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Does Publication Bias Make Antidepressants Seem More Effective at Treating Anxiety Than They Really Are?

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By Craig Williams, Professor of Pharmacy at Oregon State University

In scientific literature, studies with “good” results are more likely to be published than studies with results that are unclear or negative. A study with a new, exciting finding (a positive result) is likely to see the light of day, even if the finding is not in line with the authors hypothesis. But a study that doesn’t have a new finding (a negative result), or has an unclear finding is far less likely to be published. [Read more…]

The Healthy Debate About Mental Health

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dsm-5May 2013 may be remembered as a watershed (or maybe a Waterloo) in the history of psychiatry. Two major events have set the stage for a fundamental debate about how we should think about the nature of mental illness.

The American Psychiatric Association (APA) is about to publish the fifth edition of its diagnostic system of classification: DSM-5. And, three weeks before the publication, Thomas Insel, director of the National Institute of Mental Health (NIMH), announced that his agency will be moving away from funding studies based on the DSM categories. [Read more…]

Debate Over Psychiatry Bible DSM-5 Grows Days Before Release

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With the release of the fifth edition of the so-called psychiatrist’s bible — the “Diagnostic and Statistical Manual of Mental Disorders (DSM),” days away, the controversy surrounding the new publication is heating up.

The National Institute of Mental Health (NIMH) and the American Psychiatric Association (APA), which publishes the DSM, issued a clarifying statement Tuesday saying that they were working together to ensure that people with mental disorders would have better diagnostic resources available to them. However, while they emphasized that the new version, dubbed the “DSM-5,” will have the most up-to-date information for clinical diagnoses of mental disorders, the NIMH did not waver from its initial ruling that it would no longer use diagnoses listed in the DSM for its’ funded studies.
NIMH director Thomas Insel wrote in a statement earlier in May that the NIMH felt the proposed definitions for psychiatric disorders were too broad and ignore smaller disorders that were lumped in with a larger diagnosis.

Read more: CBS News

Flu in Pregnancy May Increase Child’s Bi-Polar Risk 4x

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Pregnant mothers’ exposure to the flu was associated with a nearly fourfold increased risk that their child would develop bipolar disorder in adulthood, in a study funded by the National Institutes of Health. The findings add to mounting evidence of possible shared underlying causes and illness processes with schizophrenia, which some studies have also linked to prenatal exposure to influenza.

“Prospective mothers should take common sense preventive measures, such as getting flu shots prior to and in the early stages of pregnancy and avoiding contact with people who are symptomatic,” said Alan Brown, M.D., M.P.H, of Columbia University and New York State Psychiatric Institute, a grantee of the NIH’s National Institute of Mental Health (NIMH). “In spite of public health recommendations, only a relatively small fraction of such women get immunized. The weight of evidence now suggests that benefits of the vaccine likely outweigh any possible risk to the mother or newborn.” [Read more…]

Cognitive and Physical Decline in Older Adults Associated with Severe Sepsis

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Older adults who survive hospitalization involving severe sepsis, a serious medical condition caused by an overwhelming immune response to severe infection, are at higher risk for cognitive impairment and physical limitations than older adults hospitalized for other reasons, researchers have found.

The research, conducted by the University of Michigan and supported primarily by the National Institute on Aging (NIA), part of the NIH, appears in the Oct. 27, 2010, issue of the Journal of the American Medical Association.

Theodore J. Iwashyna, M.D., Ph.D., and colleagues found that an older person’s risk of cognitive decline increased almost threefold following hospitalization for severe sepsis. They also found that severe sepsis was associated with greater risk for the development of at least one new limitation in performing daily activities following hospitalization.

“Sepsis is common in older people and has a high mortality rate,” said NIA Director Richard J. Hodes, M.D. “This study shows that surviving sepsis may bring substantial and under-recognized problems with major implications for patients, families and the health care system.”

In sepsis, immune system chemicals released into the blood to combat serious infection trigger widespread inflammation. This can lead to low blood pressure, heart weakness, and organ failure. Anyone can get sepsis, but infants, children, older people, and those with weakened immune systems are most vulnerable. People with sepsis often receive treatment in hospital intensive care units to combat the infection, support vital organs and prevent a drop in blood pressure.

“This study should help change the way we think about severe sepsis,” said Iwashyna. “We usually think of severe sepsis as a medical emergency and focus our efforts on making sure the patient survives. This study shows that survivors often have severe problems for years afterwards.”

Using data from the NIA-supported Health and Retirement Study (HRS), the researchers analyzed the cognitive and physical function of older people before and after hospitalization for severe sepsis. The HRS is a long-term study that collects information on the health, economic and social factors influencing the health and well-being of a nationally representative sample of Americans over age 50. Study data on participants 65 and older are linked to Medicare claims data to enable detailed analysis of medical conditions and health status.

