A study of over-prescription for depression and anxiety deserves analysis because it contains a mix of truth… and hidden agendas

 

GPs are turning us into a nation of pill-poppers, according to shock headlines last week. The research, commissioned by the charity Nuffield Health, found that GPs are 46 times more likely to prescribe medication for depression and anxiety ”rather than recommend other, medically proven alternatives such as exercise’’.

This feeds in nicely to the social narrative surrounding primary care: that GPs are too busy and harassed to listen and are only interested in pushing us out of the door clutching a prescription to keep us quiet. Dr Davina Deniszczyc, the medical director of Nuffield Health, said: ”The compelling evidence that physical activity can play an important role in both treating and alleviating early symptoms of mental ill health isn’t sufficiently filtering through to front-line and primary care services.’’

This study deserves a closer analysis because it contains a mix of truth… and hidden agendas. The newspaper reports indicated, correctly, that it was commissioned by a charity. But although Nuffield Health is technically a charity, it is actually a private hospital chain. It was criticised when it emerged that the group paid only £100,000 corporation tax in 2011, despite a turnover of £575 million, because of its ”charity’’ status. Its chief executive, David Mobbs, has a salary package of £860,000. It has 31 hospitals but also 60 membership gyms. So, a cynic could argue that it has a vested interest in, firstly, undermining people’s confidence in GPs and, secondly, commissioning research that promoted exercise. The study is, in essence, a nicely dressed up piece of covert marketing.

And it works as a marketing message because it does contain some truth. I should emphasise that I routinely prescribe antidepressants to patients with moderate to severe depressive illness, and they are effective. It is also true that sometimes antidepressants are prescribed to people for whom exercise would be beneficial, such as those with a mild depressive illness. But for many, their depression is so severe that the idea of a brisk jog in the park to lift their spirits is absurd. It can be a life-threatening illness that deserves prompt pharmacological intervention.

However, what the study failed to explore was why GPs were so ready to prescribe antidepressants. The real story here is about psychological therapy services. Historically, GPs have been reliant on antidepressants because access to the alternative – the ”talking therapies’’ – in the NHS is subject to very long waiting lists.

 

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The doctors concluded that many of the “cures” are a result of the placebo effect, when patients’ bodies heal themselves because the patient is convinced they have been given a miracle remedy.

“Even when people have three doctors telling them their treatment has no medical benefits, once they are in that zone, believing in their remedy, they won’t be persuaded otherwise.”

In the test, all of the people given duct tape found their verrucas shrank by at least one millimeter, whereas none of those who used surgical tape saw any difference at all.

Dr Cannon said: “I’ll certainly suggest to my patients that they give it a try if they aren’t having any success with other treatments.”

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A new research has shown that learning only certain activities, such as photography, may help elderly improve their cognitive functioning.

These findings reveal that less demanding activities, such as listening to classical music or completing word puzzles, probably won’t bring noticeable benefits to an aging mind.

Lead researcher Denise Park of the University of Texas at Dallas, said that it seems it is not enough just to get out and do something-it is important to get out and do something that is unfamiliar and mentally challenging, and that provides broad stimulation mentally and socially.

She asserted that when people are inside their comfort zone they may be outside of the enhancement zone.

For their study, Park and colleagues randomly assigned 221 adults, ages 60 to 90, to engage in a particular type of activity for 15 hours a week over the course of three months.

Some participants were assigned to learn a new skill – digital photography, quilting, or both – which required active engagement and tapped working memory, long-term memory and other high-level cognitive processes.

Other participants were instructed to engage in more familiar activities at home, such as listening to classical music and completing word puzzles. And, to account for the possible influence of social contact, some participants were assigned to a social group that included social interactions, field trips, and entertainment.

At the end of three months, Park and colleagues found that the adults who were productively engaged in learning new skills showed improvements in memory compared to those who engaged in social activities or non-demanding mental activities at home.

The study has been published in Psychological Science.

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Like a janitor sweeping the halls after the lights go out, major changes occur in the brain during sleep to flush out waste and ward off disease, researchers said Thursday.

The research in the journal Science offers new answers to explain why people spend a third of their lives asleep and may help in treating dementia and other neurological disorders.

In lab experiments on mice, researchers observed how cellular waste was flushed out via the brain’s blood vessels into the body’s circulatory system and eventually the liver.

These waste products included amyloid beta, a protein that when accumulated is a driver of Alzheimer’s disease.

In order to help remove the waste, cerebral spinal fluid is pumped through brain tissue.

The process is sped along during sleep because the brain’s cells shrink by about 60 percent, allowing the fluid to move faster and more freely through the brain.

The whole operation takes place in what researchers call the glymphatic system, which appears to be nearly 10 times more active during sleep than while awake.

“The brain only has limited energy at its disposal,” said lead author Maiken Nedergaard of the University of Rochester Medical Center.

