Child abuse is a serious problem that affects nearly one million children a year in the United States alone. The American Academy of Pediatrics and the US Department of Health and Human Services classify child abuse into four categories including neglect, physical abuse, sexual abuse, and emotional abuse. None of these categories, however, clearly includes the abusive use of drugs on children. A study soon to be published in the Journal of Pediatrics investigates the malicious use of pharmaceuticals and attempts to shed light on this under-recognized problem.

Dr. Shan Yin from the University of Colorado and the Rocky Mountain Poison Drug Center at Denver Health reviewed cases of pharmaceutical abuse reported to the National Poison Data System between 2000 and 2008. Dr. Yin included reports of the malicious use of alcohol, painkillers, cough and cold medicines, sedatives and sleeping pills, and antipsychotic medicines.

Of the more than 1400 cases studied, nearly 14% resulted in moderate to major consequences, including death. Nearly one-half of the abused children were exposed to at least one sedative. An average of 160 cases, including two deaths, was reported each year. Motives and legal findings were unavailable for these particular cases; however, motives for the abusive use of drugs generally are varied, and can include punishment, amusement, or a wish for a break from childcare responsibilities.

This study illustrates the seriousness of the abusive use of drugs administered to children. According to Dr. Yin, "The malicious administration of pharmaceuticals should be considered an important form of child abuse." He encourages pediatricians and emergency medical personnel to be on the watch for this form of maltreatment, and suggests the use of comprehensive drug screening during the evaluation of a child suspected to be the victim of abuse. Dr. Yin also cautions parents that the "non-therapeutic administration of pharmaceuticals to children can result in serious outcomes, including death."

While studies have shown that cognitive therapy is an effective treatment for depression, it has still not been clear the role therapists' training and expertise plays in making treatment successful. A new study finds that depressed patients show more symptom improvement when their therapists more competently follow the guidelines for delivering cognitive therapy. The study also suggests therapist competence may be a particularly important determinant of outcome for some patients. Researchers found that therapist competence was more strongly related to symptom improvement in patients who suffered from anxiety as well as depression, and for those who first experienced depression at an early age.

"People with depression who don't have complicating issues like anxiety are fairly likely to show benefit even if they don't see the most highly rated therapists," said Daniel Strunk, co-author of the study and assistant professor of psychology at Ohio State University. "But people who have substantial anxiety or a history of depression that began at an early age really do best if they have the most highly rated treatment."

While the need for competent therapists might seem obvious, Strunk said there have been very few studies looking at whether the competence with which the therapy is delivered predicts subsequent outcomes. Studies that have examined the issue have tended to examine the relation of ratings of therapists and the overall outcomes of their patients. But that ignores the possibility that the competence of the therapists may not have been responsible for their patients' improvement. "Once patients have improved, they might help to make their therapists look more competent. If so, this could explain the competence-outcome relation. So, we wanted to see if we could rule out that possibility by examining whether competence predicted subsequent outcomes," Strunk said.

The research appears in a recent issue of the Journal of Consulting and Clinical Psychology. In this study, two researchers examined videotapes of therapy sessions involving 60 adults with moderate to severe depression and their six therapists. The researchers rated competence using the Cognitive Therapy Scale, which is also used by the accrediting organization for cognitive therapists (The Academy of Cognitive Therapy). The scale rates therapists on a variety of skills, including their interpersonal relations and their use of specific techniques thought to help patients facing depression. The researchers rated the therapists' competence during the first four sessions with each of the 60 patients. In addition, patients completed a questionnaire at each session that measured their depression levels.

Strunk and his colleagues then compared how competence scores given to the therapists for each session related to change in patients' depression levels from session to session. The researchers rated competence levels without knowing how the patients were progressing and whether their symptoms were improving, Strunk said. This way, the researchers could later tell whether there was an association between competence and subsequent patient improvement. Strunk said the strongest results came when they looked at how therapist competence was related to improvement in patients with specific characteristics. That is where they found that patients with high anxiety and early onset depression benefitted most from the highly rated therapy sessions.

