."
A shorter duration of untreated psychosis was associated with greater response to standard antipsychotic treatment.
Thus, "ameliorating the symptoms of the initial psychosis may not only lessen the immediate suffering and burden of disease experienced by patients and their families," Perkins said, "but may also improve long-term prognosis by limiting progression of the illness and preserving a person's ability to respond to antipsychotic medication."
American Journal of Psychiatry,
October 2005
David Douglas
11 October 2005
South Carolina researchers to study diabetes in children, adolescents
Researchers at the University of South Carolina plan to study how diabetes affects children and adolescents.
A $3 million grant from the Centers for Disease Control and the National Institutes of Health will allow the school to expand a research project that found 2,200 people younger than 20 in South Carolina have diabetes.
In the study, which began in 2000, researchers were surprised to find that about 300 young people in the state have Type 2 diabetes, which has generally been associated with obesity and sedentary lifestyles.
Lead researcher Elizabeth Mayer-Davis, said this could mean the cause of diabetes is more complicated than previously thought.
The national study found that an estimated 76,500 children and adolescents have diabetes in the country.
http://www.thestate.com/mld/thestate/news/local/12874324.htm
Growing epidemic: U.S. obesity rates weigh on nation's health
Before we fret too much about avian flu, consider this: the United States is already in the grip of a serious epidemic that's impairing the health and cutting short the lives of adults and children alike.
I'm talking about the obesity epidemic.
And you can bet your next double cheeseburger, fries and extra-large soft drink this epidemic isn't going to end anytime soon.
Since 1970 the percentage of American adults who are obese - at least 30 percent heavier than their ideal body weight - has doubled and is now 31 percent. That's more than twice the rate of the other industrialized countries.
During that period, the percentage of obese American children has gone up almost four-fold.
Why so many supersized Americans now?
Mother Nature designed an exquisite system that allows us to store extra energy when food is plentiful and use this energy when food becomes scarce. We're like rechargeable batteries that store electric power for future use.
Our surplus energy - measured as calories - is stored as body fat. For every 3,500 extra calories in our diet beyond what's needed, we add one pound of fat to our bodies.
The problem is that this magnificent system of energy storage was developed when we lived in a more natural environment - when food was scarce and our diets didn't include processed foods that are much higher in calories. And when there was no advertising to direct us and our kids toward high fat, high sugar foods.
The real source of the current obesity epidemic is embarrassingly simple: Americans are eating 500 calories more each day than we did in 1970. More than a third of our calories are now eaten outside of the home. A Big Mac, medium fries and medium soft drink have a total of 1,340 calories. That's more than half of most people's total daily requirement.
At 3,500 surplus calories to the pound and 500 extra calories each day, it's pretty simple arithmetic to see that a lot of people are going to be gaining a lot of weight.
Why is obesity so worrisome? Let me count the ways:
Obese children have lower self-esteem and are now developing what used to be called``adult onset diabetes.'' Obese adults are at greater risk of heart attacks and strokes, diabetes, arthritis, gallstones, depression and some cancers. Obesity is responsible for more than 100,000 American deaths and costs the health care system about $75 billion each year.
If we keep eating too much and don't get enough exercise, the medical-industrial complex will continue brainwashing us that the best way to control weight is to take more of mother's little helpers, or diet pills, and have more surgery.
If we truly want to reverse the obesity curse, we have to understand that obesity is a social disease. We're a nation on a binge.
Small wonder, too. Our children see between 10,000 and 20,000 food ads on TV every year - about eight times more than in Sweden, Austria and Belgium, where the obesity rates are only about one-third as high as ours. Encouraging a healthier diet and lifestyle won't just curb the obesity epidemic and save billions a year. It will lead to healthier, more productive citizens.
Dr John Abramson
9 October 2005
http://theedge.bostonherald.com/healthNews/view.bg?articleid=106170
Consequences unknown as doctors react to questions on efficacy, safety
Use of psychiatric drugs for children declines
Warnings that drugs such as Prozac, Paxil and Effexor can increase suicidal behavior in some children have resulted in a nearly 20 percent drop in pediatric U.S. prescriptions of the widely used antidepressants and have triggered deep concerns about the quality of current data on psychiatric drugs, doctors and regulators said.
