Psychiatric treatment and psychosocial support may make a significant difference to survival and quality of life in women with cancer, a patient population with high rates of depression and anxiety, according to 2 studies presented here at the American Psychiatric Association 2011 Annual Meeting.
In the first study, a secondary analysis of a randomized controlled trial (RCT) of 125 women with metastatic breast cancer, investigators found that the median survival time for those who had decreasing depression symptom scores during a 1-year period was double that of those with increasing scores (53.6 vs 25.1 months).
"We were surprised at how big this difference was. It shows that treatment of depression, both psychotherapeutic and pharmacologic, is feasible and effective even in advanced cancer," David Spiegel, MD, Department of Psychiatry and Behavioral Sciences at Stanford University School of Medicine, California, and Stanford's Center on Stress and Health, told Medscape Medical News.
"Although the intervention we used wasn't associated with increased survival, we were able to show that decreasing depression may improve not only the quality but also the quantity of life for these women," added Dr. Spiegel.
In the second study, which was published online March 2 in Psycho-Oncology, researchers found that women who receive a cancer diagnosis during pregnancy were at particular risk of experiencing high levels of distress.
"Physicians should pay particular attention to several early markers of distress suggesting a need for referral to psychological supports. This may lead to improved long-term quality of life for both the women and for their children," Melissa Henry, PhD, from McGill University in Montreal, Quebec, Canada, told Medscape Medical News.
Monday, May 30, 2011
Thursday, May 26, 2011
Heavy Smoking Accompanies Postpartum Depression
Cigarette smoking should be a tip-off for the possibility of postpartum depression, according to a survey from the Pregnancy Risk Assessment Monitoring System. Results of a study suggesting this were presented here at American Congress of Obstetricians and Gynecologists 59th Annual Clinical Meeting.
The large survey showed that nearly 1 of every 3 mothers who reported smoking more than 10 cigarettes per day also had symptoms of clinical depression. Depression was more likely among heavier smokers who were younger, who were non-Hispanic black, and who had low levels of education.
"Our study suggests that screening and treatment of depression should be considered in all smoking-cessation programs that target new mothers," lead author Diana Cheng, MD, from the Maryland Department of Health and Mental Hygiene in Baltimore, told meeting attendees. The findings also suggest that healthcare workers should be alert to the possibility of postpartum depression in new mothers who are heavy smokers, and prescribe treatment accordingly, she added.
The study was based on a survey of a random sample of 8074 new mothers in Maryland who delivered babies between 2004 and 2008. Participants completed the survey between 2 and 9 months after delivery.
Fourteen percent of respondents reported smoking. Women were considered to have depression if they answered questions about depressive symptoms (mood and lack of interest) with "often" or "always". Compared with nonsmoking, heavier smoking was associated with 2 to 3 times the prevalence of depression (P < .05). Depression was strongly associated with the number of cigarettes smoked; it was found in 13% of nonsmokers, 22% of light smokers (10 or fewer cigarettes per day), and 29% of those who smoked more than 10 cigarettes per day.
The prevalence of depression was highest among heavier smokers who were younger than 20 years of age (41%) and were non-Hispanic blacks (39%). Depression was also strongly associated with education level: it was found in 46% of women who did not finish high school and in 9% of college graduates.
Postpartum depression is of great concern because it increases the risk of developing bipolar disorder and other psychosis, said Kristie Baisden, DO, chief resident at Georgetown University School of Medicine in Washington, DC. At the meeting, Dr. Baisden presented a poster on risk factors for postpartum depression. Her research on more than 900 women found that unemployment, being older than 35 years of age, and having any history of anxiety or depression increased the risk for postpartum depression.
"It is important to recognize and treat postpartum depression to avoid worsening mental health and subsequent problems," she stated.
The large survey showed that nearly 1 of every 3 mothers who reported smoking more than 10 cigarettes per day also had symptoms of clinical depression. Depression was more likely among heavier smokers who were younger, who were non-Hispanic black, and who had low levels of education.
"Our study suggests that screening and treatment of depression should be considered in all smoking-cessation programs that target new mothers," lead author Diana Cheng, MD, from the Maryland Department of Health and Mental Hygiene in Baltimore, told meeting attendees. The findings also suggest that healthcare workers should be alert to the possibility of postpartum depression in new mothers who are heavy smokers, and prescribe treatment accordingly, she added.
The study was based on a survey of a random sample of 8074 new mothers in Maryland who delivered babies between 2004 and 2008. Participants completed the survey between 2 and 9 months after delivery.
Fourteen percent of respondents reported smoking. Women were considered to have depression if they answered questions about depressive symptoms (mood and lack of interest) with "often" or "always". Compared with nonsmoking, heavier smoking was associated with 2 to 3 times the prevalence of depression (P < .05). Depression was strongly associated with the number of cigarettes smoked; it was found in 13% of nonsmokers, 22% of light smokers (10 or fewer cigarettes per day), and 29% of those who smoked more than 10 cigarettes per day.
