Depression linked to preemies. Why?

November 4, 2008

Depression symptoms early in pregnancy foreshadow preterm delivery

Among nearly 800 pregnant women in a study from California’s Kaiser Permanente program, those who experienced depressive symptoms early in their pregnancies were more likely to deliver preterm babies. The report is published early online in the journal Human Reproduction.

The likelihood of preterm delivery was exacerbated by:

* obesity
* lower education levels and
* a history of fertility problems

This echoes a smaller prospective study published last year. UCLA researchers found the same phenomenon, but they linked it to the medication rather than to the symptoms.

Enter “pregnancy depression” in the search box, and scroll down the page. You’ll see another new study in the American Journal of Psychiatry suggesting that this is fundamentally a circadian rhythm problem, which might be solved by a benign strategy: light therapy.

Psychiatric Times

Which antidepressants are safest in pregnancy? Find the answer in a recent review in Psychiatric Times by clicking on the dedicated link in the left column that searches this publication only.

Complementary Medicine

How about starting with the alternative remedy St. John’s wort? A search on “St. John’s wort pregnancy” in this category reveals that the herbal treatment for depression may not be innocuous to the fetus

No Comments » | Alternative Medicine, Depression, Family Medicine, Psychiatry, Women | Tagged: , , , , | Permalink
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Next: Genetic profiles on Facebook?

November 4, 2008

Project seeks volunteers to make their DNA profiles public for researchers

People may be thinking about genetic testing again, after reading recent press reports about the Personal Genome Project.

Late last month, the first few volunteers saw some of their genetic information made public on the Internet.

This effort seeks 100,000 volunteers willing to have their DNA sequenced, databased, and stored online, along with identifying medical and personal information, in order to speed the development of medical genomics.

For a quick brush-up on the pros and cons of reading your own gene map, the search term
risks genetic testing
offers some balanced reflections.

In some cases, diagnosis by history and examination has already given way to genetic testing. For instance, it’s now time to think “genotype first” when you see a child with a developmental issue, said an editorial in the New England Journal of Medicine a few weeks ago.

See what you can find by searching through the article categories with the search term “genetic testing”.

Evidence-based Articles

Scroll down first page of results for genetic testing to find a recent systematic review in JAMA about genetic testing for chronic adult diseases.

Practical Articles/News

This category holds a news article showing that an inconclusive genetic result can be as distressing as a positive one.

Patient Education

Scroll down here to find a Mayo Clinic blog for patients who may want to learn more about the topic on their own time.

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Can MRI tingle the blues away?

October 28, 2008

Transcranial magnetic stimulation approved for major depression

The FDA has reversed itself and has approved transcranial magnetic stimulation (TMS) for major depressive disorder after a first medication trial has failed. The device delivers MRI-like pulses to the brain.

A new randomized trial of 164 patients showed significant symptom improvement compared with placebo. The device will be available only at a few centers for now. It is approved only as a second-line treatment for this one indication, although it has been tested for many.

Earlier studies showed TMS to be less effective than ECT for depression, but also less invasive.

Research/Reviews

What is TMS exactly, and what has it been used for? A timely set of reviews appeared in the Canadian Journal of Psychiatry only last month.

Patient Education

Look in this category for reliable take-home information for patients who may ask about the therapeutic option.

No Comments » | Depression, Psychiatry, Uncategorized | Tagged: , , | Permalink
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Can kids be bipolar–and outgrow it?

October 21, 2008

Longitudinal study documents persistence of child bipolar to adulthood

Not only does bipolar I disorder in fact affect children (despite the skeptics), those who have it are at least 13 times as likely as others to experience the disorder as adults, according to the first major prospective study of the question. The report appears in the October Archives of General Psychiatry.

The study followed 115 children enrolled since 1995. At least half are now 18.

More than 44% continued to have manic episodes as adults, and 35% had substance use disorders. Long episode duration and daily cycling were characteristic features of the syndrome in childhood and often continued after age 18.

Young age at onset and having a mother who wasn’t very warm strongly predicted quicker relapse after recovery. Maternal warmth is a known factor from previous studies of bipolar.

