Elation, Irritability Signs of Heightened Bipolar Disorder Risk

Elation and irritability may seem like relatively harmless swings of behavior, but a new study finds that in some individuals these may signal a high risk for development of bipolar disorder. In a report published online July 27 in the Journal of Affective Disorders, researchers at the University at Buffalo said that "elation and/or irritability, if accompanied by trouble concentrating, racing thoughts, or hyperactivity, may represent a prodrome of formal bipolar disorder that indicate close follow-up and cautious use of antidepressants."

The study population was 40,512 noninstitutionalized adults who took part in the National Epidemiologic Survey on Alcohol and Related Conditions and who in 2001-2002 (Wave 1) didn't meet criteria for lifetime mania or hypomania, but indicated the presence of elation and/or irritability. (The survey is sponsored by the National Institute on Alcohol Abuse and Alcoholism.) The researchers studied the same cohort in 2004-2005 and found that "The likelihood of developing a clear episode of mania or hypomania by Wave 2 was significantly increased in subjects with elation or only irritability at Wave 1, compared with subjects who did not endorse either. Endorsement of both symptoms at Wave 1 increased the likelihood of a new epsisode of mania or hypomania 4.6 times, which was significantly higher than for those with only elation or irritability."

Read more about recent research on bipolar disorder in Psychiatric News here and here.

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Writing About a Trauma Can Weaken Its Effects

Writing about a trauma one experienced can counter posttraumatic stress disorder (PTSD), at least in individuals experiencing PTSD provoked by a motor-vehicle accident, a study reported July 20 in Behavior Research and Therapy suggests. The study assessed 46 subjects with a diagnosis of accident-related PTSD, randomly assigned to either the writing intervention or a wait list. Significantly fewer writing subjects met diagnostic criteria for PTSD at evaluations conducted 18 weeks after baseline assessments, when compared with wait-list subjects. The study was headed by Denise Sloan, Ph.D., of the National Center for PTSD in Boston.

That study adds to other noteworthy PTSD studies that have recently been reported. In one such study, researchers found that giving trauma survivors cognitive therapy shortly after the trauma or waiting a few months to begin the therapy yielded similar results. In another study, this one conducted with survivors of a devastating earthquake, genes that control the production of serotonin were associated with PTSD symptoms, pointing to a potential biomarker for PTSD. See Psychiatric News here and here.

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Food Pictures Switch on Brain's Reward Center and Appetite

When 25 healthy young women were shown pictures of food, the extent to which their brains' reward-addiction center—the nucleus accumbens—responded predicted how much the women subsequently ate. The study was headed by Natalia Lawrence, Ph.D., of the University of Exeter in England. The results appeared July 6 in Neuroimage.

Other recent research in the area of eating disorders and their etiology has pointed to the possibility that some cases of obesity are due to a food addiction and may be linked to genetics. For more information on this theory, see Psychiatric News.

In fact, binge eating disorder (BED), which has been proposed as a diagnosis to be added to the next edition of APA's Diagnostic and Statistical Manual of Mental Disorders (DSM-5), might be considered a food addiction because a major criterion for it is loss of control over eating behavior. Yet how the mechanism of loss of control in BED compares with the loss of control in other addictions remains to be determined. To read more about this topic, see Psychiatric News.

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Trauma, PTSD Common in Patients With Severe Mental Disorders

Experiencing traumatic experiences and developing posttraumatic stress disorder (PTSD) are more frequent in patients with serious mental illness than in the general population, according to a report in the Journal of Nervous and Mental Disease. The study included 102 patients with schizophrenia, bipolar disorder, or schizoaffective disorder, diagnosed using DSM-IV criteria. Epidemiological and clinical data were collected using the Brief Psychiatric Rating Scale and Traumatic Life Events and Distressing Event questionnaires. Researchers found a high number of traumatic experiences in these psychiatric patients, and 15.1 percent of the patients met all PTSD diagnosis criteria. Among patients with a serious mental illness and PTSD, 64.3 percent had made some attempt at suicide at some point in life, compared with 37.4 percent of patients without PTSD. The study, “Posttraumatic Stress Disorder Comorbidity and Clinical Implications in Patients With Severe Mental Illness,” is online here. For much more information about PTSD see Psychiatric News, here and here. (Image: Andrii Kondiuk/shutterstock.com)

