Wednesday, August 24, 2016

New Model Found Useful for Predicting Alcohol Use in Youth


A study published in AJP Advance shows that combining data from demographic interviews with data from neuropsychological and neuroimaging tests may be useful for predicting adolescents who may be at risk of initiating alcohol use by age 18.

“Previous findings have suggested that a mix of social, psychological, and biological mechanisms contribute to alcohol use during adolescence,” wrote the study authors, a team a behavioral scientists and psychiatric researchers. Neuropsychological and neuroimaging data may provide quantification of underlying behavioral mechanisms of risk for substance use and better help identify at-risk adolescent before they initiate such use.

The study involved 137 substance-naïve adolescents aged 12 to 14. Participants' demographic information was obtained at baseline through interview. Neuropsychological testing at baseline was administered to evaluate the neurocognitive function; structural magnetic resonance imaging (sMRI) and functional magnetic resonance imaging (fMRI) were used to assess brain structure. Information on participants' substance use, assessed by the Customary Drinking and Drug Use Record, was updated every six months by telephone interview until the end of the study. 

The results showed that by age 18, 70 adolescents (51%) initiated moderate to heavy alcohol use, and 67 remained nonusers. The combined data model was found to be 74% accurate in predicting such outcomes. In comparison, the demographic model had an accuracy rate of 62%, and the demographic and neuropsychological model, 69%.

In addition, the study identified 34 predictors that contributed to alcohol use by age 18, including being male, higher socioeconomic status, early dating, more externalizing behaviors, worse executive functioning, and thinner cortices, and less brain activation in diffusely distributed regions of the brain. 

"The results provide evidence that multimodal neuroimaging data, as well as neuropsychological testing, can be used to generate predictions of future behaviors with [possibly] significantly better accuracy than demographic information alone," the authors wrote. "Understanding neurocognitive factors that predate substance use initiation is crucial to specifying the consequences of substance use on brain development, as well as identifying at-risk youths and potential targets of preventive efforts." 

(iStock.com/JTobiasonPhoto)

Tuesday, August 23, 2016

FDA Approves Devices for Assessing Cognitive Function After Brain Injury


Two devices for assessing cognitive function immediately following a suspected brain injury or concussion were approved for marketing by the Food and Drug Administration (FDA) yesterday.

The Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) and ImPACT Pediatric are the first medical devices permitted for marketing that are intended to assess cognitive function following a possible concussion, according to the FDA. They are intended as part of the medical evaluation that doctors perform to assess signs and symptoms of a head injury.

“These devices provide a useful new tool to aid in the evaluation of patients experiencing possible signs of a concussion, but clinicians should not rely on these tests alone to rule out a concussion or determine whether an injured player should return to a game,” said Carlos Peña, Ph.D., M.S., director of the Division of Neurological and Physical Medicine Devices at the FDA’s Center for Devices and Radiological Health, in a statement announcing the approval.

ImPACT software runs on a desktop or laptop and is intended for use with those aged 12 to 59, while the ImPACT Pediatric runs on an iPad and is designed for children aged 5 to 11. 

ImPACT and ImPACT Pediatric are not intended to diagnose concussions or determine appropriate treatments. Instead, they are meant to test cognitive skills such as word memory, reaction time, and word recognition, all of which could be affected by a head injury. The results are compared with an age-matched control database or to a patient’s pre-injury baseline scores if available.

Only licensed health care professionals should perform the test analysis and interpret the results.

The FDA reviewed ImPACT through its de novo classification process, a regulatory pathway for novel, low- to-moderate-risk medical devices that are first of a kind and for which there are special and general controls to provide a reasonable assurance of safety and effectiveness of the devices. The assessment tools are manufactured by ImPACT Applications in Pittsburgh, Pennsylvania.

For related information, see the Psychiatric News article "Computer-Based Tool Can Offer Rapid Screening After TBI."

(Image: stockdevil/istock.com)

Monday, August 22, 2016

New Scoring System May Improve Reliability of PMDD Diagnosis


Premenstrual dysphoric disorder (PMDD)—which was added to the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5)—is a debilitating condition characterized by the emergence of mood and emotional symptoms in the luteal phase of the menstrual cycle.

This condition is difficult to diagnose, however, because doing so prospectively requires the evaluation of daily symptom ratings and their fluctuations over a two-month period. As such, many clinicians make decisions through a retrospective analysis of a patient’s symptoms, which is known to be prone to false positives, according to the authors.

A study published in AJP in Advance has proposed a new approach termed the Carolina Premenstrual Assessment Scoring System (C-PASS). Through this computerized procedure, clinicians can enter patient-provided ratings on a spreadsheet that determines a PMDD diagnosis based on a standardized thresholds. 

