Archive for the ‘research’ Category

Drugs to treat attention deficit hyperactivity disorder, (stimulants such as Ritalin/methylphenidate or Adderall/ amphetamine) for ADHD, don’t appear to put kids at higher risk of heart problems or death.

Scattered reports of sudden deaths among children on the medications have caused concern among parents and doctors in recent years, and several of the drugs now carry warnings about heart complications and behavioral side effects.

New research findings are reassuring.Funded by Shire, the researchers examined claims data from Medicaid and a commercial insurer. The study includes more than 240,000 kids ages three to 17, who received ADHD drugs and were followed for 135 days on average.

The researchers then compared those children to more than 965,000, who didn’t take the drugs but were of similar age and gender and came from the same states as the users.

That weasy officially for the researchers, because often the claims data didn’t match the hospital records.

Based on the data they could calculate, investigators estimated that there would be six sudden deaths or cardiac arrests per 1,000,000 kids taking ADHD drugs for a year.

That’s slightly more than the four per 1,000,000 kids in the comparison group. But because the numbers are so small, the difference could easily have been due to chance.

There were no strokes or heart attacks in the ADHD group, and the researchers estimate it’s very unlikely that the true rates would exceed 24 cases per 1,000,000 per year.

Rates of death “from any cause,” which were the most reliable numbers in the insurance data, were 179 per 1,000,000 kids per year in the ADHD group and 300 per 1,000,000 in the comparison group.

“For kids who would benefit from ADHD medications, the potential cardiovascular risks should not dissuade physicians from prescribing the drugs,” Hennessy told Reuters Health.

The findings, published in the journal Pediatrics, are in line with two previous reports that didn’t find evidence of a link between sudden death and ADHD drugs.

However, they run counter to one small 2009 study that found stimulant use was more common (1.8 percent) in children who died suddenly from cardiac arrest than in those who died in car accidents (0.4 percent).

One expert who was not involved in the current study said the results were hard to interpret due to the small number of deaths and heart problems.

“The new findings confirm that if there is an association between stimulants and cardiac events, it is quite rare,” Almut Winterstein, of the University of Florida College of Pharmacy in Gainesville, told Reuters Health.

But she added that at this point, there is no telling how the millions of kids on ADHD medicines will fare down the road.

“We will need to wait another decade to understand whether even slightly increased blood pressure and heart rate over several years during childhood results in increased cardiovascular risk in later life,” she said in an email.

The risk of death is certainly no higher in children who take ADHD medications than in children who don’t,” said Sean Hennessy, a pharmacist at Philadelphia’s University of Pennsylvania, who led the work.

Hennessy acknowledged that studying cardiovascular events using insurance data in youth is complex, and that he awaits the results of The U.S. Food and Drug Administration’s large safety study on stimulants.

The Controversy

The media has continued to highlight the high-stakes battle that pharmaceutical companies have waged to make a profit by convincing doctors to prescribe antidepressants. Recent articles have focused more on the fact that pharmaceutical companies were not made to release studies that failed to demonstrate effectiveness of their products. Some articles have focused more on the failure of manufacturers to reveal potential adverse reactions or side effects.

This unbalanced media coverage has the potential to undermine effective treatment of psychiatric disorders. While the pharmaceutical companies stand to profit by convincing people that mental health conditions are medical conditions, the potential to profit does not necessarily mean that their facts are wrong.

Depression as medical illness

Depression is a medical condition. Studies of the brains and the biology of persons with depression have proven that there are real functional and physical changes that take place when a person is struggling with depression.  Depression, and 7 other mental health conditions, are identified by the World Health Organization as among the top 10 most disabling medical conditions worldwide.

Depression can be treated effectively. Studies have consistently shown that medications can treat depression. It is not a one-drug-suits-all approach. Treatment requires some trial and error. But the same is true for the treatment of hypertension. In addition, much like changes in one’s life circumstances can alter a person’s severity of hypertension, so, too can a change in one’s life circumstances make depression better–or worse! Some psychotherapeutic interventions, such as cognitive behavioral therapy or mindfulness based cognitive therapy have been shown to improve depression as well.

The controversy that exists about antidepressant medications is not about whether they are effective, but instead about whether the drive for profit has resulted in overarching assertions that these medications are THE ANSWER for EVERYONE.  While the controversy continues, people continue to experience depression at alarming rates, and many people seek help to minimize the impairment that their depression produces. It remains very difficult to analyze the data to determine whether antidepressants will for an individual patient.

So, what is the depressed person to do?

Find a provider that is willing to listen, to ask for details, and to take the time necessary to assess whether an individual patient is responding to the treatment efforts.

