Sexual abuse in childhood increases the risk of suicide in men by up to ten times, say researchers from the University of Bath. A recent study of Australian men has found that those who were sexually abused as children are more likely than women to contemplate taking their own lives. Whilst gender and mental health problems are the most important risk factors for contemplating suicide, it is increasingly acknowledged that traumatic experiences such as childhood sexual abuse may be a significant risk factor.

Dr Patrick O'Leary and Professor Nick Gould from the University's Department of Social & Policy Sciences conducted a series of surveys and face-to-face interviews with men in a study funded by the University of South Australia. The findings have been published online in the peer-reviewed British Journal of Social Work.

They found that men who were sexually abused as children were up to ten times more likely to have suicidal tendencies; many of these men had not been clinically diagnosed as depressed. Dr O'Leary said: "Childhood sexual abuse is an under-recognised problem in men - most of the studies exploring the link with suicide have been in women. "Men are particularly vulnerable because they don't like to talk to others about their problems. It's difficult for anyone to come to terms with traumatic experiences such as childhood sexual abuse, but for men the stigma is worse because they don't tend to confide in their friends as much.

"Many suffer feelings of failure and isolation and think that it is a sign of weakness to discuss their past abuse with others. Men also tend to visit their doctors less frequently, so those who are at risk of suicide often slip under the radar of the healthcare system. Men are particularly vulnerable to suicide and are three and a half times more likely than women to end their own lives, with more than 2,000 men dying as a result of suicide in the UK each year. However it is estimated that for every suicide, there are between 20 and 25 failed attempts. We carried out the study in Australia, which shares a similar 'stiff upper lip' culture that we see in the UK. We're planning to do our next study in the UK to see if there are any differences."

Dr O'Leary suggested that lives could be potentially saved if abuse victims are identified earlier. He explained: "The abuse that these men have suffered as children often sees them attempting to cope by suppressing the experience through substance abuse, alcohol abuse and obsessive behaviour, with many ending up in the criminal justice system. "Greater awareness in the healthcare and criminal justice systems will help identify those who are at risk and give them treatment before it is too late."

“In psychiatry no one knows the causes of anything, so classification can be driven by all sorts of factors” — political, social and financial. “What you have in the end,” Mr. Shorter [a historian of psychiatry] said, “is this process of sorting the deck of symptoms into syndromes, and the outcome all depends on how the cards fall.”

The DSM-V is expected to fall into place in 2011-2012.

The article, Psychiatrists Revise the Book of Human Troubles, can be found at the New York Times online

Adolescents with major depression who received cognitive behavioral therapy (CBT) after responding to an antidepressant were less likely to experience a relapse or recurrence of symptoms compared to teens who did not receive CBT, according to a small, NIMH-funded pilot study published in the December 2008 issue of the Journal of the American Academy of Child and Adolescent Psychiatry.

Background
Studies have found that adults with depression who have responded to medication treatment are less likely to have a relapse if they receive CBT during the follow-up treatment phase, according to researchers Betsy Kennard, Psy.D., of the University of Texas Southwestern Medical Center, and colleagues. Scientists theorize that initial antidepressant treatment may help improve symptoms enough so that a patient becomes more receptive to CBT or other psychosocial component. Kennard and colleagues aimed to determine if a similar sequential treatment strategy would be effective with depressed adolescents.

In this pilot study, 46 depressed youths ages 11 to 18 who had responded to 12 weeks of treatment with the antidepressant fluoxetine (Prozac) were randomly assigned to either six months of continued medication management (MM), or to medication management plus cognitive behavioral therapy (MM+CBT) designed to prevent relapse.

Results of the Study
Kennard and colleagues found that the youths who received only MM were significantly more likely to relapse than the youths who received MM+CBT. The researchers estimated that 37 percent of those in the MM group were likely to relapse, while 15 percent of those in the MM+CBT group were likely to relapse. Patients getting MM+CBT also reported higher rates of satisfaction compared to those getting MM only.

Significance
This pilot study demonstrates that, as in adult studies, introducing CBT in follow-up treatment after a patient responds to antidepressant treatment may be a promising strategy in preventing relapse among depressed adolescents.

What’s Next
The researchers currently are conducting a larger trial of MM+CBT to further evaluate the effectiveness of this treatment strategy in youths with depression.

Reference
Kennard B, et al. Cognitive-behavioral therapy to prevent relapse in pediatric responders to pharmacotherapy for major depressive disorder. Journal of the American Academy of Child and Adolescent Psychiatry. 2008 Dec; 47(12):1395-1404

---

Posted at the National Institute of Mental Health (NIMH)
5 December 2008

When a group is without a leader, you can often count on a narcissist to take charge, a new study suggests. Researchers found that people who score high in narcissism tend to take control of leaderless groups. Narcissism is a trait in which people are self-centered, exaggerate their talents and abilities, and lack empathy for others. "Not only did narcissists rate themselves as leaders, which you would expect, but other group members also saw them as the people who really run the group," said Amy Brunell, lead author of the study and assistant professor of psychology at Ohio State University at Newark.

Narcissists, by definition, are self-centered and overconfident in their own abilities.

The researchers found similar results in two separate studies involving college students, and one involving business managers in an MBA program. And while narcissists are more likely to become leaders, results of one of the studies suggests that, once in power, narcissists don't perform any better than others in that leadership role. "It's not surprising that narcissists become leaders," Brunell said. "They like power, they are egotistical, and they are usually charming and extraverted. But the problem is, they don't necessarily make better leaders."

The study will appear in an upcoming print issue of the journal Personality and Social Psychology Bulletin. It is currently available to subscribers online.

The first study involved 432 undergraduate students. They all completed assessments which measured various personality traits, including narcissism. They were then put in groups of four, and told to assume they were a committee of senior officers of the student union, and their task was to elect next year's director. Each person in a group was given a profile of a different candidate for the position, and each was to argue for their particular candidate. Following the discussion, they voted on the director, and then completed a questionnaire evaluating the leadership of themselves and the other group members.