Ecstacy Use Appears to Impair Memory

The recreational drug 3,4-methylinedioxymethamphetamine (MDMA, popularly known as “ecstacy”) appears to impair memory, according to a study in the journal Addiction. Of 149 MDMA-naive subjects examined at the initial assessment of the study, 109 subjects participated again after 1 year. During this period, 43 subjects did not use any other illicit substance apart from cannabis; 23 subjects used more than 10 MDMA pills. These groups were compared for performance on a neuropsychological test battery that included measures of learning, memory, and frontal executive functions. In addition, a comprehensive number of possibly relevant confounders including age, general intelligence, cannabis use, alcohol use, cigarette use, medical treatment, participation in sports, nutrition, sleep patterns, and subjective well-being was assessed. Change scores were compared for the new users and the MDMA-naïve subjects between the initial examination and follow-up. Groups did not differ in any of the potential confounders. However, significant effects of immediate and delayed recall in learning tasks were observed between MDMA users and controls, suggesting serotonergic dysfunction in hippocampal regions as a consequence of MDMA use. The study, “A prospective study of learning, memory, and executive function in new MDMA users,” is online here. For more information about effects on mental health of ecstacy, see Psychiatric News here. (Image: Craig Wacter/shutterstock.com)

Schizophrenia, Bipolar Disorder Linked With Cancer Risk

Individuals with schizophrenia or bipolar disorder appear to be at an elevated risk of several kinds of cancer, including lung, breast, and colorectal cancer. This startling finding came from a prospective study of more than 3,300 adult Maryland Medicaid recipients with serious mental illness who were followed from 1994 through 2004; study results are published in the July Psychiatric Services. Researchers at Johns Hopkins University and the University of Maryland found that total cancer incidence in the study population was 2.6 times higher than in the general U.S. population. The highest risk was for lung cancer. No differences in risk were found between whites and African Americans in the study cohort, which differs from studies of the general U.S. population, in which African Americans are at higher risk than whites for several types of cancer. The researchers suggest that "High rates of smoking in the population with serious mental illness likely contribute to lung cancer incidence, and research suggests a possible but inconclusive elevated risk of breast cancer due to low rates of childbearing and increased prolactin levels caused by use of particular psychotropic medications. The risk factors contributing to high risk of colon cancer are less understood but may be related to smoking, a sedentary lifestyle, or a diet high in fat and low in fruits and vegetables." Read the complete report of the study in Psychiatric Services. To read interviews with psychiatrists who specialize in treating cancer patients, see Psychiatric News. (image: Lightspring/Shutterstock.com)

NIDA Backs Research on Vaccine Against Heroin, HIV

The National Institute on Drug Abuse (NIDA) has issued a $5 million grant to Gary Matyas, Ph.D., to support his research into a new vaccine that could treat heroin addiction as well as prevent HIV infection in those receiving the vaccine. Matyas, of the Walter Reed Army Institute of Research (WRAIR) in Silver Spring, Md., is the 2012 recipient of the NIDA Avant-Garde Award for Medications Development and will receive $1 million a year for five years. "This is precisely the type of ground-breaking research NIDA's Avant-Garde program was designed to support," said NIDA Director Nora Volkow, M.D. "The implications for public health are enormous."  NIDA and WRAIR began a research collaboration on development of the joint vaccine two years ago. At this point, the heroin component of the combination vaccine has been created and is ready for advanced preclinical testing. Matyas noted that "The possibility of creating a combination heroin-HIV vaccine provides an important opportunity to address both a unique treatment for heroin abuse as well as continuing the quest to develop an effective preventive HIV vaccine." Heroin is not the only illicit drug that vaccine researchers are targeting. Progress has also been made in developing a vaccine against cocaine abuse. Read more about cocaine-vaccine research in Psychiatric News. (image: smit/Shutterstock.com)

Depression Triples Between Ages 12 to 15 in Teenage Girls

The percentage of girls who experienced a major depressive episode in the preceding year tripled between the ages of 12 and 15—from 5.1 percent to 15.2 percent, respectively, according to a new report by the Substance Abuse and Mental Health Services Administration (SAMHSA).

The report also shows that an annual average of 1.4 million adolescent girls age 12 to 17 experienced a major depressive episode in the past year and that adolescent girls aged 12 to 17 are three times more likely to have experienced a major depressive episode in the past year than their male counterparts (12 percent versus 4.5 percent).

Another major finding was that older adolescent girls experiencing major depressive episodes were more likely to receive treatment than younger ones – about two-fifths of girls aged 15 to 17 received treatment as opposed to only one-third of the girls aged 12 to 14.