The study authors compared the C-PASS diagnoses of 200 women who had submitted their symptom ratings each week with those of an expert clinician who also reviewed prospectively and found a 94.5% agreement between the two (11 disagreements).

“The current C-PASS materials may be immediately useful clinically,” the study authors concluded. “However, additional development is needed to digitize data collection and streamline the diagnostic process for clinical application.”

(istock/KatarzynaBialasiewicz)

Friday, August 19, 2016

Probiotics Alone May Be Unlikely to Reduce Risk of Depression, Report Finds


Past reports suggest the consumption of foods containing probiotics, such as yogurt, may lead to health benefits, including lower fasting glucose and blood pressure levels. Do probiotics also lower the risk of depression?

According to a large cross-sectional study published today in the Journal of Neuropsychiatry and Clinical Neurosciences, the answer appears to be no. 

Researchers from the Department of Epidemiology at Janssen Research and Development in Titusville, New Jersey, assessed 18,019 adults who participated in the National Health and Nutrition Examination Survey (NHANES). As part of this survey, participants were asked to estimate the types and amounts of foods and beverages consumed during the 24-hour period prior to the interview. Depression was measured with the Patient Health Questionnaire (PHQ-9). (Participants were classified as having moderate or more severe depressive symptoms if PHQ-9 scores were 10 or greater and a score of 5 or greater was used to classify subjects with mild to more severe depressive symptoms.)

About 14% of the participants reported consuming probiotics, primarily through their diet. When making an unadjusted comparison, the probiotic users did have about half the odds of depression as non-users (odds ratio of 0.58); however, this did not factor in that people in the probiotic group were more likely to be white, older, women, healthier, and to have higher family income.

When the analysis was adjusted, the association between probiotic exposure and depression disappeared, irrespective of how depression was defined. Excluding the small subset of people who took probiotics via supplements also did not affect the results.

“These findings suggest that it is not the probiotic exposure itself, but the attributes of subjects who consume probiotics, which lessen the odds of depression,” the authors wrote. “Although these data can provide insight, information on usual dietary practices collected over time would be expected to provide a stronger indication of associations between dietary factors and health outcomes.”

For related information, see the Psychiatric News article “Food May Be a Tool to Consider When Helping Psychiatric Patients,” by Drew Ramsey, M.D.

(Image: iStock/gzorgz)

Thursday, August 18, 2016

Antipsychotic Use Early in Pregnancy Does Not Appear to Increase Risk of Birth Defects


With the possible exception of risperidone, taking antipsychotics early in pregnancy does not appear to significantly increase the risk of newborns having birth defects, a study published yesterday in JAMA Psychiatry reports. According to the study authors, more research is needed to understand the small increase in risk for malformations associated with risperidone.

To examine the risk for congenital defects associated with first-trimester exposure to different antipsychotics, Krista Huybrechts, M.S., Ph.D., of Brigham and Women’s Hospital and Harvard Medical School, Boston, and colleagues analyzed a nationwide sample of over 1.3 million pregnant women enrolled in Medicaid. Exposure to antipsychotics was defined as filling at least one prescription during the first 90 days of pregnancy, and congenital malformations overall and cardiac malformations were assessed during the first 90 days after delivery.

Among the 1,341,715 pregnancies included in the study cohort, 9,258 women (0.69%) filled a prescription for an atypical antipsychotic during the first trimester, and 733 women (0.05%) filled a prescription for a typical antipsychotic. The most frequently used atypical antipsychotic was quetiapine, followed by aripiprazole, risperidone, olanzapine, and ziprasidone.

The authors found that overall, 32.7 per 1,000 infants not exposed to antipsychotics were diagnosed with congenital malformations compared with 44.5 per 1,000 infants exposed to atypical antipsychotics and 38.2 per 1,000 infants exposed to typical antipsychotics. 

While unadjusted analyses suggested an increased risk of birth defects with atypical antipsychotics (relative risk [RR], 1.36) but not for typical antipsychotics (RR, 1.17), after controlling for potential confounding by mental and physical comorbid conditions and their associated behaviors, these relative risks fell to 1.05 and 0.90 for atypical antipsychotic and typical antipsychotic exposure, respectively. Additional analysis revealed that women taking risperidone were 26% more likely than women not taking antipsychotics to give birth to an infant with a birth defect.

“The small increase in absolute risk and RR for malformations observed with risperidone should be interpreted with caution because no apparent biological mechanism can readily explain this outcome, and the possibility of a chance finding cannot be ruled out,” the authors wrote. “This finding should therefore be interpreted as a potential safety signal that will require follow-up in other studies.