In addition to looking at how therapist competence interacted with patient characteristics, the researchers also examined how competence, measured for each individual session, was related to patient improvement from one session to the next. Results showed that higher levels of therapist competence were related to more symptom improvement during the first four sessions.

The researchers also tested patients again after 16 weeks of treatment to see if competence predicted longer-term improvement. Here, competence was significantly related to patient improvement on just one of two measures of depression severity. "When you look at how patients do after four full months of treatment, the importance of therapist competence was still there, but not as strong," he said.

Strunk said the results suggest that therapists may show higher levels of competence in some sessions compared to others, even with the same patient. "From our results, you should expect that there will be a range of competence from session to session – even among good therapists," Strunk said. "That may mean that the way we define competence is still not good enough, because we're finding that even highly trained therapists get below-average scores a fair number of times."

The results should encourage more study about the best way to measure competence in therapists. "The field is still struggling to figure out how to measure competence, and that's one of the things this study is about," he said. Strunk also said that, if replicated, these results would suggest that clinic directors should look at patient characteristics when deciding which therapists should treat individual patients with depression. Those patients with anxiety issues or early onset depression should be placed with the highest-rated therapists to get the most benefit.

A new study from the Journal of Marital & Family Therapy warns of the dramatic rise in the use of psychotropic medications for children. One in every fifty Americans is now considered permanently disabled by mental illness, and up to eight million children take one or more psychotropic drugs.

The authors, James P. Morris, Ph.D. and George Stone, LCSW, state that there is little evidence available to warrant the widespread use of psychotropic drugs for children, and little long term data regarding its long term impact on development. According to the authors the mental health field is currently designed to treat adults with psychotropic medications, but they are often misused in the case of children and adolescents, "This presents an ethical challenge to marriage and family therapists, who should be very cautious about these medications as an option for children. The long-term research on their safety for children is uncertain."

As an example, the diagnosis of early onset bipolar disorder and attention deficit hyperactivity disorder has climbed drastically in the past decade. Drugs designed to treat the above two disorders show a fair short term risk-benefit ratio, but a poor long-term benefit. Morris and Stone indicate, "If the psychiatric community has been misled by pharmaceutical companies in thinking that these drugs are safe for their children, the parents of these children have been in turn deluded into putting their children in harm's way."

The authors continue that the pharmaceutical industry is largely influenced by the desire for economic profit, and the marketing muscle behind the industry, and leniency of institutions such as the FDA, tout benefits that are not yet properly evaluated for pediatric use. Between 1994 and 2001, psychotropic prescriptions for adolescents rose more than sixty percent; the rise post-1999 was connected to the development and marketing of several new psychotropic drugs and the rebranding of several older ones.

Morris and Stone claim that family health professionals are put in the line of fire when children begin to experience the negative consequences of long-term use of these medications. They are left with the challenge of evaluating the quality of evidence-based care offered to their pediatric clients by the psychiatric community, and the negative effects of the medications without sufficient empirical evidence or information.

Poisoning is now the second leading cause of unintentional injury death in the U.S. While several recent high-profile Hollywood celebrity cases have brought the problem to public attention, the rates of unintentional poisoning deaths have been on the rise for more than 15 years, and in fact, unintentional poisoning has surpassed motor vehicle crashes as the leading cause of unintentional injury death among people 35-54 years of age. In a study published in the May issue of the American Journal of Preventive Medicine, researchers found that hospitalizations for poisoning by prescription opioids, sedatives and tranquilizers in the U.S. have increased by 65% from 1999 to 2006.

"Deaths and hospitalizations associated with prescription drug misuse have reached epidemic proportions," said the study's lead author, Jeffrey H. Coben, MD, of the West Virginia University School of Medicine. "It is essential that health care providers, pharmacists, insurance providers, state and federal agencies, and the general public all work together to address this crisis. Prescription medications are just as powerful and dangerous as other notorious street drugs, and we need to ensure people are aware of these dangers and that treatment services are available for those with substance abuse problems."