Results showed that students who scored higher on one dimension of narcissism – the desire for power - were more likely to say they wanted to lead the group, were more likely to say they did lead the group discussion, and were more likely to be viewed as leaders by the other group members.

The other dimension of narcissism – the desire for attention – was not as strongly related to leadership roles in the groups. "It's not surprising, but the desire for power is what really drives narcissists to seek leadership positions," she said.

In a second study, 408 students were placed in groups of four and given a scenario in which they imagined they were shipwrecked on an uninhabited island and had to choose which 15 salvageable items that the group should take ashore which will best help them survive. After a group discussion, those who scored highest on the power dimension of narcissism again showed the most desire to lead the group discussion, rated themselves as leaders, and were viewed by other group members as the leaders.

This study went further, though, by seeing how well the narcissists performed as leaders. Researchers looked at the lists, prepared by each individual and group, of the 15 items that they thought would help them survive. They compared their lists to one prepared by an expert who has taught survival skills to the U.S military.

Results showed that narcissists did no better than others on selecting the items that would best help them survive. In addition, groups that overall scored highest on narcissism did no better than other groups on the task.

A third study involved 153 business managers enrolled in an executive MBA program at a large southeastern university. The managers were also put in groups of four and told to assume the role of a school board deciding how to allocate a large financial contribution from a fictional company.
Two trained observers – professors or doctoral students in industrial/organizational psychology – observed the groups and rated how much of a leadership role each participant assumed in their groups.

Results showed that the MBA students rated highest in narcissism were most likely to be identified as emerging leaders by the expert observers. "Even trained observers saw narcissistic people as the natural leaders," Brunell said. "In addition, this study showed that narcissism plays a role in leadership among real-world managers."

Brunell said the studies took into account other factors – such as gender and personality traits like high self-esteem and extraversion – that may relate to leadership development. But even when these factors were taken into account, narcissism still played a key role. It is important not to confuse narcissism with high self-esteem, she said. "A person with high self-esteem is confident and charming, but they also have a caring component and they want to develop intimacy with others," Brunell explained. "Narcissists have an inflated view of their talents and abilities and are all about themselves. They don't care as much about others."

Brunell said she believes the results apply to many parts of life, from the politics of the presidential race to Wall Street. "Many people have observed that it takes a narcissistic person to run for president of the United States," she said. "I would be surprised if any of the candidates who have run weren't higher than average in narcissism." The same is true for the leaders of Wall Street firms that have made and lost millions of dollars in the past few years. "There have been a lot of studies that have found narcissistic leaders tend to have volatile and risky decision-making performance and can be ineffective and potentially destructive leaders," she said. However, that doesn't mean all the troubles in Washington or Wall Street can be blamed on narcissistic leaders. "I'm sure some of these leaders had to be overconfident and too sure of their abilities. But there's a lot more behind the troubles of government and business than the personalities of their leaders."

A link between reduced levels of the 'stress hormone' cortisol and antisocial behaviour in male adolescents has been discovered by a research team at the University of Cambridge.

Levels of cortisol in the body usually increase when people undergo a stressful experience, such as public speaking, sitting an exam, or having surgery. It enhances memory formation and is thought to make people behave more cautiously and to help them regulate their emotions, particularly their temper and violent impulses.

The new research, funded by the Wellcome Trust, shows that adolescents with severe antisocial behaviour do not exhibit the same increase in cortisol levels when under stress as those without antisocial behaviour. These findings suggest that antisocial behaviour, at least in some cases, may be seen as a form of mental illness that is linked to physiological symptoms (involving a chemical imbalance of cortisol in the brain and body).

The scientists, led by Dr Graeme Fairchild and Professor Ian Goodyer, recruited participants for the study from schools, pupil referral units, and the Youth Offending Service. Samples of saliva were collected over several days from the subjects in a non-stressful environment to measure levels of the hormone under resting conditions. The young men then took part in a stressful experiment that was designed to induce frustration. Samples of saliva were taken immediately before, during and after the experiment to track how cortisol changed during stress.

The differences between participants with severe antisocial behaviour and those without were most marked under stressful conditions. While the average adolescents showed large increases in the amount of cortisol during the frustrating situation, cortisol levels actually went down in those with severe antisocial behaviour.

These results suggest that antisocial behaviour may be more biologically-based than previously considered, just as some individuals are more vulnerable to depression or anxiety due to their biological make-up. Dr Fairchild said, "If we can figure out precisely what underlies the inability to show a normal stress response, we may be able to design new treatments for severe behaviour problems. We may also be able create targeted interventions for those at higher risk. "A possible treatment for this disorder offers the chance to improve the lives of both the adolescents who are afflicted and the communities in which they live."

The theory that depression is caused by a chemical imbalance is often presented in the media as fact even though there is little scientific evidence to support it, according to a new study co-authored by a Florida State University visiting lecturer. Jeffrey Lacasse, an FSU doctoral candidate and visiting lecturer in the College of Social Work, and Jonathan Leo, a neuroanatomy professor at Lincoln Memorial University in Tennessee, found that reporters who included statements in news articles about depression being caused by a chemical imbalance, or a lack of serotonin in the brain, were unable to provide scientific evidence to support those statements.

Lacasse and Leo spent about a year in late 2006 and 2007 monitoring the daily news for articles that included statements about chemical imbalances and contacting the authors to request evidence that supported their statements. Several reporters, psychiatrists and a drug company responded to the researchers' requests, but Lacasse and Leo said they did not provide documentation that supported the chemical imbalance theory. Their findings were published in the journal Society.