The report, “Data Spotlight: Depression Triples between the Ages of 12 and 15 Among Adolescent Girls,” is based on combined data from the 2008 to 2010 SAMHSA National Survey on Drug Use and Health (NSDUH). The full report is available here. For more information about adolescent mental health, see Psychiatric News here.

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Seniors With Vascular Risk May Respond Less Well to Antidepressants

If older depressed adults are treated with an antidepressant, the medication is less likely to benefit their workiing memory and executive function if they score high on vascular risk factors.

So reported Yvette Sheline, M.D., a professor of psychiatry at Washington University, and colleagues in the August American Journal of Geriatric Psychiatry.

Having vascular disease or severe vascular risk factors may also explain why older individuals develop depression in the first place. To learn more about this subject, visit Psychiatric News.

More information about late-life depression is available in the American Psychiatric Publishing book Essentials of Geriatric Psychiatry, Second Edition.

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Hollywood Still Relies on Stereotypes of Schizophrenia

Movies and TV shows can be a major source of information for the public about mental illness, but when it comes to protraying schizophrenia, they often rely on inaccurate and even harmful stereotypes that contribute to stigma. Movie characters such as the "homicidal maniac" are examples of one common stereotype.

A new study published in Psychiatric Services evaluated 72 movies produced between 1990 and 2010, and identified 42 characters who met DSM-IV-TR criteria for a schizophrenia diagnosis or displayed unusual behavior supposedly due to schizophrenia. Researchers found that these movies supported, but also refuted stereotypes and misconceptions about the illness. The majority of the characters, however, were violent, with 31 percent showing homicidal behavior and 24 percent committing suicide. “This study appears to be the first to provide an empirically based content analysis of the portrayal of schizophrenia in contemporary movies,” said the researchers, and the results "will help clarify the prevalence and nature of stereotypes and misinformation found in this widely patronized entertainment medium.”

For more information and the results of the study, click here.

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Hopes Fade for Alzheimer's Treatment Breakthrough

Results from a phase 3 clinical trial of a once-promising new medication to treat Alzheimer's disease (AD) showed that the drug failed to improve either cognition or daily functioning. Pfizer is developing the drug along with the Janssen Alzheimer Immunotherapy division of Johnson & Johnson. The clinical trial tested bapineuzumab in 1,100 people with mild to moderate AD, all of whom have the ApoE4 gene, which has been shown to increase the risk of developing the disease. In a July 23 press release, Pfizer said that while the company was disappointed in the results, further studies of bapineuzumab are planned, and data from a clinical trial in about 1,300 AD patients who do not carry the ApoE4 gene will be available soon. The drug is an antibody that binds to beta-amyloid in the brain—that protein is widely believed to be a cause of AD. The companies expected bapineuzumab to destroy beta-amyloid deposits. Commenting on the study results, Samuel Gandy, M.D., director of the Center for Cognitive Health at Mount Sinai School of Medicine, told the New York Times that since the brain plaques likely develop years or even decades before symptoms appear, "All these symptomatic trials are 25 years too late. I'm not terribly disappointed and I'm not discouraged" by the bapineuzumab data.

Read much more about bapineuzumab and the search for an Alzheimer's treatment in Psychiatric News here and here.

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A Parasite Is Linked With Suicide Risk

In a large prospective study of some 46,000 women in which levels of antibodies to the parasite Toxoplasma gondii were measured at childbirth,  researchers linked infection with the parasite to suicide during the subsequent decade or so after they gave birth. The lead scientist was Marianne Pedersen, M.Sc., of Aarhus University in Denmark. The results were reported online this month in the Archives of General Psychiatry.

In a previous prospective study conducted with the same large cohort of women, and in which levels of antibodies to T. gondii were also measured at childbirth, Pedersen and her team linked infection with T. gondii to the subsequent development of schizophrenia. For more information about this study, see Psychiatric News.

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Could Skin Cells Hold Answers to Alzheimer's?

Skin cells taken from patients with Alzheimer's disease can be reprogrammed into brain cells with the help of a particular stem cell research technique, Andrew Sproul, Ph.D., and colleagues at the New York Stem Cell Foundation reported at the Alzheimer's Association International Conference in Vancouver July 16. The reprogrammed cells can be used to explore the biology of Alzheimer's and for early-stage testing of potential Alzheimer's treatments, the scientists believe. One advantage of the technology, Sproul  said, is that it can generate a nearly infinite supply of brain cells.

Other Alzheimer's advances were reported recently at a National Institutes of Health-sponsored Alzheimer's summit—notably, that results from three trials of experimental Alzheimer's drugs will be announced later this year. For more information about the search for weapons to fight Alzheimer's, see Psychiatric News.