In the first comprehensive examination of nationwide hospitalizations associated with these prescription medications, researchers examined data gathered from the Nationwide Inpatient Sample (NIS), which contains records for approximately 8 million hospitalizations per year. By using standard diagnosis codes from the ICD-9-CM, the authors extracted from the NIS all poisonings by drugs, medicinal, and biological substances reported from 1999-2006, and further categorized the specific types of drugs in each case. It was also possible to determine whether the poisoning was diagnosed as intentional, unintentional or undetermined.

Dr. Coben believes that while the data reveals a fast-growing problem, there's an urgent need for more in-depth research on this wave of injuries and deaths. Writing in the article, he said, "Interviews with survivors could provide important additional details regarding the pathways to abuse of these drugs, the methods used to obtain the medications, the sequencing and combination of drugs that result in overdose, and the immediate precursors to these serious events. The association between hospitalization for prescription opioids, sedatives, and tranquilizers and subsequent morbidity and mortality is another area in need of further research."

While the majority of hospitalized poisonings are classified as unintentional, substantial increases were also demonstrated for intentional overdoses associated with these drugs, likely reflecting their widespread availability in community settings.

From 1999-2006, total estimated hospitalizations in the U.S. for poisoning by prescription opioids, sedatives, and tranquilizers increased by 65%; while unintentional poisonings by these drugs increased by 37%. In comparison, during this same period, hospitalizations for poisoning by other drugs, medicinal and biological substances increased by 33%, while all other hospitalizations increased by just over 11%. Unintentional poisonings by other substances increased by 21%. Intentional poisonings from prescription opioids, sedatives, and tranquilizers rose by a total of 130% compared to a 53% increase in intentional poisonings from other substances.

The largest percentage increase in hospitalizations for poisoning for a specific drug was observed for methadone (400%). Poisonings by benzodiazepines increased 39%. Hospitalizations for poisoning by barbiturates actually decreased 41%, as did hospitalizations for poisoning by antidepressants (a decrease of 13%).

There is no evidence to support psychological debriefing in schools after traumatic events such as violence, suicides and accidental death, which runs counter to current practice in some Canadian school jurisdictions, according to a commentary http://www.cmaj.ca/embargo/cmaj091621.pdf in CMAJ (Canadian Medical Association Journal) www.cmaj.ca .

Recent systematic reviews indicate that psychological debriefing of adults does not prevent post-traumatic stress disorder and it may even increase the risk of this disorder. While there is little research on the effectiveness and safety of these interventions in schools, "the evidence clearly points to the ineffectiveness of these interventions in preventing post-traumatic stress disorder or any other psychiatric disorder in adults," write Magdalena Szumilas of the Sun Life Financial Chair in Adolescent Mental Health Team, Dalhousie University and coauthors.

Two programs, based on the empirically-supported principles of engendering feelings of safety, calmness, sense of self and community efficacy, connectedness and hope, show promise of effectiveness. Providing Psychological First Aid immediately after an incident and providing cognitive behavioural support for students with persistent distress weeks after a school trauma has ended may be helpful.

They urge that psychological debriefing not be performed after traumatic incidents in schools, and that more research is needed to assess psychological and mental health interventions prior to implementation in schools.

Smith, Daniel B. (Autumn 2009). The Doctor Is IN. The American Scholar.

At 88, Aaron Beck is now revered for an approach to psychotherapy that pushed Freudian analysis aside.

Behavior treatment works as well as drugs for children with ADHD and bypasses the risk of medication's side effects, a meta-analysis of 174 studies on ADHD treatment conducted at the University at Buffalo, has shown. The results, published in the March issue of Clinical Psychology Review, found that teaching parents and teachers how to respond when children do things the right way -- as well as when they display harmful or aggressive behavior -- is effective, and in some cases more effective, than medication for ADHD.

"This review shows that behavioral treatments work, and in general work well," said Gregory A. Fabiano, Ph.D., assistant professor in the Department of Counseling, School and Educational Psychology in UB's Graduate School of Education, and first author on the paper. "For the past couple of decades, there has been considerable professional controversy about the role and adequacy of behavior modification treatments in the care of children with ADHD. The next step is to figure out how to make them work for individual families over the long run, because we now know that ADHD is a lifelong condition."