"The media's presentation of the theory as fact is troublesome because it misrepresents the current status of the theory," Lacasse said. "For instance, there are few scientists who will rise to its defense, and some prominent psychiatrists publicly acknowledge that the serotonin hypothesis is more metaphor than fact. As the current study documents, when asked for evidence, reporters were unable to cite peer-reviewed primary articles in support of the theory." Moreover, the researchers said, several of the responses received from reporters seem to suggest a fundamental misunderstanding of the theory's scientific status. The "Diagnostic and Statistical Manual of Mental Disorders," which almost all psychiatrists use to diagnose and treat their patients, clearly states that the cause of depression and anxiety is unknown, according to Lacasse and Leo.

The Society article builds on the pair's 2005 study, which focused on pharmaceutical advertisements that claim depression is caused by an imbalance of serotonin—an imbalance the drug companies say can be corrected by a class of antidepressants called Selective Serotonin Reuptake Inhibitors (SSRIs). "The chemical imbalance theory, which was formulated in the 1960s, was based on the observation that mood could be artificially altered with drugs, rather than direct observation of any chemical imbalances," Leo said. "Since then there has been no direct evidence to confirm the theory and a significant number of findings cast doubt on the theory."

The researchers said the popularity of the theory is in large part based on the presumed efficacy of the SSRIs, but they say that several large studies now cast doubt on this efficacy. A review of a full set of trial data published in the journal PLoS (Public Library of Science) Medicine last month concluded that much of the perceived efficacy of several of the most common SSRIs was due to the placebo effect. Other studies indicate that for every 10 people who take an SSRI, only one to two people are truly receiving benefit from the medication, according to Lacasse and Leo.

Still, the National Center for Health Statistics found that antidepressants are the most prescribed drugs in the United States, with doctors writing more than 31 million prescriptions in 2005. Both Lacasse and Leo emphasized the importance of patients being given factual information so they can make informed decisions about medications and the role of other potentially useful interventions, such as psychotherapy, exercise or self-help strategies. "Patients might make different choices about the use of medications and possibly use alternative approaches to their distress if they were fully informed," Lacasse said. "We believe the media can play a positive role by ensuring that their mental health reporting is congruent with scientific literature."

FSU News
March 2008

In a study that may significantly advance the understanding of how cognitive-behavioral therapy affects the brain, researchers have shown that significant changes in activity in certain regions of the brain can be produced with as little as four weeks of daily therapy in patients with obsessive-compulsive disorder (OCD). The discovery could have important clinical implications, according to principal investigator Sanjaya Saxena, M.D., Director of the Obsessive-Compulsive Disorders Program at the University of California, San Diego (UCSD) School of Medicine, whose findings are published on line this week in the journal Molecular Psychiatry.

“The study is exciting because it tells us more about how cognitive-behavioral therapy works for OCD and shows that both robust clinical improvements and changes in brain activity occur after only four weeks of intensive treatment," said Saxena.

OCD is an anxiety disorder in which individuals have unreasonable fears or worries that they try to manage through ritualized compulsive behaviors to reduce the anxiety. For example, a patient may experience the urgent need to engage in certain rituals, such as hand washing or repeatedly checking that the oven is off or the front door is locked.

Past studies using functional brain imaging studies of patients with OCD have demonstrated that elevated activity along the frontal-subcortical circuits of the brain decreases in response to treatment with serotonin reuptake inhibitor (SRI) medications or cognitive-behavioral therapy. However, clinical improvement of OCD symptoms was expected to require up to 12 weeks of behavioral therapy or medication treatment, the standard treatments for OCD. Only a handful of studies have looked at how therapy affects brain function, and all previous studies had examined changes over several months of treatment.

Saxena and colleagues at the David Geffen School of Medicine at UCLA made two novel discoveries in their study of 10 OCD patients and 12 control subjects. “First of all, we discovered significant changes in brain activity solely as the result of four weeks of intensive cognitive-behavioral therapy,” said Saxena. “Secondly, these changes were different than those seen in past studies after a standard 12-week therapeutic approach using SRI medications or weekly behavioral therapy.” The researchers obtained positron emission tomography (PET) scans of the ten OCD patients both before and after they received four weeks of a therapy known as “exposure and response prevention,” which gradually desensitizes patients to things that provoke obsessional fears or worries. “This is the primary kind of therapy used for OCD. It teaches patients to pay attention to their internal experiences and tolerate scary thoughts without having to act on them,” said Saxena. “They learn that nothing terrible happens if they refrain from their usual compulsive behaviors.”

The normal control subjects received no treatment and were scanned twice, several weeks apart, and metabolic changes in the brain were compared between the two groups. After four weeks of therapy and without any changes in medication, the OCD patients showed significant improvements in OCD symptoms, depression, anxiety and overall functioning. The PET scans of OCD patients demonstrated significant decreases in glucose metabolism – a measure of brain cell activity – in the right and left thalamus after treatment. These are areas of the brain involved in OCD and where changes have been seen in numerous past studies after longer-term treatment.

However, the PET scans in this study also showed a significant increase in activity in an area of the brain called the right dorsal anterior cingulate cortex, a region involved in reappraisal and suppression of negative emotions. Increasing activity in this region corresponded to the OCD patients’ improvement in clinical symptoms after the four-week course of intensive therapy. Activity in this area had previously been found to increase after cognitive-behavioral therapy for major depression. Therefore, the researchers theorize that response to cognitive-behavioral therapy across a variety of disorders may require activation of the dorsal anterior cingulate cortex, according to Saxena.

From the List Universe -- Top 10 Bizarre Mental [/neurological] Disorders

A tendency to extract messages from meaningless noise could be an early sign of schizophrenia, according to a study by Yale School of Medicine researchers.

The study this month in the British Journal of Psychiatry reported on 43 participants diagnosed with “prodromal symptoms”— meaning they exhibited early warning signs of psychosis such as social withdrawal, mild perceptual alterations, or misinterpretation of social cues. Participants in the study were randomly assigned to take the anti-psychotic medication olanzapine or a placebo, and then symptoms and neuropsychological function were assessed for up to two years.