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FDA Bans BPA Use in Baby Bottles, Sippy Cups

The U.S. Food and Drug Administration (FDA) has banned the use of the industrial chemical bisphenol A (BPA) from use in baby bottles and sippy cups. Industry experts say that manufacturers have already stopped using the chemical in these items, and the FDA's decision is a response to a request by the American Chemistry Council that allowed BPA use in those items be phased out, in part to boost consumer confidence. 

A New York Times article about the decision explains that BPA can leach into food, and cites a study of more than 2,000 people that found more than 90 percent had BPA in their urine. Traces have also been found in breast milk, the blood of pregnant women, and umbilical-cord blood. In 2010, the FDA said that it had concerns about the potential effects of BPA on the brain, behavior, and prostate gland of fetuses, infants, and children, but declined to ban use of the chemical.

Read more about the effects of BPA on neurobehavioral measures in infants in Psychiatric News, here. 

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Colorado Gunman Kills 12 in Crowded Theater

A gunman wearing a bullet-proof vest opened fire in a crowded movie theater in Aurora, Colo., during a midnight showing of "The Dark Knight Rises" last night. At least 12 people were killed and as many as 50 others are being treated for injuries. The suspect is a 24-year-old male who entered the theater through an emergency door that had been propped open. He was reportedly wearing riot gear and threw a tear-gas canister into the theater before opening fire with an automatic weapon. He was apprehended in the parking lot of the shopping center where the theater is located and is in police custody.

Aurora, a Denver suburb, is about 13 miles from Littleton, Colo., site of the April 1999 Columbine High School massacre in which teenage students Dylan Klebold and Eric Harris killed 13 people and wounded 23 others before killing themselves. 

Read about how Virginia psychiatrists responded to the more recent mass shooting at Virginia Tech University in 2007, in Psychiatric News, here. 

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Cognitive Remediation Improves Cognition in Schizophrenia

Cognitive remediation produced robust improvements in neurocognition in patients with schizophrenia, according to a report in the July American Journal of Psychiatry. Outpatients with schizophrenia (N=107) were randomly assigned to receive cognitive remediation, functional adaptation skills training, or combined treatment, with cognitive remediation preceding functional skills training. Clinical symptoms, neurocognition, social competence, functional competence, and case-manager-rated real-world behavior were assessed at baseline, at end of treatment, and at a 12-week durability assessment.

Neurocognition improved after cognitive remediation but not after functional skills training. Social competence improved both with functional skills training and with combined treatment but not with cognitive remediation alone. Improvements in functional competence were greater and more durable with combined treatment.

Read the study here. For more information about cognitive remediation and “brain training” in schizozphrenia see Psychiatric News here.

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FDA Approves Another Weight Loss Drug

The U.S. Food and Drug Administration (FDA) has approved Qsymia (phentermine and topiramate extended-release) as an addition to a reduced-calorie diet and exercise for chronic weight management. The drug is approved for use in adults with a body mass index (BMI) of 30 or greater (obese) or adults with a BMI of 27 or greater (overweight) who have at least one weight-related condition such as high blood pressure, type 2 diabetes, or high cholesterol. Qsymia must not be used during pregnancy because of increased risk of oral clefts (cleft lip with or without cleft palate) during the first trimester due to the topiramate component of the drug. Qsymia is also not for use in patients with glaucoma or hyperthyroidism because it can increase heart rate. The approval comes on the heels of the FDA's approval of Belviq (locaserin hydrochloride) last month as a weight-management aid. Qsymia, known as Qnexa during its development, is marketed by Vivus Inc.

Read more about Qsymia's journey to approval in Psychiatric News, here, here, and here.

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Middle-Schoolers Uncertain About Mental Illness Questions

Middle-school students are hazy about the causes and treatment of mental illnesses and have mixed attitudes toward people with mental illness. In a survey of 193 students in four states, 65% expressed uncertainty about whether mental disorders are caused by biological factors, and only 37% believed that medications are helpful in treating mental illness—a surprise to Otto Wahl, Ph.D., a professor of psychology at the University of Hartford, and colleagues, writing in the July Psychiatric Services. However, 72% of the students said that people with mental illness are treated unfairly.

But feelings seemed to vary inversely with distance. About 78% of students said they would talk to a person with mental illness, and 56% wouldn’t mind having one as a classmate, but just 14% would go on a date with a person who has a mental illness. Lack of knowledge about mental illness may make it hard for young people to recognize symptoms in themselves or their peers, and negative group attitudes may hinder willingness to seek care, suggested the authors.