Through use of behavior modification, children could bypass the risk of side effects from ADHD drugs and achieve the same or better results as drug treatments, Fabiano noted. William Pelham, Jr., Ph.D., UB Distinguished Professor of Psychology, Pediatrics and Psychiatry, is co-author on the study.

Fabiano noted that ADHD is one of the most common mental health disorders among children. "Prevalence rates place at least one child with ADHD in every classroom in America, highlighting the need for effective interventions. "Our results suggest that efforts should be redirected from debating the effectiveness of behavioral interventions to dissemination, enhancing and improving the use of these programs in community, school and mental health settings." In the future, Fabiano plans to work with teachers, parents, pediatricians and clinicians in the community to emphasize the effectiveness of behavior modification treatments.

His additional research includes developing strategies to get fathers more involved in the treatment of children with ADHD, and use of driving simulators to help teens with ADHD learn to drive, while also helping parents learn to provide effective driving instruction to their teens.

Fabiano is a recent recipient of the White House's Presidential Early Career Award for Scientists and Engineers, the nation's highest honor for professionals at the early stages of their independent scientific research careers.

Older adults with generalized anxiety disorder who received cognitive behavior therapy had greater improvement on measures of worry, depression and mental health than patients who received usual care, according to a study in the April 8 issue of JAMA.

Generalized anxiety disorder is common in late life, with prevalence up to 7.3 percent in the community and 11.2 percent in primary care. Late-life anxiety predicts increased physical disability, memory difficulties and decreased quality of life, according to background information in the article. Late-life anxiety is usually treated with medication, but associated risks (e.g., falls, hip fractures, memory problems) with some drugs and patient fears of adverse effects limit their usefulness. Two previous studies suggested benefits of cognitive behavior therapy in primary care for late-life GAD, but the studies were small and conclusions were limited. Older adults most often seek treatment for GAD in primary care.

Melinda A. Stanley, Ph.D., of Baylor College of Medicine, Houston, and colleagues conducted the first randomized clinical trial of CBT for late-life GAD in primary care to examine whether CBT would improve outcomes relative to enhanced usual care. The trial included 134 older adults (average age, 67 years) in two primary care settings, with treatment provided for 3 months. Assessments were conducted at the beginning of the trial, posttreatment (3 months), and over 12 months of follow-up, with assessments at 6, 9, 12 and 15 months. Patients were randomized to either CBT (n = 70), which included education and awareness, relaxation training, cognitive therapy, problem-solving skills training and behavioral sleep management; or EUC (n = 64), in which patients were telephoned biweekly during the first 3 months of the study by the same therapists to provide support and ensure patient safety. Therapists reminded patients to call project staff if symptoms worsened.

Levels of anxiety, worry, depression and physical/mental health quality of life were measured via various tests or surveys. The researchers found that CBT, compared with EUC, significantly improved worry severity, depressive symptoms and general mental health. In intention-to-treat analyses, response rates defined according to worry severity were higher following CBT compared with EUC at 3 months (40.0 percent vs. 21.9 percent).

"This study is the first to suggest that CBT can be useful for managing worry and associated symptoms among older patients in primary care," the authors write. "This study paves the way for future research to test sustainable models of care in more demographically heterogeneous groups."

The Boston Center for Refugee Health and Human Rights (BCRHHR) at Boston Medical Center recently treated many of the large number of Tibetan refugee monks who fled violent religious persecution. These individuals arrived in Boston suffering from symptoms of traumatic stress, interfering with their meditative practice. The monks were diagnosed by their traditional healers as having srog-rLung, a life-wind imbalance. Recognizing that barriers exist between western and eastern medicine, the BCRHHR researched and implemented its own complementary therapy options to heal them. These findings appear online in the March issue of Mental Health, Religion and Culture.

According to Tibetan medicine, a srog-rLung disturbance has the potential to develop into a serious mental illness, leaving the victim at odds with the balance of the universe as well as jeopardizing his personal health. Symptoms of srog-rLung include uncontrollable crying, worrying, excessive mental, physical or verbal activity and an unhappy mind. Other conditions affecting the monk’s health include anxiety, depression and post traumatic stress disorder (PTSD).