The scientists analyzed Medicare claims data from 516 people who survived 623 hospitalizations for severe sepsis between 1998 and 2005. The average age of participants was 77 at the time of hospitalization. The researchers also examined the individuals’ HRS data on cognitive function, measured through standard tests. Physical limitations were measured by the need for assistance in six activities of daily living basic self-care tasks (walking, dressing, bathing, eating, toileting and getting into and out of bed) and five instrumental activities of daily living (preparing a hot meal, shopping for groceries, making telephone calls, taking medicines and managing money), which are associated with the ability to live independently. For comparison, the researchers analyzed Medicare and HRS data on 4,517 survivors of 5,574 non-sepsis general hospitalizations during this time period.

Almost 60 percent of hospitalizations for severe sepsis were associated with worsened cognitive and/or physical function among survivors in the first survey following hospitalization. The risk of progression to moderate or severe cognitive impairment in sepsis survivors was 3.33 times higher than their risk before hospitalization. Severe sepsis was associated with the development of 1.57 new functional limitations among patients with no limitations before sepsis. In contrast, patients who did not develop sepsis and had no functional limitations before hospitalization developed an average of 0.48 new functional limitations. Non-sepsis hospital admissions were not associated with an increased risk for cognitive decline.

“This is one of more than a thousand research papers that have used Health and Retirement Study data,” said Richard Suzman, Ph.D., director of the NIA’s Division of Behavioral and Social Research, which supports the HRS. “The uniquely rich HRS dataset enabled the analysis of both cognitive and physical function in relation to hospitalization for a very specific medical condition. I look forward to the investigators refining their findings in the future.”

Source: NIH, October 26, 2010

Depression Among Low Income Latinos

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A new, small study of low-income, depressed Latinos finds that those who stigmatize mental illness are less likely than others are to take medication, keep scheduled appointments and control their condition.

The findings could help physicians develop a series of question to identity patients who might especially be resistant to care and then help them understand how treatment works, said lead study author William Vega.

“Unfortunately, mental-health stigma turns out to be one of the most serious barriers for people receiving care or staying in care,” said Vega, professor of medicine and social work at the University of Southern California.

Many cultures have stereotypes about depression and mental illness, he said, with some viewing it as something that will brand a family for generations. Latinos, in particular, value resilience and think, “it’s a cultural value to be able to handle your own affairs,” he said. “If you can’t, it implies that you’re weak.”

While it might not be surprising that Latinos stigmatize mental illness, “like many things, it’s all anecdotes and innuendo until you do something more solid, like a research study, and start finding out what the issues are,” said Vega, who worked on the study with fellow researchers while at the University of California at Los Angeles.

In the new study, published in the March/April issue of the journal General Hospital Psychiatry, researchers surveyed 200 poor, Spanish-speaking Latinos in Los Angeles. They all had visited local primary care centers; 83 percent were women. All had shown signs of depression in an initial screening.

Another screening found that all but 54 of the 200 individuals were mildly to severely depressed. Researchers deemed 51 percent as those who stigmatize mental illness, based on responses to questions about things like the trustworthiness of a depressed person.

The researchers found that those who stigmatized mental illness were 22 percent less apt to be taking depression medication, 21 percent less likely to be able to control their depression and about 44 percent more likely to have missed scheduled mental-health appointments.

The findings “shows evidence that stigma does exist, and it’s related to things that are important to provide as part of proper treatment,” Vega said.

Jamie Walkup, a Rutgers University associate professor of psychology who studies mental health and stigma, said the key is to find ways to “push back against these negative ideas, hoping that a person with depression will no longer let an aversion to being a person with depression stop them from doing what they may need to do to get help.”

It might be worth asking, he said, “whether it may sometimes make more sense to switch gears with a patient who, for whatever reason, finds it intolerable to think of themselves as having depression.”

In such cases, doctors could find other ways to work with these patients without insisting that they acknowledge their diagnosis.

Source: Vega W, Rodriguez MA, Ang A. Addressing stigma of depression in Latino primary care patients. General Hospital Psychiatry 32(2), 2010.


Elderly with Untreated Vision Problem More Likely to Develop Alzheimer’s

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Elderly people with visual disorders that are left untreated are significantly more likely to develop Alzheimer’s disease — the most common form of dementia, according to a University of Michigan Health System study.

The study used Medicare data and shows that those with poor vision who visited an ophthalmologist at least once for an examination were 64 percent less likely to develop dementia.

The study appears online ahead of print in the American Journal of Epidemiology and may draw a new picture of poor vision as predictor of dementia rather than as a symptom after the diagnosis.

“Visual problems can have serious consequences and are very common among the elderly, but many of them are not seeking treatment,” says lead author Mary A.M. Rogers, Ph.D, research assistant professor of internal medicine at the U-M Medical School and research director of the Patient Safety Enhancement Program at the U-M Health System and the Ann Arbor VA Medical Center.

For the study, Rogers and her colleague Kenneth M. Langa, M.D., Ph.D., professor of internal medicine at U-M Medical School, analyzed data from the nationally representative Health and Retirement Study and records from Centers for Medicare and Medicaid Services.

”Our results indicate that it is important for elderly individuals with visual problems to seek medical attention so that the causes of the problems can be identified and treated,” Rogers says.