To read more about this study, see Psychiatric News here. For an abstract of the study in Psychiatric Services, click here.

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Sleep Problems Appear to Raise Alzheimer's Risk

Poor sleep patterns have been linked with several physical and mental health problems, but new data may motivate those who have difficulty getting to or staying asleep to do something about the problem. Studies reported at the Alzheimer's Association International Conference in Vancouver have found that chronic sleep difficulties are linked to an increased risk of Alzheimer's disease. The largest of the studies involved more than 15,000 participants aged 70 or older in the Nurses' Health Survey. They had an initial cognitive assessment between 1995 and 2000 and were followed-up every other year for six years. Their average hours of sleep were determined in 1986 when the women were between ages 40 to 65 and again in 2000. Researchers found that too little or too much sleep was cognitively equivalent to aging by two years. After assessing the presence of beta-amyloid brain changes in a sample of the participants, they also found that "extreme sleep durations and changes in sleep duration over time may contribute to cognitive decline and early Alzheimer's changes in older adults."

The researchers pointed out that "The public health implications of these findings could be substantial, as they might lead to the eventual identification of sleep- and circadian-based strategies for reducing risk of cognitive impairment and Alzheimer's."

Read more about recent findings in Alzheimer's research in Psychiatric News here and here. For a comprehensive look at assessment and treatment of Alzheimer's see Clinical Manual of Alzheimer and Other Dementias from American Psychiatric Publishing.

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Mental Health Workforce Can't Meet Needs of Elderly Americans

Nearly 1 in 5 older Americans have a mental health or substance abuse disorder, but the mental health care workforce falls far short of the number needed to treat these individuals, according to a new report from the Institute of Medicine (IOM). And with the number of adults aged 65 or older poised to soar over the next two decades, the shortage of geriatric mental health professionals will approach crisis levels. The IOM pointed out that for decades policymakers have warned that trained geriatric specialists are especially needed to provide mental health care and that along with inadequate numbers, there is also "insufficient workforce diversity and lack of basic competence and core knowledge in key areas."

APA issued a statement saying it "strongly supports" the IOM report, which is titled "The Mental Health and Substance Use Workforce for Older Adults: In Whose Hands?" and includes recommendations to help ameliorate the building crisis. Among those is that professional organizations need to set standards for training in this area. APA President and geriatric psychiatrist Dilip Jeste, M.D., responded to the report, saying, "We hope that necessary changes are implemented soon to provide badly needed care to one of the most disenfranchised sectors of our society."

Jeste discussed mental health issues for older individuals in a recent issue of Psychiatric News. Read much more on the subject in American Psychiatric Publishing's Essentials of Geriatric Psychiatry, Second Edition.

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Traumatic Image Exposure May Help Ward Off PTSD

An experimental intervention initiated in the emergency department within hours after a person has been traumatized can reduce PTSD symptoms one and three months later. This finding was reported by Barbara Rothbaum, Ph.D., a professor of psychiatry at Emory University, and colleagues July 6 in Biological Psychiatry. Their study included 137 traumatized subjects, half of whom had been randomized to receive the experimental intervention and half of whom  received a control intervention (assessment only). The experimental intervention included imagined exposure to the trauma memory, processing of the traumatic memory material, and image-exposure homework.

This is one of several interesting PTSD findings that were reported recently. For example, two variations of genes that control the production of the neurotransmitter serotonin have been linked to PTSD symptoms. Another PTSD study found that Vietnam War veterans are still struggling with PTSD symptoms more than 30 years later. For more information about these studies, see Psychiatric News here and here.

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Spanking May Leave Long-lasting Psychological Scars

In a study based on a nationally representative sample of Americans, harsh physical punishment such as spanking or hitting during childhood was associated with an increased odds of having a lifetime diagnosis of mood disorders, anxiety disorders, alcohol and drug abuse/dependence, and several personality disorders. The results remained firm even after possibly confounding factors such as socioeconomic factors and more severe child maltreatment such as severe physical or sexual abuse were considered. The study was headed by Tracie Afifi, Ph.D., of the University of Manitoba in Canada. The results were published July 2 in Pediatrics.

One key finding from the study, which the researchers said was "surprising," was that parents with a higher educational or income level were more likely to spank, slap, or hit their children than were parents with a lower educational or income level.

In addition, other researchers who have studied the issue of spanking and other parental behaviors have found that depressed fathers are more likely to spank their children than are nondepressed fathers. For more information about this study see Psychiatric News .