The unprecedented fall of what were once considered wonder drugs comes as a series of taxpayer-funded analyses have systematically undermined the claims of industry-funded drug trials, raising thorny questions about the ways in which psychiatric drugs are being tested, marketed and used.
No one knows the consequences of such a steep decline in children's drug prescriptions: Critics of the drugs say regulators ought to crack down further, as British health authorities did last month, but many American psychiatrists are worried that reduced access to medications could cause an increase in suicide as a result of untreated depression.
As with many disputes over these and other psychiatric drugs, opinions are more readily available than definitive data. The fundamental problem, many experts said, is that there are not enough systematic long-term studies about psychiatric drugs.
"The problem is we don't have enough good data," said Thomas Laughren, director of the division of psychiatry products at the Food and Drug Administration. "All of our data are focused on the short term."
Requirements for longer trials weighed As a result, he and others said, a consensus is growing that the system of approving psychiatric drugs based on industry-run trials that sometimes last just 12 weeks is not providing doctors with the information they need — many physicians place patients on the drugs for years. Senior FDA officials say they are weighing whether companies should be required to conduct longer trials to reveal the true risks and benefits of the drugs.
Pharmaceutical makers say that profound change would increase the time and expense of bringing new medications to market.
Although the agency does ask that companies pursue long-term trials after drugs are approved, few do. At a meeting this month, Laughren said, regulators will debate whether long-term trials "should be asked for at initial approval."
Alan Goldhammer, associate vice president for regulatory affairs at the Pharmaceutical Research and Manufacturers of America, said long-term studies should be conducted by public health agencies at taxpayer expense.
"I don't think they fall within the province of the pharmaceutical industry because they are so costly and time-consuming that it would probably bring drug development to a halt," he said. "There would not be the funds to develop new drugs if one focused on one drug and tried to know everything about it."
In the absence of long-term data, however, doctors, parents and patients have been confused by a steady stream of concerns that have recently emerged:
- An FDA review last year found that newer antidepressants increase suicidal behavior among some children, and the agency ordered a "black box" warning be placed on them. British authorities last month went even further, telling doctors there never to prescribe medications to depressed children without first trying multiple alternatives, and never to prescribe drugs without also providing psychotherapy. Doctors were also warned not to prescribe the antidepressants Paxil and Effexor to depressed children under any circumstances. On Sept. 28, the FDA announced that the drug Strattera, prescribed widely to children with attention deficit disorder, had also been found to increase the risk of suicidal behavior in some, and told manufacturer Eli Lilly and Co. to add a black box warning. Also last month, a major government analysis of antipsychotic medications found newer, expensive drugs were neither safer nor more effective than an older generic medication that doctors rarely use. The drugs had never been systematically compared in a long-term trial. Another study in older patients, paid for by Canadian health authorities, found the newer drugs "are not necessarily safer" when it came to causing uncontrolled movements; for years, doctors have believed the newer drugs were significantly less likely to cause that side effect. Reflecting the confusion caused by the lack of good data, FDA regulators have drawn the ire both of critics who say the agency has not gone far enough to protect patients who take the drugs and of many psychiatrists who say the agency is going too far.
- Antidepressant prescriptions for children fell nearly 20 percent in the last year, according to a recent report by the American Psychiatric Association and data from NDCHealth, a health care information company. Experts at the association worry that patients have been scared into thinking the drugs are dangerous, when the bigger danger of suicide lies in untreated depression.
Again, the FDA's Laughren said there is little data on whether the drop in prescriptions is a good thing or a bad thing.
"It could mean that physicians are prescribing more rationally and that explains the drop, or it could mean there is a decreased access of medications," he said. "Ultimately, systematic controlled trials are the best way to figure out the risks and benefits."
Doctors jumping the gun? Many experts said without long-term studies, doctors are left to rely on trial and error — and drug company marketing. Millions of dollars have been spent to boost the profile of newer antipsychotic drugs, for example. Although some patients clearly benefit, the study paid for by the federal government suggests doctors have embraced the new products without clear evidence that they are superior.