Research in cross-cultural health settings, particularly refugee health services, shows that successful treatment is contingent on a combination of the patient’s interpretation of the illness and biomedical categories. This allows the patient to actively participate in his or her own healing. Cross-cultural psychiatric assessment is also necessary in determining appropriate treatment options, as treatment can be detrimental if not harmonized with the religious context in which mental illness will develop for these monks. The BCRHHR used traditional healers to obtain a dual diagnosis for the development of holistic therapy that responds to both PTSD and srog-rLung.

“This research and treatment involving patients accustomed only to traditional medicine, presented an opportunity for the acceptance of non-traditional therapeutic approaches,” explains Michael Grodin, MD, professor of health law, bioethics and human rights at Boston University School of Public Health, and professor of psychiatry, sociomedical sciences and community medicine at Boston University School of Medicine. “The difference between Tibetan and Western disease pathologies represents the need for evidence-based complementary therapies, such as the Tibetan monks in exile and other religious refugee populations,” said Grodin.

Tibetan Buddhist tradition dictates that the cure for suffering is enlightenment, attainable through meditation. When this occurs, the body is freed from anxieties and fears. The monks who were treated for PTSD and srog-rLung are finding that meditation, once second nature, has become difficult after nights filled with flashbacks that put the monks in a state of hyper-vigilance for the next day.

According to the researchers, in order to provide complimentary therapy for the monks, eastern and western medicine needed to be integrated to properly address both conditions. The spiritual aspect of the Tibetan medical model, which is at the core of the monks’ experience of illness, guided this research. Ancient Tibetan Bon tradition of yogic practice was used to induce the mind into a relaxed state necessary to purify oneself through motion. This yogic practice combines movement of the body and controlled breath with movements of the mind to bring mental stability and offers an alternative to the monks’ inability to eliminate invasive thoughts. Another therapy that was used is singing bowl therapy—a form of music therapy, as sound has a direct connection to the heart, which aligns with srog-rLung experienced by the monks.

Grodin said the refugee health center at BMC integrated techniques of western medicine, such as anti-depressant prescribing and psychotherapy, with Tibetan healing practices, including medicines prescribed by Tibetan Amchi, meditation advice, Tai Chi and Qi Gong exercises. Grodin is trained in traditional Chinese medicine, such as acupuncture and meditation.

Other authors on the publication were Adriana Lee Benedict of Harvard College and Linda Mancini of the LamRim Buddhist Center and the BCRHHR.

Oedipus Wrecked: Study Supporting the Mother of All Psychological Complexes Withdrawn by Brendan Borrell

A journal retracts a paper that supported the idea that your wife is likely to look like your mother, but others say that Freud's theory may still hold water

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

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

Essential Research Findings in Counselling and Psychotherapy: The Facts are Friendly

The perception that therapists and their techniques play the most significant role in influencing the outcome of treatment is challenged in a new research review, launched today at the Annual Conference of the British Association for Counselling & Psychotherapy in Telford.

The book, Essential Research Findings in Counselling and Psychotherapy: The Facts are Friendly, written by Professor Mick Cooper of the University of Strathclyde, concludes that the most important factor in successful therapy is a client, or patient, who is motivated and engaged and who is able to use therapy to build on his or her strengths. Professor Cooper also finds that a strong relationship between therapist and client is one of the best indicators of a positive therapeutic outcome, and is far more significant than a therapist's particular techniques and approach.

The review is published at a time when the government has recently committed £173 million a year to be spent on Cognitive Behavioural Therapy (CBT) as part of its Improving Access to Psychological Therapies programme. Professor Cooper, of Strathclyde's Faculty of Education, said: "Many clients will benefit from CBT but there is a danger in putting too much emphasis on the type of therapy that a therapist provides, rather than the therapist's ability to relate to his or her client in caring and understanding ways, and the needs and preferences of individual clients. "Rather than moving towards a therapeutic 'monoculture', we need to be able to provide people with a range of therapies and therapists, so that they can choose the one that best suits them and build on their particular strengths." This finding is supported by the work of eminent American psychologist Barry Duncan and colleagues. They wrote in 2004 that "clients, not therapists, make therapy work."