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Phobia, Anxiety May Contribute to Premature Aging

Phobia and anxiety disorders may contribute to premature aging by shortening telomeres, according to a report in the online journal PloSOne. Telomeres are DNA-protein complexes that cap the ends of chromosomes. Each time a cell divides, the telomeres shorten a bit. If the telomeres become too short, a cell is unable to divide further and dies.

Researchers at Brigham and Women’s Hospital and Harvard University measured telomere lengths in blood samples from 5,243 women aged 42–69 who were part of a study on phobia and anxiety. They found that higher phobic anxiety was generally associated with lower telomere lengths. This association was similar after adjustment were made for confounders. Women with the most severe phobic anxiety had telomere lengths 0.09 standardized units below average. "The magnitude of this difference was comparable to that for women 6 years apart in age," the researchers said.

The report, titled “High Phobic Anxiety Is Related to Lower Leukocyte Telomere Length in Women,” can be read here. For more information about the relationship between telomeres and mental health, see Psychiatric News here.

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More Research Urged to Assess Antipsychotics’ Risk in Pregnancy

Intrauterine antipsychotic exposure may significantly affect neuromotor performance in 6-month-old infants, but it is unknown whether the deficits are transient or reflect early evidence of a persistent disruption in neuromotor function. Also unknown is whether the deficits reflect maternal mental illness, since abnormal neuromotor scores were also significantly associated with maternal psychiatric history and overall severity and chronicity of mental disorders.

Researchers at Emory University reported in the Archives of General Psychiatry the results of a 1999 through 2008 prospective controlled study of 309 mother-infant pairs. Examiners administered a standardized neuromotor examination that tests posture, tone, reflexes, and motor skills. Infants prenatally exposed to antipsychotics scored significantly lower than those with antidepressant or no psychotropic exposure. “Taken together, results from the study raise concerns about the potential impact of both prenatal exposure and maternal psychiatric illness,” wrote lead author Katrina Johnson, Ph.D., and colleagues. And they said more research is needed to untangle the effects of medication exposure, maternal mental illness, and other factors.

To read more about this study, see Psychiatric News, here.

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Concerns Raised About Tuberculosis Outbreak in Mentally Ill Patients

An outbreak of tuberculosis in Jacksonville, Fla., has killed 13 patients and infected an additional 99, making it the biggest outbreak in 20 years. Budget cuts and the ill-timed closing of AG Holley State Hospital, a facility specializing in tuberculosis care, have hindered control of the outbreak. Recently, the American Journal of Psychiatry published a study detailing the case of a mentally ill patient who moved from an assisted-living facility to multiple treatment centers because of his schizophrenia before being diagnosed with tuberculosis eight months later in 2008.

"Because persons with mental illness often exhibit low health-care-seeking behavior, which may derive from an inability to recognize their own health problems or a general distrust of the health care system,” said the authors, “they may be especially prone to delays in diagnosis....” Experts hypothesize that about 3,000 people have been in contact with a contagious person within the past two years.

“To our knowledge, this is the first report to demonstrate the vulnerability of persons with mental illness to TB outbreaks,” said the authors. Read more about the case study in the American Journal of Psychiatry here.

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Gene Mutation Appears to Protect Against Alzheimer's

A group of Scandinavian researchers has discovered a rare gene mutation in the amyloid beta precursor protein (APP) that protects against Alzheimer's disease and age-related cognitive decline. They presented their discovery in the online July 11 Nature, and experts are calling it the most significant advance in the field in decades. According to the New York Times, the discovery bodes well for drug companies working on anti-amyloid treatments targeting Alzheimer's disease.

The first clue to the mutation came about when researchers at the Icelandic company DeCode Genetics scanned the entire DNA of 1,795 Icelanders. About 1 in 100 had a mutation in the gene for a large protein that is sliced to form beta amyloid. Then the investigators studied people who had been given an Alzheimer’s diagnosis and a group of people aged 85 and older. Those with the mutation appeared to be protected from Alzheimer’s disease. 

Read more about the quest to find effective treatments for Alzheimer's disease in Psychiatric News, here.

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Should PTSD Be Renamed?

Where is the boundary between an injury and a disorder? That’s the question raised by U.S. Army  officials regarding an all-too-frequent outcome of military combat. Concerned that calling their response to wartime experience posttraumatic stress disorder (PTSD) would keep soldiers from proper care, Gen. Peter Chiarelli (Ret.) has suggested that the term be changed to posttraumatic stress injury. That would place a soldier’s reaction in the same category as a bullet wound or a broken leg, considered by troops less stigmatizing than a psychological injury, he said. Many psychiatrists argue against any such shift, believing that it is too imprecise and won't help with diagnosis or treatment.