Many psychiatrists, in fact, were so certain the new drugs were better that they questioned the need to pit the new medications against an older drug, said Yale psychiatrist Robert Rosenheck, who helped conduct the study that found all of them did about as well.
Such misjudgments cannot be corrected when doctors are so dependent on short industry-sponsored trials, said Columbia University psychiatrist Jeffrey Lieberman, who led the antipsychotics study. Short-term studies do not tell clinicians which drug to try first or which is more cost-effective.
Many industry trials also carefully select the patients being studied in order not to muddy the results, whereas doctors routinely deal with patients with multiple conditions and complex problems. And companies have been legally allowed to keep short-term trials with inconvenient results out of public view. Studies that showed antidepressants were ineffective in children, for example, were systematically excluded from the medical literature. The result was that the data available to doctors painted a rosy picture of the drugs.
"If we only had the public evidence, we would have recommended the use of all the [drugs]," said Tim Kendall, a British psychiatrist who led a two-year analysis of both the public and secret data.
When the unpublished trials were taken into account, the evidence, he said, led them to rule out the use of Paxil and Effexor for children and to severely curtail the use of the other antidepressants.
Guidelines call for watchful waiting Children with milder forms of major depression — who are persistently teary, emotionally flat, or uninterested in activities for several weeks — ought not to be candidates for the drugs at all, he said. Instead, the new British guidelines call for watchful waiting.
Children with severe forms of major depression — losing weight, not sleeping, and showing suicidal behavior — should get talk therapy for at least three months, Kendall said, before doctors consider adding a medication.
But Thomas Insel, director of the National Institute of Mental Health in Bethesda, said requiring three months of talk therapy before giving medication is unrealistic, because talk therapy is not widely available.
"It is not clear to me that most 16-year-olds would get any treatments at all," he said. "It is hard to imagine that is an improvement."
Worrying increase in antipsychotic use Depriving doctors of antidepressants could also prompt clinicians to venture into uncharted territory with even less data, Insel said. He is concerned that physicians are already switching children from antidepressants to antipsychotic drugs, none of which have been approved for children. The federal government's top mental health researcher said it "was amazing" that nearly a quarter of all antipsychotic prescriptions for children are going to those younger than 9, the vast majority of them boys.
"I am concerned we are going to see an increase in ... antipsychotics in this population," said Insel. "Have we gone from one set of medications of known benefit and of questionable risks to a group of medications with unknown benefits and well-known risks?"
Shankar Vedantam
7 October 2005
http://msnbc.msn.com/id/9625206/
Emotional, Behavioral Issues Affect Children's Health Care
Emotional or behavioral problems may make it more difficult for children to get the health care they need. The consequences may have disrupting effects on the entire family, according to a new report.
CDC researchers found that children with chronic emotional, behavioral, or developmental problems, including attention deficit hyperactivity disorder (ADHD) and learning disabilities, have more difficulty finding and receiving the health care they need than children with chronic medical conditions like diabetes with reported emotional, behavioral, or developmental problems.
Researchers say overall about 13 percent of American children have special health care needs. Of those included in this study, about 4 percent of all children were reported by parents as suffering from emotional, behavioral, or developmental problems compared with about 29 percent of children with special health care needs.
Compared with children with other chronic medical conditions, the study shows that children with emotional or behavioral health issues were more than twice as likely to be affected by their conditions and these conditions often created financial problems at home.
Children’s Mental Health Problems Have Wide Effect In the study, researchers analyzed information from a 2001 survey of the parents or guardians of nearly 40,000 children with special heath care needs.
Of children with reported emotional, behavioral, or developmental problems, the most commonly reported conditions were attention deficit disorder (ADD) or ADHD (53.5 percent), a learning disability (51.7 percent), anxiety or depression problems (43.5 percent), and autism (6.8 percent).
The study showed that compared with other children with special health care needs, children with these problems were more likely to have:
- Health conditions that affected their daily activities
- Missed 11 or more days of school in the last year
- No or inadequate health insurance Unmet needs for health care services
- Difficulty getting health care referrals More than $1,000 in annual out-of-pocket medical expenses
In addition, family members of children with emotional, behavioral, and developmental problems were more likely to have:
- Experienced financial problems related to the child’s health
- Reduced work hours or stopped working to care for the child
- Spent 11 or more hours per week providing or coordinating health care for the child
Researchers say the results show that a child’s mental health problems can have a ripple effect on the health and welfare of the child and his or her family.