“You can think of it like having a house party. You can either entertain the guests or clean up the house, but you can’t really do both at the same time.”

Co-authors of the study, which was funded by the US National Institutes of Health, came from Oregon Health and Science University and New York University.

Source: http://www.channelnewsasia.com

 

People in debt are more than three times more likely to suffer from a mental health problem than those who are not in debt, a new study has revealed.

Researchers from the University of Southampton, along with a researcher from Kingston University, carried out a systematic review on all previous research which looked at the relationship between health problems and unsecured debt.

They conducted a ‘meta-analysis’, the first time this has been done on the issue, to statistically combine the results of previous studies involving nearly 34,000 participants.

Less than nine per cent of participants with no mental health problems were in debt, compared to more than a quarter of participants being in debt and with a mental health problem.

The team found that those in debt were also more likely to suffer from depression, drug dependence and psychosis and the results also suggested that those who die by suicide are more likely to be in debt.

Dr Thomas Richardson, Clinical Psychologist from the University of Southampton who led the research, said that the research showed a strong relationship between debt and mental health; however it is hard to say which causes which at this stage. It might be that debt leads to worse mental health due to the stress it causes. It may also be that those with mental health problems are more prone to debt because of other factors, such as erratic employment. Equally it might be that the relationship works both ways.

The study is published online in Clinical Psychology Review.

Read more: http://www.indiavision.com/news/article/health/450886/people-in-debt-more-likely-to-suffer-from-mental-health-problems/#ixzz2g5bOb8kI

 

A neurosurgery patient treated at a New Hampshire hospital this spring did have a rare brain disorder known as Creutzfeldt-Jakob Disease, health officials confirmed Friday. That means that 15 other people in three states may have been exposed to the invariably deadly infection through potentially tainted surgical equipment.

Autopsy results came back positive for CJD from the National Prion Disease Pathology Surveillance Center and were reported to the New Hampshire Department of Health and Human Services and Catholic Medical Center, where the surgery took place.

Earlier this month, New Hampshire officials notified eight patients who may have been exposed to CJD through shared equipment. Five others in Massachusetts and two in Connecticut were also warned of the risk, health officials in those states said.

“Though we are not surprised by the test results, we are saddened by the toll this disease takes on families and our sympathies go out to all those affected,” said Dr. Jose Montero, New Hampshire’s director of public health, in a statement. There is no way to confirm the disease except through autopsy after a patient’s death.

The initial patient turned out to have sporadic CJD, which occurs spontaneously. It’s not the variant form of the disease that causes a human type of “mad cow disease” and is associated with eating beef contaminated with the cattle version of the infection, called bovine spongiform encephalotpathy, or BSE, experts said.

The problem arose because standard hospital disinfection techniques cannot eradicate the prion that causes CJD. A prion is a protein and the type that causes BSE and CJD is misfolded and somehow manages to transform other proteins into disease-causing shape.

The initial patient had surgery at Catholic Medical Center in Manchester, N.H., where eight others were also treated. The five Massachusetts patients underwent surgery at Cape Cod Hospital in Hyannis, while the two Connecticut patients were treated at the Veterans Affairs Hospital in West Haven, health officials said.

The Massachusetts and Connecticut patients were all treated using a guided imaging navigation system manufactured by Medtronic Inc., as well as the surgical tools that go with it, a company spokeswoman said. Other patients were treated with tools made by different manufacturers. Hospitals frequently share high-cost neurosurgery equipment on a fee-for-use or rental basis, which explains why they were used in more than one hospital.

The risk of infection is very low, noted Dr. Joseph Pepe, president and CEO of Catholic Medical Center. The eight New Hampshire patients were notified Friday of the autopsy results.

This is not the first time contaminated hospital equipment has been implicated in potentially spreading CJD. In 2000, 14 patients in two separate incidents were exposed. The Joint Commission, an accrediting agency, this month reiterated guidelines urging hospitals to have a high degree of suspicion about CJD even when the diagnosis is not confirmed and to follow World Health Organization and Centers for Disease Control guidance on sterilization or disposal of the tools.

CJD affects about one in a million people worldwide each year, experts say. In the most recent five-year period, between 279 and 352 cases were diagnosed in the U.S. annually, according to the Centers for Disease Control and Prevention. Early symptoms include rapidly failing memory and other cognitive problems. Personality changes, anxiety, depression, lack of coordination and visual disturbances often occur. There is no treatment and no cure. officials said.

Source: http://www.nbcnews.com/health

Scientists say they’ve discovered a totally new kind of brain activity lurking beyond the “flat-lined” state seen in deep comas.