During the “babble task,” participants listened with headphones to overlapping recordings of six speakers reading neutral texts, which made the words virtually incomprehensible. The participants were asked to repeat any words or phrases that they heard. Only four words—“increase,” “children,” “A-OK,” and “Republican”—were consistently reproduced.

Eighty percent of the participants who “heard” phrases of four or more words in length went on to develop a schizophrenia-related illness during times that they were not taking olanzapine, said the lead author, Ralph Hoffman, M.D., associate professor of psychiatry. In contrast, only six percent of those in the study converted to schizophrenia-related illness if the phrases “heard” were less than three words in length. “A tendency to extract message-like meaning from meaningless sensory information can, over time, produce a ‘matrix of unreality’ that triggers the initial psychotic phase of schizophrenia-spectrum disorders,” Hoffman said.

He said further research is needed because of the small size of this study. However, if these findings are verified, Hoffman added, they could provide an inexpensive tool for identifying those individuals with early warning signs of schizophrenia who would most likely benefit from preventive drug therapy.

What's wrong with being shy, and just when and how did bashfulness and other ordinary human behaviors in children and adults become psychiatric disorders treatable with powerful, potentially dangerous drugs, asks a Northwestern University scholar in a new book that already is creating waves in the mental health community.

In "Shyness: How Normal Behavior Became a Sickness" (October 2007), Northwestern's Christopher Lane chronicles the "highly unscientific and often arbitrary way" in which widespread revisions were made to "The Diagnostic and Statistical Manual of Mental Disorders" (DSM), a publication known as the bible of psychiatry that is consulted daily by insurance companies, courts, prisons and schools as well as by physicians and mental health workers.

"The number of mental disorders the general population might exhibit leaped from 180 in 1968 to more than 350 in 1994," notes Lane, Northwestern's Herman and Beulah Pearce Miller Research Professor. In a book that calls into doubt the facade of objective research behind psychiatry's revolution, Lane questions the rationale for the changes, and whether all of them were necessary and suitably precise.

By labeling shyness and other human traits as mental conditions with a biological cause, the doors were opened wide to a pharmaceutical industry ready to provide a pill for every alleged chemical imbalance or biological problem, the author says.

Lane, who meticulously and systematically researched the archives of the American Psychiatric Association, uses social anxiety disorder (first dubbed social phobia) as the lens through which to analyze American psychiatry's extraordinary shift in the last 30 years from a psychoanalytic orientation relying on talk therapy to its current emphasis on neuroscience and drugs.

He draws on previously neglected letters and memos written by the framers of the new disorders to argue that DSM revisions to social phobia or social anxiety disorder placed the diagnostic bar too low, turning social anxiety into a mental illness common enough to be considered, according to recent studies, third only to alcoholism and major depression.

The DSM continues to stipulate that social anxiety disorder (SAD) must be "impairing" for a diagnosis to occur. The problem, Lane argues, is that DSM-defined symptoms of impairment in 1980 included fear of eating alone in restaurants, concern about hand trembling while writing checks, fear of public speaking and avoidance of public restrooms.

By 1987 the DSM had removed the key phrase "a compelling desire to avoid," requiring instead only "marked distress," and signs of that could include concern about saying the wrong thing. "Impairment became something largely in the eye of the beholder, and anticipated embarrassment was enough to meet the diagnostic threshold," says Lane.

"That's a ridiculous way to assess a serious mental disorder, with implications for the way we also view childhood traits and development," Lane adds. "But that didn't stop SAD from becoming what Psychology Today dubbed 'the disorder of the 1990s.'"

In addition to providing extensive documentation from the American Psychiatric Association archives, Lane includes previously confidential material from the drug companies themselves that present a worrisome history of the antidepressant Paxil.

That drug came onto the marketplace in 1996 despite the fact that its makers earlier had considered shelving it because of poor performance and early signs of side effects in clinical trials. Using a memo circulated among drug company executives, Lane presents evidence that a lot of information about the drug's poor track record was withheld from the public.

When Paxil became the first drug approved by the Food and Drug Administration for the treatment of social anxiety disorder in 1999, however, its makers launched a $92 million awareness campaign on the theme "Imagine Being Allergic to People." This and other advertising campaigns helped change the way Americans think about anxiety and its treatment.

"Every marketer's dream is to find an unidentified or unknown market and develop it. That's what we were able to do with social anxiety disorder," a product director for the drug told Advertising Age magazine. In 2001, with 25 million new prescriptions written for Paxil, the drug's U.S. sales alone increased by 18 percent from the year before.

Although psychiatrists insist that the line between ordinary shyness and social anxiety disorder (SAD) is sharply defined, Lane points to psychiatric literature that repeatedly confuses them, putting patients at risk of over-diagnosis and unnecessary, sometimes harmful treatment.

A professor of English in Northwestern's Weinberg College of Arts and Sciences, Lane previously directed a psychoanalytic studies program in Emory University's psychiatry department.

Long interested in psychology, he presents evidence of a burgeoning backlash to psychiatry's current trends in the form of analyses of novels including "The Corrections" by Jonathan Franzen and "The Diagnosis" by Alan Lightman, as well as the film "Garden State" by Zach Braff.

Lane was awarded a Guggenheim Fellowship to study psychopharmacology and ethics, and audited medical courses.

He invited psychiatrists and pharmacologists to review his book, particularly a chapter on rebound syndrome. That term refers to a boomerang effect experienced by some patients on discontinuing Paxil that is more intense and dangerous than the turmoil that caused them to take the drug in the first place.

In examining the American Psychiatric Association archives, Lane -- who argues that psychiatry is using drugs with poor track records to treat growing numbers of normal human emotions -- even came across a proposal to establish "chronic complaint disorder," in which people moan about the weather, taxes or the previous night's racetrack results.