Jennifer Warner
7 October 2005
http://www.foxnews.com/story/0,2933,171620,00.html
Mental Illness Behind Self-Harm Often Undiagnosed
U.S. hospital emergency departments often under-diagnose mental disorders in children and young adults being treated for deliberate self-harm, researchers report.
The study of patients 7 to 24 years old found that just 56 percent of those who went to emergency departments to be treated for deliberate self-harm were diagnosed with a mental disorder and admitted to the hospital.
A diagnosis of depressive disorders -- a major risk factor for youth suicide -- was strongly associated with inpatient admission, the study said.
"In addition, 29 percent of the visits resulted in outpatient care referral; 5.8 percent resulted in referral to the emergency department for continuing care, and follow-up care was unspecified in 3.4 percent of the visits," wrote researchers from Columbia University Medical Center, in New York City. Their findings appear in the October issue of the journal Archives of General Psychiatry.
Deliberate self-harm, such as cutting, poisoning or piercing, is an important risk factor for subsequent suicide, the study noted.
"Mental disorders were diagnosed in roughly one-half of the emergency visits by young people treated for episodes of deliberate self-harm," the authors said. "This suggests substantial under-recognition of mental illness and likely inadequate referral for follow-up mental health care."
"Efforts should be made to fortify mental health assessments," they added. "One promising strategy involves routine administration of rapid and efficient diagnostic instruments to all young people following deliberate self-inflicted harm. Improving mental health assessment of these young people provides an important opportunity for secondary prevention."
Robert Preidt
6 October 2005
http://www.forbes.com/lifestyle/health/feeds/hscout/2005/10/06/hscout528306.html
EXTRACTS FROM
THE “OTHER“ JOURNALS
RELATING TO CHILDREN, YOUTH AND FAMILIES
— IN THE FIELDS OF HEALTH, SUBSTANCE ABUSE, EDUCATION, PSYCHOLOGY, SCIENCE
. . .
Drug helps combat teen heroin addiction As an add-on to counseling in treating opioid addiction in adolescents, the drug buprenorphine is more effective than a standard addiction treatment, according to a new report.
The researchers note that despite an increase in opioid dependency among adolescents over the last decade, relatively little research has been done to identify effective therapies for these young patients.
Dr. Lisa A. Marsch, from the University of Vermont in Burlington, and colleagues assessed the outcomes of 36 opioid-dependent teens who were assigned to medication-assisted withdrawal therapy with either buprenorphine or clonidine. All of the subjects also received thrice-weekly behavioral counseling.
Seventy-two percent of patients in the buprenorphine group stayed in treatment compared with just 39 percent of those given clonidine, the team reports in the Archives of General Psychiatry.
Moreover, the percentage of buprenorphine-treated patients with opiate-negative urine test results was 64 percent, double the percentage seen in the clonidine group.
Relief of withdrawal symptoms and reduction in drug-related HIV risk behavior was noted among subjects in both groups, the authors note.
In general, buprenorphine-treated subjects described more positive effects of their medication than those given clonidine. No evidence of opioid intoxication or psychomotor impairment was seen.
"This study, to our knowledge, was the first randomized controlled trial to evaluate combined behavioral and pharmacological treatments for adolescents dependent on opioids," Marsch's group concludes. The results suggest that buprenorphine plus behavioral counseling is an effective intervention for opioid addiction in this population.
SOURCE: Archives of General Psychiatry, October 2005.
http://today.reuters.com/news/newsArticle.aspx?type=healthNews&story ID=2005-10-05T234340Z_01_KWA585400_RTRUKOC_0_US-TEEN-HEROIN.xml
Children's disease study would be largest ever
Researchers hoping to determine the causes of many common diseases like autism and diabetes will follow 100,000 US children from birth through adulthood in the largest ever study of its kind. ''We're looking to find the root causes of many common diseases and disorders. When we do, we'll be in a position to prevent them from ever occurring," said US Surgeon-General Dr. Richard Carmona.