The prevalence of depression was highest among heavier smokers who were younger than 20 years of age (41%) and were non-Hispanic blacks (39%). Depression was also strongly associated with education level: it was found in 46% of women who did not finish high school and in 9% of college graduates.
Postpartum depression is of great concern because it increases the risk of developing bipolar disorder and other psychosis, said Kristie Baisden, DO, chief resident at Georgetown University School of Medicine in Washington, DC. At the meeting, Dr. Baisden presented a poster on risk factors for postpartum depression. Her research on more than 900 women found that unemployment, being older than 35 years of age, and having any history of anxiety or depression increased the risk for postpartum depression.
"It is important to recognize and treat postpartum depression to avoid worsening mental health and subsequent problems," she stated.
Wednesday, May 25, 2011
Many Adults Report Troubled Childhood Experiences
Dec. 16, 2010 -- More than half of adults surveyed reported experiencing one or more difficult childhood experiences, such as domestic violence or verbal abuse, indicating that troubled childhood experiences could be common, according to a CDC study.
Adverse childhood experiences, such as physical abuse, sexual abuse, parents going through a divorce, a family member being in jail, and being mentally ill or abusing drugs, have been associated with an increased risk for several health problems, including heart disease, depression, cancer, and diabetes. By identifying and documenting the prevalence of adverse childhood experiences (ACEs), health care providers can boost their efforts in child abuse prevention and other parenting programs as a means to reduce ACEs.
Health Risks From Childhood
In this study, researchers from five state departments of health analyzed data from 26,229 adults living in Arkansas, Louisiana, New Mexico, Tennessee, and Washington State. The survey participants were asked about their childhood experiences involving eight categories of ACEs: verbal, physical, or sexual abuse, household mental illness, household substance abuse, witnessed domestic violence, parental separation or divorce, and incarcerated household member. Fifty-nine percent of the group reported experiencing at least one of these eight ACEs. Among the researchers' other findings:
8.7% of survey respondents reported experiencing five or more ACEs. Women were more likely than men to report more than five ACEs, 10.3% vs. 6.7%.
41% reported no ACEs.
Substance abuse was reported by 29.1% of the group, whereas an incarcerated family member was the least common response at 7.2%.
More than a quarter of respondents reported being verbally abused as a child; 14.8% reported physical abuse, and 12.2% reported sexual abuse.
Sexual abuse was more common among females than males, 17.2% vs. 6.7%.
26.6% of the group reported parental separation/divorce.
19.4% reported a history of living with someone mentally ill.
16.3% reported witnessing domestic violence.
Younger adults reported higher levels of physical abuse during their childhood compared with older adults, 16.9% among those aged 18 to 24 vs. 9.6% for those aged 55 and up.
Education was a major factor in ACEs, whereas race was not as significant. People with the least education were far more likely to report five or more ACEs compared with those who had higher levels of education; 14.9% among those who didn't complete high school vs. 8.7% among high school graduates vs. 7.7% among those with more than a high school education.
The findings are published in the Dec. 17 issue of Morbidity and Mortality Weekly Report (MMWR), a publication of the CDC.
"State-based surveillance of ACEs can provide guidance for the allocation of maltreatment prevention strategies and trauma-related intervention services," the authors write in MMWR. "In addition, more research is needed to disentangle the specific role each ACE plays in the development of health problems later in life."
Adverse childhood experiences, such as physical abuse, sexual abuse, parents going through a divorce, a family member being in jail, and being mentally ill or abusing drugs, have been associated with an increased risk for several health problems, including heart disease, depression, cancer, and diabetes. By identifying and documenting the prevalence of adverse childhood experiences (ACEs), health care providers can boost their efforts in child abuse prevention and other parenting programs as a means to reduce ACEs.
Health Risks From Childhood
In this study, researchers from five state departments of health analyzed data from 26,229 adults living in Arkansas, Louisiana, New Mexico, Tennessee, and Washington State. The survey participants were asked about their childhood experiences involving eight categories of ACEs: verbal, physical, or sexual abuse, household mental illness, household substance abuse, witnessed domestic violence, parental separation or divorce, and incarcerated household member. Fifty-nine percent of the group reported experiencing at least one of these eight ACEs. Among the researchers' other findings:
8.7% of survey respondents reported experiencing five or more ACEs. Women were more likely than men to report more than five ACEs, 10.3% vs. 6.7%.
41% reported no ACEs.
Substance abuse was reported by 29.1% of the group, whereas an incarcerated family member was the least common response at 7.2%.
More than a quarter of respondents reported being verbally abused as a child; 14.8% reported physical abuse, and 12.2% reported sexual abuse.