A team of Canadian and Romanian researchers found evidence of cerebral activity both in a human coma patient and in 26 cats induced by drugs into an incredibly deep (but reversible) coma. They describe the new phenomenon, which they’ve dubbed “Nu-complexes,” in a paper published Wednesday in the journal PLoS ONE.

Initial stages of comas are comparable to deep sleep, but if a person progresses into a deeper and deeper quietude, the brain state alters more dramatically. In cases of very deep comas, an electroencephalogram (EEG) monitor will render a flat line (also called an isoelectric line), marking a state in which the brain’s electrical activity has either stopped or is so low it is virtually undetectable. This is considered one of the boundary lines between having a living brain and brain death, but is not the only criteria that doctors use to declare someone brain-dead; there usually has to be evidence of structural damages in the brain as well.

This new research suggests that cerebral activity can revive after the flat-lined state, under certain conditions. The work started when Romanian doctor and study coauthor Bodan Florea observed unusual brain activity in a hospital patient who went into a coma following a heart attack.

Source: http://www.ibtimes.com

Isabelle Arnulf and colleagues from the Sleep Disorders Unit at the Université Pierre et Marie Curie (UPMC) have outlined case studies of patients with Auto-Activation Deficit who reported dreams when awakened from REM sleep – even when they demonstrated a mental blank during the daytime. This paper proves that even patients with Auto-Activation Disorder have the ability to dream and that it is the “bottom-up” process that causes the dream state.

In a new paper for the neurology journal Brain, Arnulf et al compare the dream states of patients with Auto-Activation Deficit (AAD) with those of healthy, control patients. AAD is caused by bilateral damage to the basal ganglia and it is a neuro-physical syndrome characterized by a striking apathy, a lack of spontaneous activation of thought, and a loss of self-driven behaviour. AAD patients must be stimulated by their care-givers in order to take part in everyday tasks like standing up, eating, or drinking. If you were to ask an AAD patient: “what are you thinking?” they would report that they have no thoughts.

During sleep, the brain is operating on an exclusively internal basis. In REM sleep, the higher cortex areas are internally stimulated by the brainstem. When awakened, most normal subjects will remember some dreams that were associated with their previous sleep state, especially in REM sleep. Would the self-stimulation of the cortex by the brainstem be sufficient to stimulate spontaneous dreams during sleep in AAD patients?

Discovering the answer to this question would go some way to proving either the top-down or bottom-up theories of dreaming. The top-down theory stipulates that dreaming begins in higher cortex memory structures and then proceeds backwards as imagination develops during wakefulness. The bottom-up theory posits that the brainstem structures which elicit rapid eye movements and cortex activation during REM sleep result in the emotional, visual, sensory, and auditory elements of dreaming.

Thirteen patients with AAD agreed to participate in the study and record their dreams in dream diaries during the week leading up to the evaluation. These patients were compared with thirteen non-medicated, healthy control subjects. Video and sleep monitoring were performed on all twenty six participants for two consecutive nights. The first night evaluated the patient’s sleep duration, structure, and architecture of their dreams. During the second night of sleep evaluation, the researchers woke the subjects up as they entered the second non-REM sleep cycle, and again after 10 min of established REM sleep during the following sleep cycle, and asked them what they were dreaming before being woken up. The dream reports were then independently analysed and scored according to; complexity of dream, bizarreness, and elaboration.

Four of the thirteen patients with AAD reported dreaming when awakened from REM sleep, even though they demonstrated a mental blank during the daytime. This is compared to 12 out of 13 of the control patients. However, the four AAD patients’ dreams were devoid of any complex, bizarre, or emotional elements. The presence of simple yet spontaneous dreams in REM sleep, despite the absence of thoughts during wakefulness in AAD patients, supports the notion that simple dream imagery is generated by brainstem stimulation and sent to the sensory cortex. The lack of complexity in the dreams of the four AAD patients, as opposed to the complexity of the control patients’ dreams, demonstrates that the full dreaming process require these sensations to be interpreted by a higher-order cortical area.

Therefore, this study shows for the first time that it is the bottom-up process that causes the dream state.

Yet, despite the simplicity of the dreams, Isabelle Arnulf commented that the banal tasks that the AAD patients dreamt about were fascinating. For instance, Patient 10 dreamt of shaving – an activity he never initiated during the daytime without motivation from his caregivers, and an activity he could not do by himself due to severe hand dystonia. Similarly, Patient 5 dreamt about writing even though he would never write in the daytime without being invited by his caregivers to do so.

Interestingly, there were no real differences in the sleep measures between the AAD patients and the control patients apart from 46% of the AAD patients had a complete absence of sleep spindles (a burst of oscillatory brain activity visible on an EEG that occurs during stage 2 sleep). The striking absence of sleep spindles in localized lesions in the basal ganglia of these 6 AAD patients highlights the role of the pallidum and striatum in spindling activity during non-REM sleep. This is a key distinction between the AAD patients and the control patients; all thirteen control subjects displayed signs of sleep spindles.