The types of vision treatment that were helpful in lowering the risk of dementia were surgery to correct cataracts and treatments for glaucoma, retinal disorders and other eye-related problems.

Proper vision is a requirement for many of the activities that previously have been found to lower the risk of Alzheimer’s disease. These include reading, playing board games, other mentally stimulating activities, social networking, as well as physical activity such as walking and routine exercising. A visual disorder may interfere with normal mobility and may also hinder a person’s ability to participate in such activities.

“Many elderly Americans do not have adequate health coverage for vision, and Medicare does not cover preventative vision screenings for most beneficiaries,” Rogers says. “So it’s not unusual that the elderly receive vision treatment only after a problem is severe enough to warrant a visit to the doctor when the problem is more advanced.”

According to a survey conducted by the National Eye Health Education Program, less than 11 percent of respondents understood that there are no early warning signs for eye problems such as glaucoma and diabetic retinopathy.

However, vision problems and blindness are among the top 10 disabilities among adults and can result in a greater tendency to experience other health conditions or even to die prematurely.

“While heart disease and cancer death rates are continuing to decline, mortality rates for Alzheimer’s disease are on the rise,” says Rogers. “So if we can delay the onset of dementia, we can save individuals and their families from the stress, cost and burden that are associated with Alzheimer’s disease.”

The study was based on the surveys and medical information from 625 people compiled from 1992-2005. Only 10 percent of Medicare beneficiaries who developed dementia had excellent vision at the beginning of the study, while 30 percent of those who maintained normal cognition had excellent vision at the onset of the study.

One in five Americans who are over age 50 report experiencing a visual impairment, according to the U.S. Centers for Disease Control and Prevention. Approximately 5 million Americans have Alzheimer’s disease and the number has doubled since 1980. It is expected to be as high as 13 million by 2050.

Source: American Journal of Epidemiology,/em> 2010 Feb. 11; doi:10.1093; University of Michigan

Overtime Work Can Lead to Anxiety and Depression

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Overtime work habits can lead to anxiety and depression, according to a study conducted by Norweigan researchers.

Using a standard screening questionnaire to measure symptoms of anxiety and depression, Elisabeth Kleppa and colleagues at the University of Bergen, Norway, analyzed data on hours worked by a large sample of Norwegian men and women. Scores for anxiety and depression were compared for 1,350 workers putting in 41 to 100 hours of overtime a week, and some 9,000 workers working regular hours (40 or less) without overtime.

Overtime work was linked to higher anxiety and depression scores among both men and women, while “possible” depression rose from about 9% for men working regular hours to 12.5% for those working overtime. “Possible” depression rates in women rose from 7% to 11% and for men and women the “possible” anxiety and depression rates were higher among workers with lower incomes and for less—skilled workers.

The relationship between overtime and anxiety/depression was strongest among men who worked the most overtime—49 to 100 hours per week. Men working such very long hours also had higher rates of heavy manual labor and shift work and lower levels of work skills and education.

Health and safety concerns have been raised in previous studies, but these concentrated on shift work rather than overtime. European Union work rules allow employees to refuse to work more than 48 hours per week. These latest results show increased rates of anxiety and depression among overtime workers, supporting the European Union directive.

Even moderate overtime hours appear to increase the risk of ‘mental distress’, although the study offers no conclusions as to how working long hours results in increased anxiety and depression. It is surmised that working overtime leads to increased “wear and tear,” or that individuals with characteristics predisposing to anxiety and depression (such as low education and job skills) are more likely to take jobs requiring long work hours.

Source: Journal of Occupational and Environmental Medicine, official publication of the American College of Occupational and Environmental Medicine (ACOEM), June, 2008.

Brain Changes in Elderly Can Affect Mobility and Balance

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Changes in the brain can affect old people’s mobility and balance, according to a recent study. Particularly affecting balance and walking are white matter changes called leukoaraiosis.

The 639 men and women between the ages of 65 and 84 in the study underwent brain scans and walking and balance tests. 284 people in the group had mild age-related white matter changes, 197 moderate changes, and 158 severe changes.

People with severe white matter changes were twice as likely to score poorly on the walking and balance tests as people with mild white matter changes, the study found. The people with severe changes were also twice as likely as those with mild changes to have a history of falls. The moderate group was only one and a half times as likely as the mild group to have a history of falls.

"Walking difficulties and falls are major symptoms of people with white matter changes and a significant cause of illness and death in the elderly," said study author Hansjoerg Baezner, MD, PhD, with the University of Heidelberg in Mannheim, Germany. "Exercise may have the potential to reduce the risk of these problems since exercise is associated with improved walking and balance. We’ll be testing whether exercise has such a protective effect in our long-term study of this group."

"Mobility is one of the key determinants of independent aging," said Baezner. "Limitations in mobility often lead to hospitalization and nursing home placement. This will become a major problem for our social and economic systems in the upcoming decades."

Published in Neurology, the medical journal of the American Academy of Neurology,the 3-year study was coordinated by the Department of Neurological and Psychiatric Sciences of the University of Florence.

Source: Neurology, March 18, 2008