Sexual abuse was more common among females than males, 17.2% vs. 6.7%.
26.6% of the group reported parental separation/divorce.
19.4% reported a history of living with someone mentally ill.
16.3% reported witnessing domestic violence.
Younger adults reported higher levels of physical abuse during their childhood compared with older adults, 16.9% among those aged 18 to 24 vs. 9.6% for those aged 55 and up.
Education was a major factor in ACEs, whereas race was not as significant. People with the least education were far more likely to report five or more ACEs compared with those who had higher levels of education; 14.9% among those who didn't complete high school vs. 8.7% among high school graduates vs. 7.7% among those with more than a high school education.
The findings are published in the Dec. 17 issue of Morbidity and Mortality Weekly Report (MMWR), a publication of the CDC.
"State-based surveillance of ACEs can provide guidance for the allocation of maltreatment prevention strategies and trauma-related intervention services," the authors write in MMWR. "In addition, more research is needed to disentangle the specific role each ACE plays in the development of health problems later in life."
Psychiatry Deemed a Religion in New Study
Researchers at Jakarta's renowned Hebrew University recently published a study conclusively proving that Psychiatry should be classified as a religion. The study consisted of a study of Psychiatric textbooks and journals (which will now be known as scriptures) and interviews with Psychiatrists (better classified as priests) and patients (hereafter known as "the flock").
This work brings a logical answer to many nagging questions, like how Psychiatry could be considered the "authority" in matters of the mind when their results in the field have been poor, and are known to cause more damage than benefit. It may also shed some light on the tendency of Psychiatrists to molest children in a much higher percentage than the general populace.
"Psychiatry is portrayed alternately as a scientific study or branch of medicine but either of these is rapidly disproved," says Moshe Sapere of Hebrew University. "The science of Psychiatry is flawed. Their studies are mainly funded by drug companies and they publish illogical conclusions which - Surprise! - make the drug companies look good. Psychiatry claims similarity to medicine but this is in reality only marketing; the only real similarities to actual medicine are clothing and terminology. If you dressed up a parrot in a doctor's smock and taught it some Latin phrases, it wouldn't be a doctor. It's the same with Psychiatrists."
Some of the researchers were reluctant to agree with the "religion" moniker for a group known to be profit-based and harmful, but a study of religions of the past shows that many have been used for profit and have done harm to others. The matter of faith in a deity was also a sticking point but a study of Psychiatric scriptures reveals that Psychiatrists believe in an invisible entity known as "chemical imbalance". The existence of Chemical Imbalance is stated as fact in the texts though there is no proof of his existence, analogous to a Christian's belief in God or a Muslim's belief in Allah.
The key answer that led the researchers to declare Psychiatry as a religion is that their High Priests demand complete belief in unobservable phenomena and continue to forward their beliefs despite no obvious benefit. They are also known to vehemently attack anyone who points out the lack of proof to their claims. Most religions promise salvation in a future existence. Psychiatry does not specifically make those claims but clearly provides dubious benefit in this existence. The researchers are pleased that they have been able to finally clarify this subject and would like to pass the following message to Psychiatrists worldwide, "may Chemical Imbalance bless you".
This work brings a logical answer to many nagging questions, like how Psychiatry could be considered the "authority" in matters of the mind when their results in the field have been poor, and are known to cause more damage than benefit. It may also shed some light on the tendency of Psychiatrists to molest children in a much higher percentage than the general populace.
"Psychiatry is portrayed alternately as a scientific study or branch of medicine but either of these is rapidly disproved," says Moshe Sapere of Hebrew University. "The science of Psychiatry is flawed. Their studies are mainly funded by drug companies and they publish illogical conclusions which - Surprise! - make the drug companies look good. Psychiatry claims similarity to medicine but this is in reality only marketing; the only real similarities to actual medicine are clothing and terminology. If you dressed up a parrot in a doctor's smock and taught it some Latin phrases, it wouldn't be a doctor. It's the same with Psychiatrists."
Some of the researchers were reluctant to agree with the "religion" moniker for a group known to be profit-based and harmful, but a study of religions of the past shows that many have been used for profit and have done harm to others. The matter of faith in a deity was also a sticking point but a study of Psychiatric scriptures reveals that Psychiatrists believe in an invisible entity known as "chemical imbalance". The existence of Chemical Imbalance is stated as fact in the texts though there is no proof of his existence, analogous to a Christian's belief in God or a Muslim's belief in Allah.
The key answer that led the researchers to declare Psychiatry as a religion is that their High Priests demand complete belief in unobservable phenomena and continue to forward their beliefs despite no obvious benefit. They are also known to vehemently attack anyone who points out the lack of proof to their claims. Most religions promise salvation in a future existence. Psychiatry does not specifically make those claims but clearly provides dubious benefit in this existence. The researchers are pleased that they have been able to finally clarify this subject and would like to pass the following message to Psychiatrists worldwide, "may Chemical Imbalance bless you".