Find a provider who is willing to provide education and answers about their treatment decisions, and to include the patient’s preferences in their decision making.

Find a provider who can be flexible and adaptive  in their approach, willing to try something different if a patient is not responding, and who is willing to obtain consultations from other experts when necessary.

Free time is not always a fun time for people with autism. Giving them the power to choose their own leisure activities during free time, however, can boost their enjoyment, as well as improve communication and social skills, according to an international team of researchers.

“For many of us, we look at recreation as a time to spend on activities that are fun and that are designed for our enjoyment,” said John Dattilo, professor of recreation, park and tourism management, Penn State. “But for some people with disabilities, particularly those who have autism, these activities can be a source of frustration, simply because they didn’t have a chance to make their own leisure choices.”

Dattilo said that a group of 20 autistic adults who participated in a yearlong recreation program that offered them a chance to choose activities, scored higher on personality tests that measure social and communication skills than the control group of 20 autistic adults who were randomly assigned to the program’s waiting list. Participants met for two hours each weekday and could choose among several activities that promoted engagement and interactivity, including games, exercises, crafts and events.

The researchers, who released their findings in the current issue of Research in Autism Spectrum Disorders, said that after completing the program, participants showed significant improvement at recognizing and labeling emotions. The participants scored about 24 percent higher than the control group in the ability to recognize emotions in a person in a picture. The score of the participants’ ability to label those emotions correctly was 50 percent higher than the control group’s score.

Since people with autism are less willing to interact socially, caregivers are particularly interested in programs that help improve social and communication skills, according to Dattilo, who worked with Domingo Garcia-Villamisar, professor of psychopathology, Complutense University of Madrid, Spain.

“The big measure for us in this program was the improvements in social behavior and interaction,” said Dattilo. “The defining quality of people with autism is that they have difficulty in social situations.”

The participants also improved their ability to carry out executive functions, such as setting goals and maintaining attention.

Dattilo said recreation programs that encourage people with autism to make their own leisure choices create a cycle of increasing independence, rather than a pattern of reliance on caregivers to provide recreational activities.

“While people are learning, you can also give them choices,” said Dattilo. “And as they make those choices, they are also learning and are empowered to make even more choices.”

The works of University of Rochester psychologist Edward Deci and author and psychologist Mihaly Csikszentmihalyi inspired the researchers to pursue the experiment, Dattilo said. Deci and Csikszentmihalyi emphasize self-determination as a critical component of human fulfillment.

SOURCE: http://live.psu.edu/story/51689

A joint research project between Harvard University and University of Utah scientists has resulted in the development of a new biological test for autism.

The test  uses magnetic resonance imaging (MRI) to measure deviations in brain circuitry, and  is an objective way of identifying individuals with the disorder that could someday replace the subjective methods that are currently used.

Today, Autism is diagnosed  with clinical interviewing  and  observation of the child for another hour or so.  It is hoped that this MRI will provide a more definitive way of determining autism early on, by pointing to something in the brain that is biologically based

Dr. Lange, Nicholas Lange, ScD, associate professor of psychiatry at Harvard Medical School,  was the senior study author, and with  Janet E. Lainhart, MD, from the University of Utah, Salt Lake City, and other colleagues, they set out to explore the hypothesis that study of white matter microstructure in regions of the brain responsible for language, emotion, and social cognition would further the understanding of autism neuropathology.

Diffusion tensor imaging measures white matter microstructure by mapping directions of water diffusion in a local brain tissue frame of reference.

Other types of MRI scans, such as those that compare the sizes of various parts of the brain between healthy individuals and individuals with a particular brain disorder,have not shown much difference in autism.

The researchers took white matter microstructure measurements from the superior temporal gyrus and temporal stem in 30 males aged 7 to 28 years who were diagnosed as having autism by the standard subjective scoring system and in 30 matched controls.

In the subjects with autism, less information was being exchanged in the key areas of the brain responsible for language, social functioning, and emotional behavior.

The test was able to detect autism in this study with 94% accuracy, by identifying less organized wiring.

The findings correlate with the clinical impairments of autism, such as the inability to read body language, and the resulting lack of friendships.

“There appears to be a lack of ordered directional diffusion along the axons to help them make those connections, and we were able to pinpoint just where this is occurring through this brain circuitry imaging,” Dr. Lange noted.

Dr. Lange is hopeful that this test will someday be used clinically to make  accurate and prompt diagnoses in young children.

Early diagnosis may allow intensive, individualized, and early interventions to minimize the impact of the disorder.

This test is NOT YET ready for clinical use. At the present time, child and adolescent clinicians must continue to rely upon careful clinical assessments to diagnosis Autism.