"It might be funny," he says, save for the fact that the DSM's next edition, due to be completed in 2012, is likely to establish new categories for apathy, compulsive buying, Internet addiction, binge-eating and compulsive sexual behavior. Don't look for road rage, however. It's already in the DSM, under intermittent explosive disorder.

Horowitz, A.V. and Wakefield, J.C. (2007). The Loss of Sadness: How Psychiatry Transformed Normal Sorrow into Depressive Disorder. NY: Oxford University Press. (link to Amazon.com)

Suggests that loss of treatment response is likely due to loss of placebo response

Providence, RI – A new study by Rhode Island Hospital researchers indicates that a relapse during antidepressant continuation treatment may be due to a relapse in patients who were not true drug responders. The loss of drug response may be due to loss of placebo response (a positive medical response to taking a placebo as if it were an active medication.). The study was published in the August issue of the Journal of Clinical Psychiatry.

Historically, the treatment of depression is divided into three phases – initial/acute, continuation and maintenance. During the initial phase, the goal is to reduce symptoms and psychosocial impairment. During the continuation phase, usually six months to one year after initial treatment response, the goal is to maintain the gains and prevent a relapse. In the maintenance phase, which occurs after a sustained period of improvement, the goal is to further maintain the gains and prevent recurrence of the disorder.

Mark Zimmerman, MD, director of outpatient psychiatry at Rhode Island Hospital and associate professor of psychiatry and human behavior at the Warren Alpert School of Medicine at Brown University, is the paper’s lead author. Zimmerman, along with his colleague Tavi Thongy, MD, also of Rhode Island Hospital and Brown University, conducted a meta-analysis of continuation studies of new generation antidepressants that began as placebo-controlled acute phase studies. Treatment studies of depression have found that approximately 50 to 65 percent of patients respond to medication and that approximately 25 to 35 percent respond to placebo.

Past studies have indicated that a number of patients who respond to treatment in the initial phase experience a relapse or recurrence despite ongoing pharmacotherapy during the two latter phases of treatment. This return of symptoms is often interpreted as a loss of efficacy of antidepressant activity, and is referred to as tachyphylaxis or the “poop-out” effect. Zimmerman says, “When a patient improves after being prescribed an antidepressant medication you do not know if they got better because of the medication or because they had a placebo response.”

The researchers used formulas developed by Quitkin and colleagues more than a decade ago to calculate the relapse rate attributable to relapse in presumptive placebo responders. “Our study suggests that the return of symptoms despite ongoing treatment during the continuation and maintenance phases of treatment may not represent a loss of drug effect because the patient may not have experienced a true drug response in the first place.” Zimmerman also notes, “While our conclusion is limited to the continuation phase of treatment, our results suggest that these findings probably also apply to the maintenance phase of treatment.”

The researchers note that these findings are not inconsistent with conclusions that continuation and maintenance studies of antidepressants have clearly established the benefit of ongoing treatment beyond the acute phase.

Analyses of a national sample of individuals with alcohol dependence (alcoholism) reveal five distinct subtypes of the disease, according to a new study by scientists at the National Institute on Alcohol Abuse and Alcoholism (NIAAA), part of the National Institutes of Health (NIH).

“Our findings should help dispel the popular notion of the ‘typical alcoholic,’” notes first author Howard B. Moss, M.D., NIAAA Associate Director for Clinical and Translational Research.  “We find that young adults comprise the largest group of alcoholics in this country, and nearly 20 percent of alcoholics are highly functional and well-educated with good incomes.  More than half of the alcoholics in the United States have no multigenerational family history of the disease, suggesting that their form of alcoholism was unlikely to have genetic causes.”

“Clinicians have long recognized diverse manifestations of alcoholism,” adds NIAAA Director Ting-Kai Li, M.D, “and researchers have tried to understand why some alcoholics improve with specific medications and psychotherapies while others do not. The classification system described in this study will have broad application in both clinical and research settings.”  A report of the study is now available online in the journal Drug and Alcohol Dependence.

Previous efforts to identify alcoholism subtypes focused primarily on individuals who were hospitalized or otherwise receiving treatment for their alcoholism.  However, recent reports from NIAAA’s National Epidemiological Survey on Alcohol and Related Conditions (NESARC), a nationally representative epidemiological study of alcohol, drug, and mental disorders in the United States, suggest that only about one-fourth of individuals with alcoholism have ever received treatment. Thus, a substantial proportion of people with alcoholism were not represented in the samples previously used to define subtypes of this disease.

In the current study, Dr. Moss and colleagues applied advanced statistical methods to data from the NESARC.  Their analyses focused on the 1,484 NESARC survey respondents who met diagnostic criteria for alcohol dependence, and included individuals in treatment as well as those not seeking treatment.  The researchers identified unique subtypes of alcoholism based on respondents’ family history of alcoholism, age of onset of regular drinking and alcohol problems, symptom patterns of alcohol dependence and abuse, and the presence of additional substance abuse and mental disorders:

• Young Adult subtype: 31.5 percent of U.S. alcoholics.  Young adult drinkers, with relatively low rates of co-occurring substance abuse and other mental disorders, a low rate of family alcoholism, and who rarely seek any kind of help for their drinking.


• Young Antisocial subtype: 21 percent of U.S. alcoholics.  Tend to be in their mid-twenties, had early onset of regular drinking, and alcohol problems.  More than half come from families with alcoholism, and about half have a psychiatric diagnosis of Antisocial Personality Disorder.  Many have major depression, bipolar disorder, and anxiety problems.  More than 75 percent smoked cigarettes and marijuana, and many also had cocaine and opiate addictions. More than one-third of these alcoholics seek help for their drinking.