Tuesday, May 24, 2011
Chromosome 3 Area Linked to Depression- this heading will be posted in both blog , facebook and twitter, and the content below will be posted in blog only
May 19, 2011 — A study led by scientists at the Washington University School of Medicine, Saint Louis, Missouri, shows genomewide significant linkage between a region on chromosome 3 and major depressive disorder in individuals with a history of heavy smoking.
An independent study at King's College London, United Kingdom, has also identified this region — 3p25–3p26 — as being linked to severe depression. Both reports were published online May 15 in the American Journal of Psychiatry.
Replicated findings in separate studies of depression are unusual in the genetic linkage literature and in genomewide association studies (GWAS). The new studies provide "one of the strongest replicated genetic findings in studies for depression," said the British paper.
The US study stemmed from an interest in the high incidence of depression among cigarette smokers. Genetic factors are widely acknowledged in depression, but major depression is estimated to occur at some time in the lives of more than 60% of smokers who try to quit. Smokers with this history often experience more difficult nicotine withdrawal and are more likely to resume smoking.
Study participants were selected from families with a history of cigarette smoking and at least 1 pair of siblings having a history of major depression. Both depressive disorder, based on the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, and tobacco use and dependency were evaluated by telephone interviews.
Participants (91 Australian families, 187 participants; and 25 Finnish families, 33 participants) were genotyped, and analysis of "affected sibling pair nonparametric linkage" generated logarithmic odds ratio (LOD) scores. Typically, a LOD score greater than 3.0 is evidence of linkage. If LOD equals 3, the odds are 1000 to 1 (ie, 103 to 1) that the linkage is not caused by chance.
"I don't think linkage necessarily provides an advantage over association studies [GWAS], they are just different approaches," explained first author Michele L. Pergadia, PhD, from the Department of Psychiatry, Washington University School of Medicine, in an email to Medscape Medical News.
"Linkage is a classic way to map very broad genomic regions in families that are characterized by specific traits," said Dr. Pergadia. "[I]t highlights an area that may be of interest to study further, in order to identify the actual genes, but it is not a method for identification of the specific genes yet, just a first step in that process."
Analysis of the Australian cohort found a "multipoint LOD score" equaling 4.14 for major depressive disorder in a region on chromosome 3, a result that has genomewide significance (P = .004).
The highest LOD score for a single-point marker was 3.7 for a location within GRM7, the gene for the metabotropic glutamate receptor 7.
The Finnish sample showed no regions with this level of significance, and major linkage signals did not overlap between the Australian and Finnish samples. However, when the US scientists sought to replicate their results, the British researchers contacted them to report the same significant finding, says the Washington University press release.
Authors of the US study note that previous investigators have found evidence of associations between GRM7 variants and depressive disorder, but none of this evidence has reached genomewide significance.
"GRM7 is an interesting gene," observed Douglas F. Levinson, MD, professor of psychiatry, Stanford University School of Medicine, California, in an email to Medscape Medical News. "If you search in PubMed for GRM7 and mood or depression, you will find a large animal pharmacological literature that suggests a role in mood regulation and interest in this gene as a possible antidepressant target."
Dr. Levinson had coauthored a study that suggested a possible GWAS signal in GRM7, but after genomewide correction, the results were not statistically significant. In fact, he is unaware of any significant evidence of associations for GRM7 after correction.
"Our linkage findings highlight a broad area, which spans many genes (>90) that could potentially be contributing to our findings," said Dr. Pergadia. "There are many interesting candidate genes in this region, including, for example, those that code for proteins related to the oxytocin receptor gene (OXTR) [or] GABA transporters (eg, SLC6A11), in addition to those associated with glutamate receptors (eg, GRM7 and GRIP2), but again we did not find any that met genomewide significance.
"So far as I know, while suggestive association has been reported, none of these genes has been associated with depression at the level which would meet genomewide significance (eg, ~5 × 10−8)," Dr. Pergadia added.
The King's College London study investigated recurrent depression, rather than nicotine use, studying sibling pairs with recurrent unipolar depression from clinics in several countries. Their study involved genomewide linkage analysis of 839 families, including 971 pairs of siblings affected with recurrent severe depression.
Their highest LOD scores found were 4.01, for "severe recurrent and very severe recurrent" depression, which identified a linkage signal with genomewide significance in the 3p25-3p26 region. However, when this region was mapped in a depression GWAS sample, the association did not achieve significance. Among potential candidate genes within the region are GRM7 and OXTR, as well as ITPR1 — encoding a receptor for inositol triphosphate, which influences calcium channels and serves as a second messenger in the nervous system.