The book, which is the first reader-friendly summary of research findings in the field, also offers advice to people who are considering seeing a therapist, on their choice of practitioner and the best type of therapy available to them. Professor Cooper said: "Think about choosing a therapist who can help you build on your strengths - for instance, if you are good at understanding why you do the things you do, a therapist who can help you develop these reflective skills may be more use to you than a therapist who wants to focus mainly on your behaviour or emotions. "Ask potential therapists what thoughts they might have on why you are facing the difficulties you are and what they think might help. If these are radically different from your own understandings, it may be more difficult to establish a good working relationship. "Ask yourself whether you like your therapist and feel respected by them – the quality of your relationship, early on in therapy, will be one of the best indicators of eventual outcomes, so don't put up with a bad relationship. Remember that probably the best predictor of the outcomes of therapy will be the extent to which you actively involve yourself in the process."

Professor Cooper also suggested that people experiencing a specific psychological disorder, such as a phobia, may wish to consult the website of the National Institute for Clinical Excellence (NICE) to find out which kind of therapy has the strongest evidence base for their problem. If, however, a particular therapy is not on the list, it is almost certainly because it has yet to be tested, rather than because it has been proven to be ineffective.

Psychodynamic psychotherapy lasting for at least a year is effective and superior to shorter-term therapy for patients with complex mental disorders such as personality and chronic mental disorders, according to a meta-analysis published in the October 1 issue of JAMA.

Evidence indicates that short-term psychodynamic psychotherapy is insufficient for a considerable proportion of patients with complex mental disorders, i.e., patients with multiple or chronic mental disorders or personality disorders. Some studies suggest that long-term psychodynamic psychotherapy (LTPP) may be helpful for these patients, according to background information in the article. LTPP is therapy in which emphasis is placed on more interpretive or supportive interventions, depending on the patient's needs, and that involves careful attention to the therapist-patient interaction.

Falk Leichsenring, D.Sc., of the University of Giessen, Germany, and Sven Rabung, Ph.D., of the University Medical Center Hamburg-Eppendorf, Hamburg, Germany, conducted a meta-analysis to examine the effectiveness of LTPP (lasting for at least a year, or 50 sessions) and whether it is superior to shorter psychotherapeutic treatments for complex mental disorders, including personality disorders, chronic mental disorders (defined as lasting at least a year) and multiple mental disorders. The researchers identified and included 23 studies for the meta-analysis (11 randomized controlled trials and 12 observational studies), involving a total of 1,053 patients receiving LTPP.

The authors found: "In this meta-analysis, LTPP was significantly superior to shorter-term methods of psychotherapy with regard to overall outcome, target problems, and personality functioning. Long-term psychodynamic psychotherapy yielded large and stable effect sizes in the treatment of patients with personality disorders, multiple mental disorders, and chronic mental disorders. The effect sizes for overall outcome increased significantly between end of therapy and follow-up."

With regard to overall effectiveness, analysis indicated that after treatment with LTPP patients with complex mental disorders on average were better off than 96 percent of the patients in the comparison groups. The authors add that further research should evaluate the cost-effectiveness of LTPP.

An analysis of news media coverage of medical studies indicates that news articles often fail to report pharmaceutical company funding and frequently refer to medications by their brand names, both potential sources of bias, according to a study in the October 1 issue of JAMA.

New articles represent an important source of medical information for many patients, and even some physicians. "An increasingly recognized source of commercial bias in medical research is the funding of studies by companies with a financial interest in the results," the authors write. Little is known about how frequently news articles report the funding sources of the medical research they report on, or how frequently news articles use brand medication names instead of generic names, which could create commercial bias.

Michael Hochman, M.D., of the Cambridge Health Alliance and Harvard Medical School, Cambridge, Mass., and colleagues reviewed U.S. news articles from newspaper and online sources about pharmaceutical-funded medication studies to determine how frequently and prominently they indicate the funding source and how often they refer to medications by their brand vs. generic names. The studies were published in five major general medical journals (JAMA, New England Journal of Medicine, Lancet, Archives of Internal Medicine and the Annals of Internal Medicine). The researchers also surveyed editors at the 100 most widely circulated newspapers in the U.S. about their publications' practices on the reporting of company funding and the use of generic medication names.