Reflecting on the findings in a related editorial, Katherine Wisner, M.D., M.S., and colleagues wrote, “The sophisticated pharmacoepidemiologic methodology comprehensively tackles the major challenge in observational studies, that is, confounding by underlying disease factors that are (like the APs [antipsychotics]) potentially associated with pregnancy outcomes. The task is to separate the effect of two exposures (APs and psychiatric disease) on the reproductive outcomes. The finding that “associations between AP exposure and birth defects were attenuated after adjustment for confounding ... implies that these variables, rather than AP exposure, account for much of the effect on congenital malformations.”

For related information on weighing the risks and benefits of medications when treating pregnant women, see the Psychiatric News article “Yes or No: Prescribing Antidepressants to Pregnant Patients” by Jennifer L. Payne, M.D.

(Image: iStock/nattrass)

Wednesday, August 17, 2016

Report Finds YouTube Presents ‘Distorted Picture’ of Schizophrenia


Although many people may turn to YouTube for information on a variety of health conditions, few studies have investigated the accuracy or quality of the information on mental illness presented in these videos. A study published this week in Psychiatric Service in Advance has concluded that schizophrenia presentations on the global video-sharing site “offer a distorted picture of the condition.”

For the study, a team of researchers from the United Kingdom performed a search for all YouTube videos purporting to show footage of individuals exhibiting the signs and symptoms of acute schizophrenia. Eligible videos were independently rated by two consultant psychiatrists on two separate occasions for probable psychiatric diagnosis and psychopathological symptoms; the raters were also asked to answer the yes-or-no question “Considering the quality and content of this video, would you consider using it in a medical student teaching session as an illustration of the signs and symptoms of acute psychosis in schizophrenia?” Videos receiving a “yes” response by both independent raters were considered to have good educational utility.

Of the 4,200 videos assessed, 35 videos met the authors’ eligibility and adequacy criteria. Of these 35 videos, only 12 were considered to present accurate depictions of acute schizophrenia. Compared with cases with a diagnosis other than schizophrenia, schizophrenia cases had a significantly higher prevalence of persecutory delusions (83% versus 15%), inappropriate affect (75% versus 8%), and negative symptoms (83% versus 15%). Of all adequate cases, 16 (46%) were deemed by both raters to have good educational utility.

“Our main findings were that eligible videos were largely inaccurate, containing psychopathological features not specific to schizophrenia,” the researchers wrote. “These findings are important for psychiatrists, given that the Internet has a vast amount of medical information that is easily accessible to medical students.”

While the authors noted that the study did not investigate how YouTube videos may affect understanding of schizophrenia by students, they emphasized “Mental health professionals and medical schools should be aware of this source of inaccurate information when advising students and patients about sources of health information.”

(iStock/ozgurdonmaz)

Tuesday, August 16, 2016

Early Improvement in Work Productivity May Predict Treatment Success in Depression


Patients with depression who report robust improvement in work productivity in the first few weeks of treatment may be most likely to remain in remission several months later, according to a report in AJP in Advance. The findings highlight the potential value of including work productivity assessments as part of routine clinical practice when evaluating the effectiveness of antidepressant treatment.

Researchers from the departments of psychiatry and clinical sciences at the University of Texas Southwestern Medical Center, Dallas, and the National University of Singapore analyzed remission data from the Combining Medications to Enhance Depression Outcomes trial. This multisite, single-blind, randomized, controlled trial of outpatients with chronic and/or recurrent nonpsychotic depression compared the effectiveness of antidepressant monotherapy (escitalopram plus placebo) with combination therapies (buproprion plus escitalopram or venlafaxine plus mirtazapine). As part of the original trial, the researchers measured work productivity at baseline and at each study visit throughout the trial.

Analysis of these self-reports revealed three distinct trajectories of work productivity during the first six weeks of treatment: robust early improvement (24% of participants), minimal change (49% of participants), and high-impairment slight reduction (27% of participants). (Work productivity outcomes were similar for SSRI monotherapy and the buproprion and venlafaxine combinations, controlling for baseline severity; all work productivity outcomes significantly improved after 12 weeks of treatment.)

Compared with other patients, patients who had “robust early improvement” had three to five times higher remission rates at three months and two to five times higher remission rates at seven months, even after the researchers controlled for select baseline variables and remission status at week six.

“We have ... demonstrated that early changes in work productivity are significant predictors of long-term clinical course,” the researchers wrote. “These findings highlight the multidimensional improvement with antidepressant treatment and argue for inclusion of work productivity assessments in routine clinical practice.”

For related information, see the Psychiatric News article "Mental Health in Workplace Integral to Business Success, CEOs Say.”


(Image: iStock/Yuri_Arcurs)

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