In particular, scientists will try to find out whether there is a link between environment and diseases.
Most studies used now to link environment and disease are retrospective, meaning they rely on a patient's or a parent's recall of events, food eaten, and behaviors. Scientists place much greater faith in studies that look at actual behaviors in real time to more accurately link them to consequences.
''The National Children's Study would follow more than 100,000 children, from before birth -- and, in some cases, even before pregnancy," said Dr. Duane Alexander, director of the National Institute of Child Health and Human Development, one of the National Institutes of Health. ''It would meticulously measure their environmental exposures while tracking their health and development, from infancy through childhood, until age 21," he added.
Researchers will also take samples from the children and their parents to see what chemicals they have absorbed into their bodies.
''In the search for environmental influences on human health, and their relationship to genetic constitution, National Children's Study researchers plan to examine such factors as the food children eat, the air they breathe, their schools and neighborhoods, their frequency of visits to a health care provider, and even the composition of the house dust in their homes," the NICHD said in a statement.
Six centers were named Thursday where the research will begin -- the University of California in Irvine, the University of North Carolina in Chapel Hill, the Mount Sinai School of Medicine in New York, Children's Hospital of Philadelphia, the University of Utah in Salt Lake City, and the University of Wisconsin-Madison.
The NIH hopes to eventually get 105 communities involved. Each team will enroll at least 250 newborns each year for five years beginning in 2007, with initial results available around 2010.
The researchers will look for women who may become pregnan tto see if accidental or unintended exposures or behaviors affect any children they may later have.
''The study might eventually lead to preventions or treatments for many common conditions," Carmona said.
Maggie Fox
October 3, 2005
http://www.boston.com/news/globe/health_science/articles/2005/10/03/
childrens_disease_study_would_be_largest_ever/
ADHD drug may raise suicide risk in
youths
Strattera will carry a black-box warning, says the drug maker
The Food and Drug Administration warned doctors Thursday about reports of suicidal thinking in some children and adolescents who are taking Strattera, a drug used to treat attention deficit hyperactivity disorder.
Manufacturer Eli Lilly & Co. announced that a black-box warning will be added to the drug's label in the United States.
Such a warning is the most serious that can be added to a medication's label, and similar warnings will be added to the drug's labels in other countries. The company said a study showed instances of suicidal thinking were rare.
In a statement, the FDA said it "is advising health care providers and caregivers that children and adolescents being treated with Strattera should be closely monitored for clinical worsening, as well as agitation, irritability, suicidal thinking or behaviors, and unusual changes in behavior, especially during the initial few months of therapy or when the dose is changed."
Old studies being reviewed There was no evidence of increased suicidal thoughts in adults taking Strattera, which also goes by the generic name atomoxetine, Indianapolis-based Eli Lilly said.
"The actual risk is very low," said Dr. Thomas Laughren, head of the FDA's psychiatric drug unit. Despite the warning, he said, "FDA still views Strattera as an effective drug."
At the FDA's request, Eli Lilly will publish a guide for doctors and pharmacists to give to people who are prescribed Strattera.
The warning is the result of a larger FDA review of psychiatric drugs and their possible association with suicide, the agency said. Old drug studies are being reviewed for occurrences of suicides and suicidal thoughts. Last year, the FDA ordered warnings on all antidepressants that indicated they "increase the risk of suicidal thinking and behavior" in children who take them.
Strattera won praise from some doctors and parents when it became available because, unlike Ritalin, it is not a stimulant, a class of drug that can be addictive. But its chemical makeup is similar to certain antidepressants.
Liver problems reported A review of other ADHD drugs is continuing, Laughren said.
About 3.4 million patients — adults and children — have been prescribed Strattera since it became available, with Lilly officials saying about 75 percent of those taking the medication are children.
Strattera's worldwide sales have dropped lately, falling 31 percent to $123.5 million during this year's second quarter from a year earlier.
Lilly warned doctors in December to stop using Strattera in patients with jaundice or who show signs of liver problems, and it placed a warning on the label and in prescribing information after at least two patients on the medication developed liver problems.
John Lumpkin
http://www.chron.com/cs/CDA/ssistory.mpl/health/3375935
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