The study was sponsor by the National Institutes of Mental Health. Dr. Lange and Dr. Lainhart have disclosed no relevant financial relationships.

Autism Res. Published online November 29, 2010.

New research by scientists at the University of Cambridge suggests that the neurotransmitter serotonin, which acts as a chemical messenger between nerve cells, plays a critical role in regulating emotions such as aggression during social decision-making.

Serotonin has long been associated with social behavior, but its precise involvement in impulsive aggression has been controversial. Though many have hypothesised the link between serotonin and impulsivity, this is one of the first studies to show a causal link between the two. The research also provides insight into clinical disorders characterized by low serotonin levels, such as depression and obsessive compulsive disorder (OCD), and may help explain some of the social difficulties associated with these disorders.

These findings highlight why some of us may become combative or aggressive when we haven’t eaten.The only way to build serotonin in the brain is by consuming tryptophan in our diet, through foods such as poultry or chocolate. Serotonin levels are lower when a person has not eaten.  Since serotonin levels naturally decline when we don’t eat,  the researchers took advantage of this effect in designing their experiment.

• The researchers were able reduce brain serotonin levels in healthy volunteers for a short time by manipulating their diet.
• They used a situation known as the ‘Ultimatum Game’ to investigate how individuals with low serotonin react to what they perceive as unfair behaviour. In this game one player proposes a way to split a sum of money with a partner. If the partner accepts, both players are paid accordingly. But if he rejects the offer, neither player is paid.
• Normally, people tend to reject about half of all offers less than 20-30% of the total stake, despite the fact that this means they receive nothing – but rejection rates increased to more than 80% after serotonin reductions.
• Other measures showed that the volunteers with serotonin depletion were not simply depressed or hypersensitive to lost rewards.

These results suggest that serotonin plays a role in social decision making.

• Normally, serotonin keeps aggressive social responses in check.
• Changes in diet and stress cause fluctuations in serotonin levels, and this study suggests that the fluctuations in serotonin affect every day decision-making
• This study suggests that patients with depression and anxiety disorders may benefit from therapies that teach them strategies for regulating emotions during decision making, particularly in social scenarios.

This research was  funded by the Wellcome Trust and the Medical Research Council.

Eating disorders are frequently seen as psychological or societal diseases, but do they have an underlying biological cause? A new study shows that the levels of a brain protein differ between healthy and anorexic women.

Anorexia is a serious and potentially fatal eating disorder most commonly affecting women. Scientists do not yet understand the physical causes of anorexia, though some studies suggest a link to low levels of a brain protein called BDNF. BDNF stands for brain derived neurotrophic factor. This molecule, found in the brain’s fear hub could have a significant impact on the study of several anxiety disorders including Post Traumatic Stress Disorder, as well as on anorexia and bulimia.

Now, a study recommended by psychiatrist Cindy Bulik,  founder and director of the  UNC Eating Disorders Program shows that BDNF levels are higher in women who have recovered from anorexia. This suggests that low BDNF levels may be reversible.

Researchers at Chiba University in Japan found that anorexic women had lower levels of BDNF in their blood than healthy women or those who had recovered from anorexia. Women with low BDNF also had the lowest self-image, suffered from anxiety and depression, and performed poorly on certain tests of cognitive ability.

Further study is needed to determine what role BDNF plays in anorexia, and if it can be used to predict the risk of developing it, but Bulik forecasts that “…BDNF may emerge as a useful biomarker of [anorexia] and of recovery from [anorexia].

There are a number of  current integrative and complementary treatment studies for children and adolescents.

Timothy Culbert is the medical director of the integrative medicine program at Minneapolis-based Children’s Hospitals and Clinics of Minnesota, one of the largest hospital-based, pediatric complementary medicine programs in the country.  Dr. Culbert and his colleagues are about to launch a study at four hospitals in the U.S. and Canada to examine in greater depth the use of nondrug coping skills in kids with cancer.

Several years ago, they developed a “Comfort Kit” designed to teach children coping skills including: deep-breathing relaxation techniques; aromatherapy, in which patients inhale chemicals produced by plant oils; and acupressure, a variant of acupuncture with pressure applied to certain points in the body. 

In several pilot studies, Dr. Culbert’s team found that kids can learn such skills and appear to find them helpful. In one study of 150 kids who underwent surgery , 87% said the techniques helped them cope with pain after the procedure. Another study found that a majority of kids with cancer felt relief from their nausea with accupressure. 