The authors identified 306 news articles, of which 175 were from newspapers and 131 were from online sources. Among the 306 news articles about company-funded medication studies, the funding source for the studies was not reported in 42 percent of the articles. There was no significant difference in nonreporting rates between articles obtained from newspaper and online sources. Of the 306 news articles, 277 concerned medications with both generic and brand names. Among these 277 articles, 38 percent used only brand names and 67 percent used brand names in at least half of the medication references.

The survey of newspaper editors found that 88 percent indicated that his/her publication often or always reported company funding in articles about medical research, and that 77 percent reported that they often or always referred to medications by the generic names in articles about medical research. Three percent of editors indicated that their publication had a written policy stating that company funding should be reported in articles about medical research, while the editor at two percent of newspapers responded that his/her publication had a written policy stating that medications should be referred to predominantly by their generic names.

However, the editors' perceptions diverged from their publications' actual performances. A total of 104 newspaper articles were analyzed from publications for which editors reported always identifying company funding. Of these articles, 45 percent failed to cite company funding. Additionally, a total of 75 newspaper articles were analyzed from publications for which the editors reported always using generic names. Of these articles, 76 percent used brand names in at least half of the medication references.

"Our findings raise several concerns. For patients and physicians to evaluate new research findings, it is important that they know how the research was funded so they can assess whether commercial biases may have affected the results. Additionally, the use of generic medication names by the news media is preferable so that physicians and patients learn to refer to medications by their generic names, a practice that is likely to reduce medication errors and may decrease unnecessary health care costs," the authors write.

American children are approximately three times more likely to be prescribed psychotropic medication than children in Europe. A new study published today in BioMed Central's open access journal Child and Adolescent Psychiatry and Mental Health claims that the differences may be accounted for by regulatory practices and cultural beliefs about the role of medication in emotional and behavioural problems.

Julie Zito led a team of researchers from the USA, Germany and the Netherlands who investigated prescription levels in the three countries. She said, "Antidepressant and stimulant prevalence were three or more times greater in the US than in the Netherlands and Germany, while antipsychotic prevalence was 1.5 to 2.2 times greater".

The use of antidepressants, like Prozac, and stimulants, like Ritalin, in children has been the subject of a great deal of controversy and this study quantifies the differences in practice between the US and Western Europe. The authors claim that the differences may be partly due to different diagnostic classification systems, "The US trend of increasing bipolar diagnosis in children and adolescents does not reflect European practice". The authors also mention government cost restrictions in Europe, the larger number of child psychiatrists per capita in the US and the use of two or more different psychotropic drugs in a single year in US children as possible explanations.

Zito concludes that, "Direct to consumer drug advertising, which is common in the US, is also likely to account for some of the differences. The increased use of medication in the US also reflects the individualist and activist therapeutic mentality of US medical culture".

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.

An interview with Albert Ellis, developer of Rational Emotive Behavior Therapy (REBT). The groundbreaking treatment rests on the premise that most of our emotional problems are based on irrational beliefs.

A common drug [propranolol] administered in the first hours following trauma to patients deemed to be at risk of developing post-traumatic stress disorder (PTSD) reduced the occurrence of PTSD, according to a study led by researchers at the University of Lille, France [in 2003].

While the study involved a small number of subjects, its results are encouraging, says its senior author, Charles Marmar, MD, associate chief of staff for mental health at the San Francisco VA Medical Center and professor and vice chair of psychiatry at University of California, San Francisco.

"The study is based on the new theory that PTSD is most likely to occur in patients who experience a particularly severe and prolonged response to trauma. If this model proves accurate after five or ten replications of studies like this one, it could have very profound ramifications. From a public health perspective, if you could identify the subgroup of people who are susceptible to PTSD, giving them this course of medication -- which is brief, very well tolerated and inexpensive -- could be very effective prevention [following major trauma] and may have great social relevance." The study appears in the November 1 issue of Biological Psychiatry. [read rest of article]

Also: The Memory Pill (60 Minutes video -- 26 Nov 2006)
Bad Memory? Wipe It Clean With New Pill (16 Jan 2006)

Why Does Cognitive Therapy Work?
By James Krehbiel

Cognitive-Behavioral Therapy for Somatization Disorder [abstract]
A Randomized Controlled Trial

Lesley A. Allen, PhD; Robert L. Woolfolk, PhD; Javier I. Escobar, MD; Michael A. Gara, PhD; Robert M. Hamer, PhD || Arch Intern Med 2006;166:1512-1518.