Retired Canadian general Romeo Dallaire experienced PTSD while on peacekeeping duty in Rwanda. Now, thanks to his efforts, Canada’s armed forces use “operational stress injury” to describe a soldier’s experience, while leaving the clinical description of PTSD unchanged. “That established a framework in which individuals could define themselves in an honorable position, seek support, and end the stigma from both the chain of command and from their peers,” said Dallaire.

For more about this ongoing discussion in Psychiatric News, click here. For information on recent trends in the treatment of PTSD and other mental disorders in the VHA, click here.

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FDA Rejects Call for Special Training Before Prescribing Narcotic Painkillers

The Food and Drug Administration (FDA) announced its decision yesterday about the need for mandatory training by physicians before they would be allowed to prescribe opioid painkillers for their patients. Its conclusion was that specialized training would not be required as a precondition for prescribing this often-abused category of medication, but that the 20 or so companies that manufacture these medications would be "required to make education programs available to prescribers.... It is expected that the companies will meet this obligation by providing educational grants to continuing education providers, that will develop and deliver the training." The FDA said as well that drug companies "will be expected to achieve certain FDA-established goals for the percentage of prescribers of opioids who complete the training, as well as assess prescribers' understanding of important risk information over time." The companies will have to conduct "periodic assessments of the implementation of the [program] and the success of the program in meeting its goals" and are responsible for covering the cost of the programs.

Nearly 23 million prescriptions for opioid pain medications were written last year, according to the FDA, and these drugs are linked to widespread "overuse, abuse, misuse, and death, and the numbers continue to rise." Nearly 15,600 deaths were attributed to opioid painkillers in 2009. The first of the continuing education activities will be offered by March 1, 2013.

Read more about use and misuse of opioid pain medications in Psychiatric News here and here.

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Diabetes, Depression Combination Increases Dementia Risk

Individuals with diabetes who also have depression face a greater risk of developing dementia than do diabetes patients who do not have concurrent depression. That was the finding of a study that surveyed a racially and ethnically stratified random sample of patients with type-2 diabetes in a large managed care setting. In the study, cases of depression were identified among a sample of 19,239 diabetes registry members aged 30 to 75 enrolled in Kaiser Permanente Northern California. Patients with comorbid depression had a 100 percent increased risk of dementia during a period three to five years after onset of the study.

“Prior studies have shown that depression in patients with diabetes is a risk factor for macrovascular and microvascular complications,” lead author Wayne Katon, M.D., told Psychiatric News, “This new study adds to this prior work by showing comorbid depression is also a risk factor for development of dementia.” For coverage of the study see Psychiatric News here.

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Pesticides Linked With Troubling Sleep Disorder

Smoking, head injury, low education level, working in a farm, and pesticide exposure may be risk factors for REM sleep behavior disorder—an illness that makes people kick or punch during sleep, Ronald Postuma, M.D., and colleagues at McGill University reported June 27 in Neurology. Until now, not much was known about the risk factors for this rare disorder, except that it was more common in men and in older people.

The disorder can also be a precursor to Parkinson's disease. Intriguingly, one of the factors assessed in the new study, pesticide exposure, appears to be a risk factor for Parkinson's, in addition to its link with REM sleep behavior disorder. However, smoking seems to be a protective factor as far as Parkinson's disease is concerned, other researchers have found.

For more information about the psychiatric issues often found in Parkinson's patients, including sleep problems, see a report in Psychiatric News.

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Heat May Pose Serious Risk for Those With Mental Illness

In view of the brutal heat experienced by many Americans last week, a study reported in the June British Journal of Psychiatry was especially prescient. Using a representative sample of British patients with psychosis, dementia, or substance abuse, the researchers found a sharp increase in the risk of death among them during periods of hot weather. The increased risk was greater than that seen in general population samples using similar methodology.

Other interesting links have been made recently between climate or weather and mental health. Specifically, scientists have linked suicide rates not just with the early-summer time period and with barometric pressure, but with air pollutants such as particulate matter, sulfur dioxide, and ozone as well. Read about that pollution-related finding in Psychiatric News. In fact, with the arrival of global warming and its ability to trigger extreme weather events, eco-psychiatry may be an emerging field. For more information on the subject, see Psychiatric News.