Source: Medical News today

 

Adopted children may be more likely than their non-adopted siblings to attempt suicide, according to a new U.S. study.

Researchers urged doctors to be on the lookout for signs of trouble in adopted teen patients but said parents should not be overly alarmed by the results.

“While our findings suggest that adoptees may have an elevated risk for suicide attempt, the majority of the adopted individuals in our study were psychologically well-adjusted,” lead author Margaret Keyes, a psychologist at the University of Minnesota in Minneapolis, said.

Suicide is the third leading cause of death for young people between the ages of 10 and 24 years old, according to the Centers for Disease Control and Prevention. According to the agency, 4,600 youth deaths each year in the U.S. are suicides, and a much larger number of young people make attempts to take their own lives.

Previous research in Sweden found that adopted kids in that country were more likely to attempt suicide than non adopted kids, but no comparable study had been done in the U.S., according to Keyes and her coauthors writing in the journal Pediatrics.

They examined data from an existing University of Minnesota study of 692 adopted children and 540 non adopted siblings in Minnesota.

All of the adopted kids, who were between 11 and 21 years old during the study period, had been taken in by their families before age two and had a biologically unrelated teenage sibling in the same home.

Almost three quarters of the adopted children were born abroad, most of the foreign-born children were from South Korea and 60 percent of those were girls.

At the beginning of the study, and again about three years later, the researchers asked participating parents and kids if either of the children had made a suicide attempt.

Over the three years of the study, 56 children attempted suicide at least once, according to the family members’ reports. Of those kids, 47 were adopted and nine were not adopted.

When previous self-harm behavior was taken into account, researchers calculated that adopted teens were 3.7 times more likely to attempt suicide than the other teens.

When the researchers adjusted for other factors often linked with suicidal thinking or behavior, including drug use, depression, academic struggles and personality traits like alienation and impulsivity, the increased risk for adopted kids remained.

Although this study could not determine why the adopted teens were more likely to attempt suicide, the authors note that other research has suggested burdens carried by adopted children that may be contributing factors.

In the Swedish study, for example, researchers showed that substance abuse, suicidal behavior and mental illness among the biological parents of domestically adopted kids could explain about one third of the children’s increased risk for suicide.

For children adopted from abroad, Keyes’ team writes, there is also the possibility that loss of cultural identity and experience of ethnic discrimination only add to the pressures on a child.

“Other mediating factors, not considered in our study, may include: heritable risk, prenatal factors, factors unique to relinquishment by a biological parent, early trauma, weak attachment to adoptive families and loss of cultural identity and ethnic discrimination,” Keyes told Reuters Health by email.

Two of those factors may be most critical in determining suicide risk, according to Ritch C. Savin-Williams, a professor of developmental psychology at Cornell University in Ithaca, namely: genetics and early trauma.

“Many of us believe that these two might well be the most important distinguishing factors separating the two groups, answering the question of why were these babies put up for adoption in the first place,” he told Reuters Health.

The small size of the study and limited ethnic diversity make these results not generalizable to the whole of the United States, Savin-Williams said.

The study was also limited to self-reported suicide attempts and did not distinguish between types of attempts, some of which can be far more serious and worrisome than others, Savin-Williams noted.

“We do not believe that adoptive parents should be alarmed by these findings,” Keyes said.

“However, parents and clinicians may want to be aware of the increased potential for suicide attempt in adopted adolescents who evidence other risks for suicidal behavior,” she said.

Source : Fox News

 

A physician has said that the reason behind the slow progress in researchers` quest for the cause of multiple sclerosis is that most of the research has targeted the wrong part of the brain.

Steven Schutzer, a physician and scientist at Rutgers New Jersey Medical School, attacked the problem from a different direction. He is one of the first scientists to analyze patients` cerebrospinal fluid (CSF) by taking full advantage of a combination of technologies called proteomics and high-resolution mass spectrometry.

He said that proteins present in the clear liquid that bathes the central nervous system can be a window to physical changes that accompany neurological disease and the latest mass spectrometry techniques allow us to see them as never before.

In this study, Schutzer used that novel approach to compare the cerebrospinal fluid of newly diagnosed MS patients with that of longer term patients, as well as fluid taken from people with no signs of neurological disease.

What Schutzer found startled one of his co-investigators, Patricia K. Coyle of Stony Brook University in New York, one of the leading MS clinicians and researchers in the country.

The proteins in the CSF of the new MS patients suggested physiological disruptions not only in the white matter of the brain where the myelin damage eventually shows up.

They also pointed to substantial disruptions in the gray matter, a different part of the brain that contains the axons and dendrites and synapses that transfer signals between nerves.

The new findings have been published in the journal PLOS ONE.

 Source: Zee News