Despite the replicated findings of these 2 studies, a gene or genes responsible for severe depression are still not identified. Dr. Pergadia summarized the current situation: "I think we're just beginning to make our way through the maze of influences on depression."
The Pergadia study was supported by the European Union and a Center for Inherited Disease Research grant. Various authors in the Pergadia study report receiving an Academy of Finland postdoctoral fellowship, an Australian National Health and Medical Research Council fellowship, the National Health and Medical Research Council (Australia) Sidney Sax Fellowship, and an Australian National Health and Medical Research Council fellowship, as well as funding from the Doctoral Programs of Public Health, University of Helsinki; National Institutes of Health; US Department of Defense; Netherlands Organisation for Scientific Research; Australian National Health and Medical Research Council; AstraZeneca; Genentech; Pfizer; and the Academy of Finland Center of Excellence for Complex Disease Genetics, in addition to receiving an advisory panel payment from AstraZeneca, consultation fees and an unrestricted grant from Pfizer. The Breen study was supported by GlaxoSmithKline Research and Development. Authors in the Breen study report having been employed by GlaxoSmithKline, being a shareholder with GlaxoSmithKline, being an employee and a shareholder with F. Hoffman-La Roche, being affiliated with Medical Genetics, being employed by NeuroSearch A/S, and having received travel and subsistence from GlaxoSmithKline. Dr. Levinson has disclosed no relevant financial relationships.
An independent study at King's College London, United Kingdom, has also identified this region — 3p25–3p26 — as being linked to severe depression. Both reports were published online May 15 in the American Journal of Psychiatry.
Replicated findings in separate studies of depression are unusual in the genetic linkage literature and in genomewide association studies (GWAS). The new studies provide "one of the strongest replicated genetic findings in studies for depression," said the British paper.
The US study stemmed from an interest in the high incidence of depression among cigarette smokers. Genetic factors are widely acknowledged in depression, but major depression is estimated to occur at some time in the lives of more than 60% of smokers who try to quit. Smokers with this history often experience more difficult nicotine withdrawal and are more likely to resume smoking.
Study participants were selected from families with a history of cigarette smoking and at least 1 pair of siblings having a history of major depression. Both depressive disorder, based on the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, and tobacco use and dependency were evaluated by telephone interviews.
Participants (91 Australian families, 187 participants; and 25 Finnish families, 33 participants) were genotyped, and analysis of "affected sibling pair nonparametric linkage" generated logarithmic odds ratio (LOD) scores. Typically, a LOD score greater than 3.0 is evidence of linkage. If LOD equals 3, the odds are 1000 to 1 (ie, 103 to 1) that the linkage is not caused by chance.
"I don't think linkage necessarily provides an advantage over association studies [GWAS], they are just different approaches," explained first author Michele L. Pergadia, PhD, from the Department of Psychiatry, Washington University School of Medicine, in an email to Medscape Medical News.
"Linkage is a classic way to map very broad genomic regions in families that are characterized by specific traits," said Dr. Pergadia. "[I]t highlights an area that may be of interest to study further, in order to identify the actual genes, but it is not a method for identification of the specific genes yet, just a first step in that process."
Analysis of the Australian cohort found a "multipoint LOD score" equaling 4.14 for major depressive disorder in a region on chromosome 3, a result that has genomewide significance (P = .004).
The highest LOD score for a single-point marker was 3.7 for a location within GRM7, the gene for the metabotropic glutamate receptor 7.
The Finnish sample showed no regions with this level of significance, and major linkage signals did not overlap between the Australian and Finnish samples. However, when the US scientists sought to replicate their results, the British researchers contacted them to report the same significant finding, says the Washington University press release.
Authors of the US study note that previous investigators have found evidence of associations between GRM7 variants and depressive disorder, but none of this evidence has reached genomewide significance.
"GRM7 is an interesting gene," observed Douglas F. Levinson, MD, professor of psychiatry, Stanford University School of Medicine, California, in an email to Medscape Medical News. "If you search in PubMed for GRM7 and mood or depression, you will find a large animal pharmacological literature that suggests a role in mood regulation and interest in this gene as a possible antidepressant target."
Dr. Levinson had coauthored a study that suggested a possible GWAS signal in GRM7, but after genomewide correction, the results were not statistically significant. In fact, he is unaware of any significant evidence of associations for GRM7 after correction.
"Our linkage findings highlight a broad area, which spans many genes (>90) that could potentially be contributing to our findings," said Dr. Pergadia. "There are many interesting candidate genes in this region, including, for example, those that code for proteins related to the oxytocin receptor gene (OXTR) [or] GABA transporters (eg, SLC6A11), in addition to those associated with glutamate receptors (eg, GRM7 and GRIP2), but again we did not find any that met genomewide significance.
"So far as I know, while suggestive association has been reported, none of these genes has been associated with depression at the level which would meet genomewide significance (eg, ~5 × 10−8)," Dr. Pergadia added.