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Republicans Vow to Repeal Health Care Reform Law

House Republicans are moving forward with plans for a new attempt to repeal President Obama's health care law, according to a report yesterday in Politico. The House Rules Committee announced that it will meet at 5 p.m. Monday to discuss the "Repeal of Obamacare Act"—the GOP's response to the Supreme Court ruling that upheld the law. Minutes after the court announced its decision last week, House Majority Leader Eric Cantor (R-Va.) vowed to hold a repeal vote the week of July 9. The Rules Committee meeting is a precursor to such a vote.

House Republicans have previously tried to repeal the law, but those efforts died—as this one likely will—in the Democratic-controlled Senate. For more information about congressional opposition to the health reform law, see Psychiatric News here. In addition, American Psychiatric Publishing has published “Healthcare Reform: A Primer for Psychiatrists,” which can be found online here.

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Judge Says Doctors Can't Be Barred From Discussing Guns

Florida physicians will again be able to ask their patients about the presence of guns in their homes now that a federal judge has ruled illegal a state law barring physicians from discussing the subject. Judge Marcia Cooke said the law violates the freedom-of-speech protections in the First Amendment of the U.S. Constitution. The Florida Psychiatric Society and other physician organizations challenged the law, which was introduced by gun advocates in the state legislature who claimed that asking patients about gun possession violated the Second Amendment protection of the right to bear arms. The law made such discussions a felony and passed by a wide margin in the Republican-controlled legislature.

Psychiatrists and others argued that asking patients about the presence of guns in their homes would help them evaluate whether patients might pose a danger to themselves or the community and that such discussions would go a long way toward preventing suicides. They maintained as well that the law illegally infringed on the doctor-patient relationship by interfering with their ability to provide the medical care their patients might require. Cooke said in her ruling that censoring what physicians could talk about during medical visits has had a "chilling" effect on medical care. "What is curious about this law," she said, "is that it aims to restrict a practitioner's ability to provide truthful, nonmisleading information to a patient, whether relevant or not at the time of the consult with the patient." The Florida Department of Health hasn't announced whether it will appeal the ruling.

To read more about this law and the fight to undo it, see Psychiatric News here and here.

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FDA Approves In-Home HIV Test

The Food and Drug Administration (FDA) has approved the first over-the-counter home use HIV test kit. The OraQuick In-Home HIV Test is a self-administered test to detect the presence of antibodies to human immunodeficiency virus type 1 (HIV-1) and type 2 (HIV-2). A version of the test for use by trained technicians in clinical settings was approved in 2004.

The OraQuick In-Home HIV Test is designed to allow individuals to collect an oral fluid sample by swabbing the upper and lower gums inside of their mouths, then placing that sample into a developer vial; test results appear in 20 to 40 minutes. A positive result does not mean that an individual is definitely infected with HIV, but that additional testing should be done in a medical setting to confirm the test result. Similarly, a negative test result does not mean that an individual is definitely not infected with HIV, particularly when exposure may have been within the previous three months. The test has the potential to identify large numbers of previously undiagnosed HIV infections, especially if used by those unlikely to use standard screening methods. OraSure Technologies, the manufacturer of the OraQuick In-Home HIV Test, said it will have a phone-based consumer support center that will be open 24 hours a day.

Psychiatric News has reported on advice from experts on managing neurocognitive impairment associated with HIV disease. Read about it here.

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Postsurgical Delirium Linked to Loss of Long-Term Cognitive Function

Delirium is common after cardiac surgery and may be associated with long-term changes in cognitive function, said researchers at the Division of Geriatric Medicine of the University of Massachusetts Medical School in the July 5 New England Journal of Medicine. They enrolled 225 patients aged 60 or older who were planning to undergo coronary-artery bypass grafting or valve replacement. Patients were assessed preoperatively, daily during hospitalization beginning on postoperative day two, and at one, six, and 12 months after surgery. Cognitive function was assessed with  the Mini–Mental State Examination. Delirium was diagnosed with the Confusion Assessment Method. They examined performance on the MMSE in the first year after surgery.

The 103 participants (46 percent) in whom delirium developed postoperatively had lower preoperative mean MMSE scores than those in whom delirium did not develop. Patients with delirium had a larger drop in cognitive function two days after surgery than did those without delirium, and they had significantly lower postoperative cognitive function than those without delirium, both at one month and at one year after surgery. “Delirium is associated with a significant decline in cognitive ability during the first year after cardiac surgery, with a trajectory characterized by an initial decline and prolonged impairment,” the researchers

Read more about causes and treatment of delirium in the Textbook of Geriatric Neuropsychiatry, Third Edition, available from American Psychiatric Publishing, here.

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