• Functional subtype: 19.5 percent of U.S. alcoholics. Typically middle-aged, well-educated, with stable jobs and families.  About one-third have a multigenerational family history of alcoholism, about one-quarter had major depressive illness sometime in their lives, and nearly 50 percent were smokers.


• Intermediate Familial subtype: 19 percent of U.S. alcoholics.  Middle-aged, with about 50 percent from families with multigenerational alcoholism.  Almost half have had clinical depression, and 20 percent have had bipolar disorder. Most of these individuals smoked cigarettes, and nearly one in five had problems with cocaine and marijuana use. Only 25 percent ever sought treatment for their problem drinking.


• Chronic Severe subtype:  9 percent of U.S. alcoholics. Comprised mostly of middle-aged individuals who had early onset of drinking and alcohol problems, with high rates of Antisocial Personality Disorder and criminality.  Almost 80 percent come from families with multigenerational alcoholism.  They have the highest rates of other psychiatric disorders including depression, bipolar disorder, and anxiety disorders as well as high rates of smoking, and marijuana, cocaine, and opiate dependence.  Two-thirds of these alcoholics seek help for their drinking problems, making them the most prevalent type of alcoholic in treatment.

The authors also report that co-occurring psychiatric and other substance abuse problems are associated with severity of alcoholism and entering into treatment.  Attending Alcoholics Anonymous and other 12-step programs is the most common form of help-seeking for drinking problems, but help-seeking remains relatively rare.

People who were abused and neglected during childhood have a higher risk of major depression when they become young adults, according to a report in the January issue of the Archives of General Psychiatry, one of the JAMA/Archives journals.

Child abuse has been linked to depression in clinical populations and community surveys, according to background information in the article. But few prospective longitudinal studies have examined the relationship between abuse or neglect in childhood and depression in adulthood.

Cathy Spatz Widom, Ph.D., then of the New Jersey Medical School, University of Medicine and Dentistry of New Jersey, Newark, and now of John Jay College of Criminal Justice, New York, and colleagues conducted a prospective study to determine whether abused and neglected children were at elevated risk of major depressive disorder (MDD) and psychiatric illness, compared with matched control subjects, when followed up into young adulthood. The study included 676 children with substantiated cases of physical and sexual abuse and neglect before the age of 11. They were matched based on age, race, sex, and approximate family social class with 520 non-abused and non-neglected children. All were followed up into young adulthood (average age: 28.7).

"The current results show that childhood physical abuse was associated with increased risk for lifetime MDD," the authors write. "We also provide new evidence that neglected children are at increased risk for depression as well."

Child abuse and neglect were associated with a 51 percent increased risk for current MDD in young adulthood. Children who were physically abused had a 59 percent increased risk of lifetime MDD. Those who experienced multiple types of abuse had a 75 percent increased risk of lifetime MDD. The risk of current MDD was 59 percent higher for those who were neglected.

Childhood sexual abuse was not associated with an elevated risk of MDD. "However, childhood victims of sexual abuse reported significantly more depression symptoms than controls," the authors point out.

"In addition, these findings reveal that onset of depression began in childhood for many of the children," they write. "Our age-at-onset findings reinforce the need to intervene early in the lives of these abused and neglected children, before depression symptoms cascade into other spheres of functioning."

Genetic factors may be at play when it comes to the link between the personality trait of neuroticism and vulnerability for depression, according to a new study by Virginia Commonwealth University researchers.

In the October issue of the journal Archives of General Psychiatry, researchers reported the results from both longitudinal and genetic analyses that showed that neuroticism is a strong predictor for major depression. Using twin modeling, the researchers determined that a substantial proportion of the genetic vulnerability to depression is shared with neuroticism.

"The personality trait of neuroticism - perhaps better understood as "negative emotionality" is a strong risk factor of major depression. Our study shows that this occurs largely because levels of neuroticism are an index of the genetic liability to depression," said Kenneth S. Kendler, M.D., a professor of psychiatry and human genetics in VCU's School of Medicine and lead author on the study.

VCU researchers, together with researchers from the Karolinska Institute in Sweden evaluated lifetime major depression of approximately 21,000 same-sex twin pairs born between 1926 and 1958 from the Swedish National Twin Registry. In 1972 and 1973, participants completed a questionnaire containing 18 items selected from a personality test called the Eysenck Personality Inventory that assessed the personality traits of neuroticism and extroversion.

More than 25 years later, participants were interviewed in person to determine if they developed depression during their lifetime. The study sought to clarify the magnitude and nature of the association between neuroticism, extroversion and risk for major depression.

Kendler and his team found a weak relationship between extroversion and major depression. They concluded that this major dimension of personality has little to do with risk for depression.

Previous studies in literature have reported that neuroticism or neuroticism-like traits have consistently predicted future depressive episodes.

These results suggest that efforts to identify specific genes that have an impact on risk for depression might be considered also using neuroticism as a target trait.

EurekAlert!
2 October 2006

DURHAM, N.C. -- Nicotine may improve the symptoms of depression in people who do not smoke, Duke University Medical Center scientists have discovered.

The finding does not mean that people with depression should smoke or even start using a nicotine patch, the researchers caution. They say that smoking remains the No. 1 preventable cause of death and disability in the United States, and that the addictive hazards of tobacco far outweigh the potential benefits of nicotine in depression.

But the finding suggests that it may be possible to manipulate nicotine's effects to safely reap its potential medical benefits, according to the researchers. As an example of the drug's potential, they said, pharmaceutical companies already are developing compounds for treating other brain disorders by mimicking the beneficial properties of nicotine while avoiding its addictive nature.

"The hope is that our research on nicotine will spur the development of new treatments for depression, which is a huge public health problem," said lead study investigator Joseph McClernon, Ph.D., an assistant research professor of medical psychiatry and researcher at the Duke Center for Nicotine and Smoking Cessation Research.