Related searches

Treatment of Early Age Mania study

WASH-U-KSADS

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New cardiac test for primary care: Depression screening

October 14, 2008

AHA, APA advise depression screening for all with coronary heart disease

People who have coronary heart disease should all be screened for depression, the American Heart Association and the American Psychiatric Association advise in new recommendations published in Circulation.

The report offers substantial information about links between heart disease and depression. Using SearchMedica, you can quickly locate many of the supporting documents listed in the references.

Recent evidence suggests that young women may be at particularly high risk of depression after myocardial infarction.

Numerous studies link depression and depressive symptoms with poor outcomes in patients with coronary heart disease. Find them using the query “depression cardiac risk factor”.

Or you can retrieve a particular study in the reference list by using words from the title as your search term.

Depression and anxiety predict onset of cardiac events, according to a recent report in the Archives of General Psychiatry, located with the search term “depression anxiety predictors 2-year cardiac events”.

An earlier article in the same journal pinpointed a direct link between depression and the onset of coronary events.

There’s plenty of evidence that people with depression have poor adherence to treatment for cardiac conditions.

On the other hand, cardiac rehabilitation improves depression.

So, primary care physicians should be looking for, and probably treating, depression in heart patients.

Which screening instruments should they use?

Way back in 2000, the New England Journal published an article identifying ways to manage depression in outpatient practice.

In this case, even using its exact title (”Managing depression in medical outpatients”), that article appears far down the list, on page 3.

That’s not good! Why isn’t it at the top of the list?

(Because the article is so old, and SearchMedica’s default setting ranks newest articles highest.)

Try de-selecting the option “Prioritize results by publication date” just beneath the search box, making relevance to your search term rank higher than publication date. The eight-year-old article appears at the top of the list.

Practice Guidelines

Find a new guideline for treatment of depression in adults in primary care using this article category.

CME

Find a new CME course about treating depression in primary care, from an authoritative source.

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Intensive psychotherapy validated (while vanishing)

October 14, 2008

Long-term psychodynamic therapy proves best for some disorders

It must be a challenge to do even one randomized controlled trial of long-term psychotherapy. But German researchers found 11 of them published since 1960, added 12 observational studies, and carried out a meta-analysis which appears in the October 1 edition of the Journal of the American Medical Association.

Psychodynamic psychotherapy continued for at least a year was better than other treatments for

* complex depression or anxiety
* personality disorders, and
* chronic and multiple psychiatric disorders

Only 8 of the trials had sufficient power to be authoritative. And a lack of randomization prevented firm conclusions about whether adding medication to long-term therapy improves the outcomee.

Despite its flaws, a companion editorial asked, does the meta-analysis satisfy the demand for evidence of long-term therapy’s efficacy? Its assessment was a “qualified yes”.

The editorial points out that psychotherapy actually produces changes in brain structure and function, according to the results of recent research.

Evidence that the most challenging of patients can respond to intensive therapy comes at a time when ever fewer psychiatrists offer psychotherapy.

Evidence-based Articles

Use this article category to find rigorous evidence about the effects of long-term psychodynamic psychotherapy.

Psychiatric Times

Last month’s edition of Psychiatric Times featured a review of the effects of psychotherapy on brain function.

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Chelation and autism: End of the line?

October 7, 2008

NIMH pulls the plug on chelation therapy trial for autism

A clinical trial of chelation therapy in autistic children with detectable blood levels of mercury has been cancelled by the NIMH.

The agency explained that a suggested link between mercury-containing vaccines and autism has not been proven.

Also, rat studies suggested that chelation therapy might be dangerous in the absence of blood lead.

No children had been enrolled in the clinical trial before it was cancelled.

All of Medicine tab

This month’s edition of Archives of Disease in Childhood compiles a recent study finding no link between the MMR vaccine and autism with letters responding to that study.

Practical Articles/News

A recent article in Psychiatric Times reviews complementary therapies for autism.

Evidence-based Medicine

Placebo worked just as well as chelation therapy in reducing distress among people concerned about the mercury in their dental fillings, according to an old randomized study found in this article category.