 At the University of Alberta in Edmonton, Canada, Sunita Vohra is running a clinical trial with 80 participants to examine whether a self-calming strategy can help children with a variety of diagnoses, including attention-deficit hyperactivity disorder and opposition-defiant disorder. The aim is to teach children to focus on “their presence in the moment”—by paying attention to breathing and other sensations and blocking out external commotion.

Vohra is beginning an individualized study of the use of probiotics—micro-organisms thought to be healthy for the person that consumes them—with gastrointestinal diseases. Dr. Vohra is also studying whether melatonin aids sleep in kids with attention-deficit hyperactivity disorder. 

Wake Forest’s Dr. Kemper has investigated the pediatric use of music therapy, chiropractic care that involves manipulating the body, and “healing touch,” which is based on the premise that the presence of one person’s electromagnetic energy field has an affect on another person. 

Dr. Kemper’s research, including one published in the journal Pediatric Research, has shown that music helps soothe kids with cancer. In 2008, she and her colleagues published findings on eight premature infants showing that live harp music can help them gain weight. Previous findings depicting this effect puzzled them, because such babies can’t increase the number of calories they are eating on their own.

To figure out what was going on, Dr. Kemper’s group put devices called actimeters, which measure very small movements, on the legs of the infants and found that those babies who were exposed to the music were alert and paying attention compared to those in a quiet room or getting the usual care. Soothed babies exhibit fewer tiny muscle movements compared with more tense babies, which reduces the amount of calories they burn.

 It isn’t always clear from these studies what the active ingredient is that’s responsible for the apparent benefit of the therapy. Recent preliminary findings from Dr. Kemper’s group show that kids with cancer report feeling calmer, less anxious and more comfortable in the presence of someone performing healing touch. Yet the study can’t tease apart whether it is the mere presence of a calm person in the room or the actual healing touch that appears to affect the patient.

A method that is safe can be utilized even if it is not shown to be effective, because it gives children and families a sense that they are doing something. The caution is that if a therapy has side effects,expensive, or is used in place of a therapy known to be effective, then the risks outweight the benefits.

Researchers under  Dr. Matthew State, an associate professor of child psychiatry, psychiatry and genetics at Yale University School of Medicine. have been studying the genome of  a family in which the father and all eight of his children have Tourette Syndrome  and have identified a mutation on the HDC gene that encodes the enzyme L-histidine decarboxylase, which is involved in regulating levels of the neurotransmitter histamine in the central nervous system.

This research provides clues to treating Tourettes Disorder, a neurological disorder that can cause debilitating, involuntary motor and verbal tics.

While the variant itself is likely very rare — meaning most people with Tourette syndrome don’t have the precise mutation — what’s known about the gene’s function in the body hints at new treatments, researchers explained.

Previous research in mice has shown that manipulating brain levels of histamine by decreasing activity of HDC makes mice more likely to have repetitive behaviors, such as biting, rearing and chewing, which may be similar to tics in humans.

Drugs that increase the release of histamine in the brain, but don’t affect histamine levels in other parts of the body, are in the latter stages of development. Previous research has shown that when given to mice, these drugs decrease the repetitive behaviors. It’s possible those drugs could also help people with Tourette syndrome.

Genetics may point to the function of the gene, which points to what kind of mechanisms might be involved in the disorder.

The study is published in the New England Journal of Medicine.

Tourette syndrome tends to run in families. The disorder usually emerges in childhood and, for some, improves in adulthood. Although the causes of the syndrome are unknown, previous research suggests abnormalities in certain brain regions and in the neurotransmitters dopamine, serotonin and norepinephrine may play a role.

Children who see doctors for Tourette syndrome often have other disorders as well, including depression, attention-deficit/hyperactivity disorder, obsessive-compulsive disorder or learning disabilities.

Many cases of Tourette syndrome are mild and improve over time. But severe cases can be debilitating — socially and physically — and current treatment options are limited.

In addition to behavioral intervention, first-line medications include antidepressants and anti-anxiety medication. More severe symptoms of the syndrome can be treated with antipsychotic medications such as risperidone (Risperdal) or neuroleptic medications, such as haloperidol (Haldol), but long-term side effects can be serious.

The mutation identified in this family may be unique to them, but suggests the likelihood that functional differences in the  HDC gene or in the histamine biochemical pathway would play a role in other families affected by Tourettes.

SOURCES: Matthew State, M.D., Ph.D., associate professor, child psychiatry, psychiatry and genetics, Yale University School of Medicine, New Haven, Conn.; Francis J. McMahon, M.D., chief, Genetic Basis of Mood and Anxiety Disorders, National Institute of Mental Health, Bethesda, Md.; May 5, 2010, New England Journal of Medicine, online