"Our study also provides evidence that smokers may indeed smoke, in part, to improve their mood -- a notion that has been quite controversial in the field," he said.

The team's findings are scheduled to appear the week of Sept. 11, 2006, in the online edition of the journal Psychopharmacology and will be published in print in November.

The research was supported by the National Alliance for Research on Schizophrenia and Depression.

Scientists have established that people prone to depression are twice as likely to be smokers, and are less likely to succeed in quitting smoking after taking up the habit, according to McClernon. The Duke study explored the theories behind the higher smoking rates among people experiencing depression.

"Smokers may be more prone to depression than nonsmokers," said Edward Levin, Ph.D., a professor of biological psychiatry and researcher at the Duke center, who was senior investigator in the current study. "Or, people with depression may be self-medicating by smoking, albeit in a deadly way."

In the study, the researchers recruited 11 people who did not smoke but who were experiencing symptoms of depression. Participants were randomly assigned to wear either a nicotine patch or a placebo patch that did not contain any nicotine. The researchers used a standardized method, a 20-item questionnaire called the Center for Epidemiological Studies Depression scale, to measure depression symptoms among the study participants.

"Despite the small number of participants, this is the largest study of its kind," McClernon said.

The team found that participants who wore the nicotine patch for at least eight days experienced a significant decline in their depression-assessment rating scores. McClernon said this finding indicates that the drug led to an improvement in depression symptoms.

As a possible explanation for how nicotine exerts its beneficial effect, McClernon said: "The same areas of the brain that are stimulated by nicotine appear to be involved in the regulation of mood."

Nicotine stimulates the release of specific neurotransmitters, including serotonin, dopamine, and norepinephrine, which carry messages between nerves cells. Depression has been linked to chemical imbalances of these neurotransmitters, McClernon said.

Looking ahead to possible therapeutic uses of nicotine for treating depression, the researchers say the nicotine molecule can be manipulated to remove its addictive effect while maintaining its ability to increase levels of the various brain chemicals that can alter mood. Currently, pharmaceutical companies are developing nicotinelike drugs that target chemical imbalances in the brain that are thought to cause anxiety, schizophrenia, attention deficient hyperactivity disorder, Alzheimer's disease and Parkinson's disease.

The study also suggests that people prone to depression may need extra help in order to quit smoking, such as nicotine replacement therapy, the scientists said.

Despite the positive effects of nicotine discovered in their study, the researchers emphasize that it is not currently appropriate for treatment of any medical disorder outside of nicotine dependence.

"I certainly recommend that people don't smoke," Levin said. "If you do smoke, quit."

DukeMedNews

Intermittent Explosive Disorder could be behind cases of road rage and spousal abuse; Early detection key to treatment

BOSTON--A seldom-studied mental illness called Intermittent Explosive Disorder, characterized by recurrent episodes of angry and potentially violent outbursts--seen in cases of road rage or spousal abuse--has been found to be much more common than previously thought. Depending upon how broadly it is defined, this disorder affects as many as 7.3 percent of adults, or 16 million Americans, in their lifetimes. In a year, Intermittent Explosive Disorder affects nearly 4 percent of Americans, or 8.6 million adults, reports Ronald Kessler, PhD, professor of health care policy at Harvard Medical School (HMS), and colleagues. The study also found that Intermittent Explosive Disorder may predispose people to other mental illnesses and substance abuse. These results are reported in the June 2006 issue of Archives of General Psychiatry.

Intermittent Explosive Disorder attacks are out of proportion to the social stressors triggering them and are not due to another mental disorder or the effects of drugs or alcohol, according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV). People with this disorder overreact to situations with uncontrollable rage, feel a sense of relief during the angry outburst, and then feel remorseful about their actions. [read more]

EurekAlert!
5 June 2006

About 17 percent of college students -- 20 percent of women and 14 percent of men -- report that they have cut, burned, carved or harmed themselves in other ways, reports a new survey by Cornell and Princeton University researchers, the largest study on self-injurious behavior (SIB) in the United States to date. [read more]

EurekAlert!
5 June 2006

A steadily increasing number of patients younger than age 20 received prescriptions for antipsychotic medications between 1993 and 2002, according to a report published in the June issue of Archives of General Psychiatry, one of the JAMA/Archives journals.

Antipsychotics are medications used to treat mental disorders, such as schizophrenia and mania, that may involve loss of contact with reality. Several studies have indicated that prescriptions for these medications have been increasing among children and adolescents, raising concerns among professionals and the public. However, no national data have previously been available, according to background information in the article. Most prescriptions given to children and adolescents are for second-generation antipsychotics, which are not approved by the U.S. Food and Drug Administration for pediatric patients. [read more]

EurekAlert!
5 June 2006

Perfectionist fathers can reinforce tendencies
Perfectionist fathers can reinforce disordered eating among college-age young people already preoccupied over their physical looks and subject to the demanding expectations of peers and media, according to a Penn State study.

A survey of 424 college students revealed that, with sons and daughters alike, the father, not the mother, is more likely to create pressures leading college-age children to indulge in erratic eating habits that in turn can lead to anorexia, bulimia and other clinical illnesses, says Dr. Michelle Miller-Day, associate professor of communication arts and sciences.

"Another finding was that food itself was not the issue with students who reported disordered eating behaviors," Miller-Day notes. "Personal perfectionism, reinforced by peer and parental expectations of perfection in combination with the allure of advertising, may cause many young people to feel that they are not in control of their own lives and bodies. Eating then becomes an area in which they DO have a sense of personal control."

"These findings make clear that treatment for maladaptive eating must extend to a patient's relational network and not just focus on the individual patient," she adds. "A specific focus on the patient's history of communication with parents might provide insights into the development of negative eating behaviors. Eating disorders such as anorexia nervosa have a very high mortality rate. The mortality rate associated with anorexia is 12 times higher than the death rate of other causes of death for females 15-24 years old."