(The chelating drug did elute mercury, but people on placebo scored equally on anxiety and somatization measures after treatment.)

No Comments » | Adolescent, Family Medicine, Internal Medicine, Pediatrics, Psychiatry, Uncategorized | Tagged: , , , , , | Permalink
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Sunshine is an antidepressant

September 30, 2008

New data explain why winter causes blues and summer lightens the mood

The amount of circulating serotonin available to the brain correlates with number of daylight hours, which should help to explain why people get the blues during the winter months.

This information comes from a new study that used improved biological methods to test healthy volunteers with no history of depression.

Daylight correlated with a reduction in regional serotonin transporter binding potential, which is related to the amount of serotonin available to the brain. Levels were higher in fall and winter for all volunteers, meaning that more serotonin was bound to the transporter and unavailable.

Then what about the evidence that suicides are most common in the spring, when there’s more daylight? A good question for further research, the authors say.

Maybe it has something to do with the sudden shift in serotonin transporter levels, or with differences in brain regionalization as they change.

Life events also affect levels of this molecule, according to previous studies.

Depression also correlates with time of sunrise, according to a 2003 study from Quebec. The author suggested manipulating daylight savings time with this in mind.

Clinical Trials

The relationship between light and depression is the subject of numerous clinical trials now underway.

Related searches

melatonin seasonal depression

light therapy SAD

photoperiod depression

Seasonal Pattern Assessment Questionnaire

Seasonal Health Questionnaire SAD

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A new way to feel everyone watching

August 19, 2008

Has reality TV spawned a new form of paranoid delusion?

A psychiatrist at New York’s Bellevue Hospital Center has been collecting cases of patients who have the delusion that their lives are a reality TV show. Because several of them identify with Jim Carrey’s character in the movie “The Truman Show”, a proposed new syndrome is named after that film.

(Looking for news from a wider range of sources than the selective SearchMedica list? Choose the option “The entire Web” just below the search box.)

The Bellevue psychiatrist in question, Joel Gold, was a coauthor of the study that documented PTSD among New York residents after the 9/ll attack.

In the high-surveillance, anti-terror era that came after, it’s no delusion that we’re being watched. But for decades psychiatrists have been reporting delusions that involve television.

Related searches

thought broadcasting

delusions virtual reality

Evidence-based Articles

What defines a new delusional syndrome? Authors from Massachusetts suggest that different delusions are more alike than unlike, in this 1999 review.

Free full text is available by clicking on “View Medline abstract on pubmed.gov” and finding the publisher’s link at the upper right of the next screen.

No Comments » | Psychiatry, Schizophrenia, Uncategorized | Tagged: , , , , | Permalink
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New “epidemic”: Accidental suicides

August 12, 2008

Meds + booze + street drugs @ home = sharp rise in accidental deaths

Fatal medical errors skyrocketed in the two decades after 1983—but not in hospitals. The increase overwhelmingly involved people who died at home after mixing medicines, street drugs, and alcohol. Death rates in this category rose 30-fold between 1983 and 2003.

Oddly, accidental deaths from any of those three substances in isolation did not increase markedly during the same period.

Don’t just blame substance abusers: At-home deaths involving medications but not street drugs or alcohol increased nearly six-fold during those two decades.

The most common victims were men between the ages of 40 and 59.

The study of death certificates is newly published in the Archives of Internal Medicine.

The increase in these deaths has been accelerating. The article urges medical professionals to address the problem by:

* assessing how well patients can manage their own medicines
* taking pains to educate them about the risks of their medications and
* keeping track of their progress

Related searches

screening alcohol use

self-report alcohol drug

Research/Reviews

What’s the best way to talk with patients about their new prescriptions? We found interesting insights with the query communication risks.

Practical Article/News

In a recent review in Psychiatric Times, a Yale University psychiatrist warns about an emerging problem among aging baby boomers: substance abuse.

No Comments » | Family Medicine, Internal Medicine, Medical ethics, Psychiatry, Uncategorized | Tagged: , , , , , | Permalink
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