The King's College London study investigated recurrent depression, rather than nicotine use, studying sibling pairs with recurrent unipolar depression from clinics in several countries. Their study involved genomewide linkage analysis of 839 families, including 971 pairs of siblings affected with recurrent severe depression.
Their highest LOD scores found were 4.01, for "severe recurrent and very severe recurrent" depression, which identified a linkage signal with genomewide significance in the 3p25-3p26 region. However, when this region was mapped in a depression GWAS sample, the association did not achieve significance. Among potential candidate genes within the region are GRM7 and OXTR, as well as ITPR1 — encoding a receptor for inositol triphosphate, which influences calcium channels and serves as a second messenger in the nervous system.
Despite the replicated findings of these 2 studies, a gene or genes responsible for severe depression are still not identified. Dr. Pergadia summarized the current situation: "I think we're just beginning to make our way through the maze of influences on depression."
The Pergadia study was supported by the European Union and a Center for Inherited Disease Research grant. Various authors in the Pergadia study report receiving an Academy of Finland postdoctoral fellowship, an Australian National Health and Medical Research Council fellowship, the National Health and Medical Research Council (Australia) Sidney Sax Fellowship, and an Australian National Health and Medical Research Council fellowship, as well as funding from the Doctoral Programs of Public Health, University of Helsinki; National Institutes of Health; US Department of Defense; Netherlands Organisation for Scientific Research; Australian National Health and Medical Research Council; AstraZeneca; Genentech; Pfizer; and the Academy of Finland Center of Excellence for Complex Disease Genetics, in addition to receiving an advisory panel payment from AstraZeneca, consultation fees and an unrestricted grant from Pfizer. The Breen study was supported by GlaxoSmithKline Research and Development. Authors in the Breen study report having been employed by GlaxoSmithKline, being a shareholder with GlaxoSmithKline, being an employee and a shareholder with F. Hoffman-La Roche, being affiliated with Medical Genetics, being employed by NeuroSearch A/S, and having received travel and subsistence from GlaxoSmithKline. Dr. Levinson has disclosed no relevant financial relationships.
AN EXAMPLE OF PHYSICAL PROBLEMS DUE TO MANIFESTATION OF INNER PSYCHIC CONFLICTS
"A MAN CAME WITH COMPLAINTS OF BURNING SENSATION AND GENERALIZED BODY ACHE,HIS ALL INVESTIGATION REPORTS WERE NORMAL ON ENQUIRING IT WAS FOUND THAT HE HAS RELATIONSHIP PROBLEMS WITH HIS WIFE,WHICH CAUSED HIM MASKED DEPRESSION , AFTER DOING COUNSELING AND PRESCRIBING ANTIDEPRESSANTS .HE IS DOING WELL NOW 1 MONTH LATER"
THIS IS AN EXAMPLE OF PHYSICAL PROBLEMS DUE TO MANIFESTATION OF INNER PSYCHIC CONFLICTS - Dr.Tirthankar Dasgupta.
THIS IS AN EXAMPLE OF PHYSICAL PROBLEMS DUE TO MANIFESTATION OF INNER PSYCHIC CONFLICTS - Dr.Tirthankar Dasgupta.
Wednesday, May 18, 2011
Experiencing trauma and/or witnessing traumatic events may significantly increase the risk of developing physical disease, including diabetes, obesity, and cardiovascular disease (CVD), new research suggests.
A national study presented here at the American Psychiatric Association 2011 Annual Meeting shows undergoing injurious or psychological trauma or directly witnessing a traumatic event were all associated with a significant unadjusted risk for CVD, arteriosclerosis or hypertension, gastrointestinal (GI) disease, diabetes, arthritis, and obesity.
In addition, experiencing a natural disaster or terrorism was associated with all these conditions except for obesity, whereas combat trauma was associated with cardiovascular and GI disease only.
"We found that a variety of events were significantly associated with a number of physical conditions, which, based on past research, was expected," principal investigator Natalie Husarewycz, MD, told Medscape Medical News.
Injurious (or direct) trauma included accidents or physical attacks; psychological trauma included neglect, being stalked, or threatened with a weapon; and combat-related trauma included events experienced by active military personnel, peacekeepers, unarmed civilians in war time, and refugees.
Clinical Implications
Although the study could not establish causation, Dr. Husarewycz said the findings have important clinical implications.
"Even in individuals with a trauma history that don't fulfill Axis I or II disorder criteria, we should perhaps consider screening for physical health conditions. And there may be reason for primary care physicians seeing people with multiple somatic conditions to consider screening for past traumatic events."
Dr. Husarewycz reported that patients with peptic ulcer disease, CVD, asthma, or diabetes have increased odds of having a mood or anxiety disorder.