Miller-Day and Jennifer D. Marks, a doctoral student at Penn State, presented their fdinings in the paper, "Perceptions of Parental Communication Orientation, Perfectionism and Disordered Eating Behaviors of Sons and Daughters," in the spring issue of the journal Health Communication.

In a survey of 424 college students, the Penn State researchers measured the relationship between self- and parentally-prescribed perfectionism and perceptions of personal control and maladaptive eating behavior. Their data revealed that 17 percent of the overall sample participated in maladaptive eating patterns including such behaviors as vomiting because of feeling uncomfortably full.

The Penn State study indicated that father-child communicative interaction marked by high paternal standards might increase young people's risk of unwholesome eating behaviors, in part, perhaps, by socializing the adolescent to be compliant with externally imposed messages of what is considered "ideal." In this way, adolescents may become more vulnerable to media and peer group portrayals of ideal body images.

"Our analysis also suggested that perceived loss of personal control might lead to negative eating patterns," say the researchers. "If an individual feels out of control of his or her life, focusing on food intake may be one of the few arenas where he or she can assert personal control. The more young people felt in control of their lives, particularly when positively reinforced by fathers, the less likely they were to engage in maladaptive eating behaviors."

EurekAlert
1 May 2006

Cosgrove, L., Krimsky, S., Vijayaraghavan, M. & Schneider, L. (2006). Financial Ties between DSM-IV Panel Members and the Pharmaceutical Industry. Psychotherapy and Psychosomatics, 75, 154-160.

ABSTRACT
Background: Increasing attention has been given to the transparency of potential conflicts of interest in clinical medicine and biomedical sciences, particularly in journal publishing and science advisory panels. The authors examined the degree and type of financial ties to the pharmaceutical industry of panel members responsible for revisions of the Diagnostic and Statistical Manual of Mental Disorders (DSM).

Methods: By using multimodal screening techniques the authors investigated the financial ties to the pharmaceutical industry of 170 panel members who contributed to the diagnostic criteria produced for the DSM-IV and the DSM-IV-TR.

Results: Of the 170 DSM panel members 95 (56%) had one or more financial associations with companies in the pharmaceutical industry. One hundred percent of the members of the panels on 'Mood Disorders' and 'Schizophrenia and Other Psychotic Disorders' had financial ties to drug companies. The leading categories of financial interest held by panel members were research funding (42%), consultancies (22%) and speakers bureau (16%).

Conclusions: Our inquiry into the relationships between DSM panel members and the pharmaceutical industry demonstrates that there are strong financial ties between the industry and those who are responsible for developing and modifying the diagnostic criteria for mental illness. The connections are especially strong in those diagnostic areas where drugs are the first line of treatment for mental disorders. Full disclosure by DSM panel members of their financial relationships with for-profit entities that manufacture drugs used in the treatment of mental illness is recommended.

Copyright © 2006 S. Karger AG, Basel

Teenage girls with symptoms of depression may have a higher risk of subsequent physical abuse by their partners than those who don't have symptoms of depression, according to a study in the March issue of Archives of Pediatrics & Adolescent Medicine, one of the JAMA/Archives journals.

Major depressive disorder affects about 21 percent of girls and women aged 15 to 24 years, and an additional 10 percent experience minor depression, according to background information in the article. Depressive symptoms and disorders during adolescence have been linked to a number of negative outcomes later in life, including low self-esteem, interpersonal difficulties, divorce, impaired social functioning and problems at work. Depression is understood to often occur as a consequence of partner violence, but few studies have examined whether depression early in life puts women at an increased risk for subsequent exposure to such violence. [read more]

EurekAlert
6 March 2006

Debate simmers over popular antidepressant ad claims
28 February 2006

Summary: Despite claims by pharmaceutical companies and contrary to popular belief, there is no research evidence that depression is caused by serotonin deficiency in the brain. In fact, there are numerous reasons to question this "chemical imbalance" theory of depression altogether:

• There is currently no way to measure levels of neurochemicals in the living brain, so chemical imbalance theories are speculative;
  
• Research indicates that psychotherapy, particularly cognitive therapy, is as or more effective as meds in treating depression and preventing relapse, and does so without the side effects associated with medications;
  
• Research also demonstrates the benefits of exercise in improving mood;
  
• Just because SSRIs [selective serotonin reuptake inhibitors] can alleviate some depressions doesn't necessarily mean low serotonin levels caused the depression to begin with. "The fact that aspirin cures headache does not prove that headaches are due to low levels of aspirin in the brain," researchers note. The same may be true for SSRIs and depression.

Nonetheless, pharmaceutical companies' various direct-to-consumer ads, specifically Pfizer's Zoloft ad, have convinced the general population of this oversimplified biochemical explanation for depression, which may be preventing people from getting the "more comprehensive care" they need.

See also:
Advertisements for SSRIs May Be Misleading

People suffering generalised social phobia experience increased brain activity when confronted with threatening faces or frightening social situations, new research shows. The finding could help identify how severe a person's generalised social phobia is and measure the effectiveness of pharmacological and psychological treatments for the condition. [read article]

PsychDaily
23 January 2006

Drug Prescriptions for Teens Surge 250 Percent Over Seven Years
Waltham, MA - Psychotropic drug prescriptions for teenagers skyrocketed 250 percent between 1994 and 2001, rising particularly sharply after 1999, when the federal government allowed direct-to-consumer advertising and looser promotion of off-label use of prescription drugs, according to a new Brandeis University study in the journal Psychiatric Services.

This dramatic increase in adolescent visits to health care professionals which resulted in a prescription for a psychotropic drug occurred despite the fact that few psychotropic drugs, typically prescribed for ADHD, depression and other mood disorders, are approved for use in children under 18. The study is one of the first to focus on prescriptions to adolescents, rather than children in general.

3 January 2006
Brandeis News