Background: Patients diagnosed as having somatization disorder (SD) who present with a lifetime history of multiple, medically unexplained physical symptoms represent a significant challenge to health care providers. To date, no psychotherapeutic or pharmacologic intervention has been found to produce clinically meaningful improvement in symptoms or functioning of patients with SD. We examined the efficacy of cognitive-behavioral therapy (CBT) for SD.

Methods:  Eighty-four participants meeting criteria for SD were randomly assigned to 1 of 2 conditions: (1) standard medical care augmented by a psychiatric consultation intervention or (2) a 10-session, manualized, individually administered CBT regimen added to the psychiatric consultation intervention. Assessments were conducted at baseline and 3, 9, and 15 months after baseline. The primary outcome measure was the severity scale of the Clinical Global Impression Scale for Somatization Disorder (CGI-SD). Secondary outcome measures were responder status as determined by clinical ratings, self-reported measures of physical functioning and somatic symptoms, and health care utilization assessed via medical records.

Results:  Fifteen months after baseline, somatization symptoms were significantly less severe in the group treated with CBT (0.84 points on the CGI-SD 7-point scale) (P<.001). Patients treated with CBT also were significantly more likely to be rated as either very much improved or much improved than patients treated with only augmented standard medical care (40% [n = 17] vs 5% [n = 2]). Cognitive-behavioral therapy was associated with greater improvements in self-reported functioning and somatic symptoms and a greater decrease in health care costs.
Author Affiliations: Department of Psychiatry, University of Medicine and Dentistry of New Jersey, Robert Wood Johnson Medical School, Piscataway (Drs Allen, Escobar, and Gara); Department of Psychology, Rutgers University, Piscataway (Dr Woolfolk); Department of Psychology, Princeton University, Princeton, NJ (Dr Woolfolk); and Department of Psychiatry, University of North Carolina School of Medicine, Chapel Hill (Dr Hamer).

When Alcoholics Anonymous and other 12-step programs are examined in controlled studies, a new review reports, scientists find no proof that they are superior to any other intervention in reducing alcohol dependence or alcohol-related problems.

The researchers, led by Marica Ferri of the Italian Agency for Public Health in Rome, found little to suggest that 12-step programs reduced the severity of addiction any more than any other intervention. And no data showed that 12-step interventions were any more — or any less — successful in increasing the number of people who stayed in treatment or reducing the number who relapsed after being sober.

Alcoholics Anonymous is a self-help group that offers emotional support for alcohol abstinence and holds that alcoholism is a spiritual and a medical disease. [read more]

New York Times
By Nicholas Bakalarp
Published: July 25, 2006

On his 150th anniversary, Freud's legacy is being dismantled by the ideas of his greatest challenger, Aaron Beck. Cognitive therapy is now the orthodox talking cure in Britain, and the government wants more of it. But with cognitive science comes a new battle for the meaning of the human mind.

After Freud by Alexander Linklater & Robert Harland
Prospect (June 2006)

...but researchers say side effects, interactions largely unknown. Read more about pediatric polypharmacy in this HealthDay News article.

The efficacy of cognitive therapy was evaluated in a University of Pennsylvania study of 120 suicide attempters from an emergency room. Half of the subjects received cognitive therapy and half received standard therapy. Over the course of an 18 month follow-up, 24.1% of those who got cognitive therapy made a second suicide attempt, compared to 41.6% of those who got standard treatment. Subjects who had received cognitive therapy also scored significantly lower on measurements of depression. Read more about the study:

Cognitive Therapy Halves Risk of Second Suicide Attempt
By Ed Edelson
HealthDay Reporter