According to the presentation, past research has suggested an association between posttraumatic stress disorder (PTSD) and chronic pain conditions, CVD, GI disease, and cancer. Other findings have suggested that physical and sexual abuse is significantly associated with health conditions that include neurologic, musculoskeletal, and GI disorders.
"However, there has been a dearth of population-based research examining whether the nature of trauma experienced may be related to physical health conditions," the study authors report.
"Our questions were: is there a cumulative effect of multiple traumatic events that would predict these physical conditions? And is it the nature of the trauma that was experienced or a mental disorder that would drive the relationship to physical health conditions?" added Dr. Husarewycz.
The researchers evaluated data on 34,653 patients older than 20 years from the US National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) Wave II.
Lifetime trauma experiences and past-year physician-diagnosed medical conditions were reported by all NESARC participants in a face-to-face interview.
Significant Physical Conditions
Results showed substantial overlap between the groups, with 30.68% of the participants experiencing an injurious trauma, 17.32% a psychological trauma, 16.10% a natural disaster or terrorism-related trauma, and 7.53% a combat-related trauma. A total of 71.57 reported witnessing a traumatic event.
Overall, there was "an increased likelihood of suffering from physical health conditions with increased exposure to traumatic events, in a linear pattern," reported Dr. Husarewycz.
After adjusting for sociodemographic factors only, the odds ratios (ORs) were significant for experiencing all physical health conditions by those who underwent injurious (ORs ranging from 1.24 to 1.89) or psychological trauma (ORs, 1.17 – 1.77) or witnessed trauma (ORs, 1.30 – 1.78); were significant for experiencing all but obesity by those who underwent trauma involving natural disaster or terrorism (ORs, 1.20 – 1.55); and were significant for experiencing CVD (OR, 1.36) and GI disease (OR, 1.39) for those with combat trauma.
After also adjusting for any Axis I or Axis II mental disorders in a second model, the findings were similar except that combat trauma was negatively associated with obesity and actually offered a protective effect (OR, 0.87).
In a third study model that adjusted also for all other trauma groups to account for event overlap, the findings were similar to the second model except that psychological trauma was no longer associated with arteriosclerosis/hypertension or obesity and natural disaster/terrorism was no longer associated with arteriosclerosis/hypertension or diabetes.
In addition, in this model, combat trauma lost association with all physical health conditions except for offering a protective effect for obesity.
Biological Changes
When discussing possible reasons for the various associations found, Dr. Husarewycz explained that alterations in hormones and other mediators are commonly seen in patients with PTSD, including cortisol levels. However, some research has found that even without PTSD, survivors of trauma have increased autonomic reactivity.
"It's likely that trauma itself is associated with biological changes," said Dr. Husarewycz.
She noted that "the main reason" why the association between the physical conditions and combat-related trauma disappeared in the last adjustments was because "the other types of trauma, which were controlled for only in the final model, likely mediated the relationship."
She also voiced the possibility of a "healthy warrior" effect. "This is the idea that perhaps chronically ill soldiers are selectively withheld from deployment while physically healthier soldiers may be deployed and would then experience the trauma."
Study limitations cited included its retrospective design and that participants self-reported their physical conditions, which may have led to some recall bias.
During a question and answer session following the presentation, session moderator Jerald Block, MD, asked Dr. Husarewycz if perhaps the investigators were "measuring a somatic preoccupation in patients exposed to trauma" — and therefore getting more medical diagnoses.
"As with anything that is self-reported, there is certainly that potential. In these data, it's supposedly physician diagnosed, but there wasn't any way to know that for sure," replied Dr. Husarewycz.
"Traumatic events related to physical conditions is a finding that's been talked about for years and years and goes back to psychoanalytic theory about PTSD and such. So I think it's helpful and good to see confirmation in these sorts of findings," Dr. Block, clinical director for the Rural Mental Health Program for the Portland VA in Oregon, later told Medscape Medical News.
"It's certainly an important area of study but at this early phase I'd be cautious about drawing too much from the specifics in this research. Still, I think it's very worthwhile to pursue it more," concluded Dr. Block.
The study authors and Dr. Block have disclosed no relevant financial relationships.
American Psychiatric Association (APA) 2011 Annual Meeting: Scientific and Clinical Report Session 6, No. 3. Presented May 14, 2011.
In addition, experiencing a natural disaster or terrorism was associated with all these conditions except for obesity, whereas combat trauma was associated with cardiovascular and GI disease only.
"We found that a variety of events were significantly associated with a number of physical conditions, which, based on past research, was expected," principal investigator Natalie Husarewycz, MD, told Medscape Medical News.
Injurious (or direct) trauma included accidents or physical attacks; psychological trauma included neglect, being stalked, or threatened with a weapon; and combat-related trauma included events experienced by active military personnel, peacekeepers, unarmed civilians in war time, and refugees.
Clinical Implications
Although the study could not establish causation, Dr. Husarewycz said the findings have important clinical implications.
"Even in individuals with a trauma history that don't fulfill Axis I or II disorder criteria, we should perhaps consider screening for physical health conditions. And there may be reason for primary care physicians seeing people with multiple somatic conditions to consider screening for past traumatic events."
Dr. Husarewycz reported that patients with peptic ulcer disease, CVD, asthma, or diabetes have increased odds of having a mood or anxiety disorder.
According to the presentation, past research has suggested an association between posttraumatic stress disorder (PTSD) and chronic pain conditions, CVD, GI disease, and cancer. Other findings have suggested that physical and sexual abuse is significantly associated with health conditions that include neurologic, musculoskeletal, and GI disorders.
"However, there has been a dearth of population-based research examining whether the nature of trauma experienced may be related to physical health conditions," the study authors report.
"Our questions were: is there a cumulative effect of multiple traumatic events that would predict these physical conditions? And is it the nature of the trauma that was experienced or a mental disorder that would drive the relationship to physical health conditions?" added Dr. Husarewycz.
The researchers evaluated data on 34,653 patients older than 20 years from the US National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) Wave II.
Lifetime trauma experiences and past-year physician-diagnosed medical conditions were reported by all NESARC participants in a face-to-face interview.
Significant Physical Conditions
Results showed substantial overlap between the groups, with 30.68% of the participants experiencing an injurious trauma, 17.32% a psychological trauma, 16.10% a natural disaster or terrorism-related trauma, and 7.53% a combat-related trauma. A total of 71.57 reported witnessing a traumatic event.
Overall, there was "an increased likelihood of suffering from physical health conditions with increased exposure to traumatic events, in a linear pattern," reported Dr. Husarewycz.
After adjusting for sociodemographic factors only, the odds ratios (ORs) were significant for experiencing all physical health conditions by those who underwent injurious (ORs ranging from 1.24 to 1.89) or psychological trauma (ORs, 1.17 – 1.77) or witnessed trauma (ORs, 1.30 – 1.78); were significant for experiencing all but obesity by those who underwent trauma involving natural disaster or terrorism (ORs, 1.20 – 1.55); and were significant for experiencing CVD (OR, 1.36) and GI disease (OR, 1.39) for those with combat trauma.
After also adjusting for any Axis I or Axis II mental disorders in a second model, the findings were similar except that combat trauma was negatively associated with obesity and actually offered a protective effect (OR, 0.87).
In a third study model that adjusted also for all other trauma groups to account for event overlap, the findings were similar to the second model except that psychological trauma was no longer associated with arteriosclerosis/hypertension or obesity and natural disaster/terrorism was no longer associated with arteriosclerosis/hypertension or diabetes.
In addition, in this model, combat trauma lost association with all physical health conditions except for offering a protective effect for obesity.
Biological Changes
When discussing possible reasons for the various associations found, Dr. Husarewycz explained that alterations in hormones and other mediators are commonly seen in patients with PTSD, including cortisol levels. However, some research has found that even without PTSD, survivors of trauma have increased autonomic reactivity.
"It's likely that trauma itself is associated with biological changes," said Dr. Husarewycz.
She noted that "the main reason" why the association between the physical conditions and combat-related trauma disappeared in the last adjustments was because "the other types of trauma, which were controlled for only in the final model, likely mediated the relationship."
She also voiced the possibility of a "healthy warrior" effect. "This is the idea that perhaps chronically ill soldiers are selectively withheld from deployment while physically healthier soldiers may be deployed and would then experience the trauma."
Study limitations cited included its retrospective design and that participants self-reported their physical conditions, which may have led to some recall bias.
During a question and answer session following the presentation, session moderator Jerald Block, MD, asked Dr. Husarewycz if perhaps the investigators were "measuring a somatic preoccupation in patients exposed to trauma" — and therefore getting more medical diagnoses.
"As with anything that is self-reported, there is certainly that potential. In these data, it's supposedly physician diagnosed, but there wasn't any way to know that for sure," replied Dr. Husarewycz.
"Traumatic events related to physical conditions is a finding that's been talked about for years and years and goes back to psychoanalytic theory about PTSD and such. So I think it's helpful and good to see confirmation in these sorts of findings," Dr. Block, clinical director for the Rural Mental Health Program for the Portland VA in Oregon, later told Medscape Medical News.
"It's certainly an important area of study but at this early phase I'd be cautious about drawing too much from the specifics in this research. Still, I think it's very worthwhile to pursue it more," concluded Dr. Block.
The study authors and Dr. Block have disclosed no relevant financial relationships.
American Psychiatric Association (APA) 2011 Annual Meeting: Scientific and Clinical Report Session 6, No. 3. Presented May 14, 2011.
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