Category Archives: Drug News
THURSDAY May 23, 2013 — Symptoms of borderline personality disorder often mimic traits of other psychiatric disorders, complicating diagnosis and treatment. But researchers in Canada say they have identified a characteristic that may be unique to borderline personality disorder: a tendency to misinterpret emotions expressed by the face.
“They have difficulty processing facial emotions and will see a negative emotion on a neutral face,” said Anthony Ruocco, a clinical neuropsychologist and assistant professor at the University of Toronto. “This is not seen in bipolar disorder or schizophrenia.”
Inaccuracies in recognizing anger, sadness, fear and disgust also were noted in Ruocco’s recent study, with greater deficits related to anger and disgust.
Although more research is needed to understand the brain mechanisms involved in these misperceptions and their significance, Ruocco called these “potentially important” deficits.
“There may be neurobiological factors that contribute to these biases in emotion perception,” he said. Pinpointing those factors might lead to better understanding of the illness and improved treatments.
But whether these misperceptions trigger the outbursts so common among people with borderline personality disorder was not within the scope of the studies.
People with borderline personality disorder have trouble regulating their emotions. They tend to act impulsively, lash out in anger and have stormy relationships. Many fear abandonment, complain of feeling empty and engage in bodily self-harm, such as cutting. High rates of suicide also are associated with the condition.
Ruocco discussed the study, published in the journal Psychological Medicine, at recent conferences co-sponsored by the National Education Alliance for Borderline Personality Disorder in Boston and New Haven, Conn.
His research, called a meta-analysis, involved a review of 10 previously published studies on emotion recognition. More than 500 people were involved: 266 with borderline personality disorder and 255 mentally healthy people, or controls. Participants were overwhelmingly female, with an average age of 29.
Not only did subjects with borderline personality disorder misread facial emotions, the studies showed, but they also took more time to interpret facial emotions than others. And when they perceived anger, it induced stronger reactions than in healthy control subjects, Ruocco’s team found.
Two of the studies analyzed noted that patients were more likely to report negative emotions when viewing faces displaying no emotion.
“Neutral faces are simply faces that were produced by actors with the intention of showing no emotion,” Ruocco said. “Typically, researchers have tested these faces with healthy individuals and confirmed that nearly all people perceive them as neutral.”
A smaller study conducted by Ruocco’s team, which is not yet published, found that individuals with borderline personality disorder also reported mild expressions of sadness as more intensely sad than others do. This was true even when the researchers accounted for depression.
About 6 percent of adults in the United States have borderline personality disorder, according to the National Education Alliance for Borderline Personality Disorder, which also estimates that 20 percent of all psychiatric hospital admissions and 10 percent of outpatient treatment involve the condition.
The National Education Alliance for Borderline Personality Disorder has more about borderline personality disorder.
Posted: May 2013
THURSDAY May 23, 2013 — While some fast-food chains are required to provide calorie and other nutritional information to help customers make informed choices, kids who eat fast food at least twice a week are 50 percent less likely to use this information than kids who eat fast food less often, according to a new U.S. study.
Those most likely to use the calorie information are girls and children who are obese, said the researchers from the U.S. Centers for Disease Control and Prevention.
The study was published online May 23 in the Journal of Public Health.
“Our findings are important given the high prevalence of obesity among youth and the adverse health effects associated with obesity,” study lead author Dr. Holly Wethington said in a journal news release. “It is encouraging that a large number of youth, particularly youth who are obese, reported using the calorie information.
“This may have potential to lead to improved food and beverage choices as a way to manage weight, although more research is needed to assess whether youth know how many calories they should consume in a day given their activity level,” added Wethington, of the CDC’s division of nutrition, physical activity and obesity.
Childhood obesity has tripled in recent decades, partly due to fast food that is higher in calories, salt and fat than food prepared at home, the CDC researchers noted. In conducting the study, they analyzed mail surveys from 721 kids ranging in age from 9 to 18 years.
The survey, done in the fall of 2010, asked the children how often they ate fast food, and if they considered the calorie information on the menu. They were also asked if this information influenced their food choices. The researchers also considered the participants’ age, gender, height and weight.
Fifty-six percent of those surveyed were boys, and while most of the children were a healthy weight, 13 percent were obese.
The survey revealed that 66 percent of the kids said they ate fast food once a week or less, and 34 percent reported eating fast food two or more times a week.
Forty-two percent of the kids said they considered the calorie information when making food choices; nearly 58 percent said they never used it, the survey found.
Girls were 80 percent more likely to consider calories than boys, and obese children were about 70 percent more likely to use calorie information.
Those eating fast food twice a week or more were 50 percent less likely to consider calorie counts than the kids who ate fast food less frequently, the investigators found.
The study authors suggested that public health and school officials could create educational programs designed to help young people understand calorie information so it can become a part of an overall weight management strategy.
“This welcome research adds to our understanding of young people and their food choices,” Lindsey Davies, president of the U.K. Faculty of Public Health, said in the news release. “It’s good news that some young people want to understand more about the food they’re eating and are using calorie information when they eat in fast-food restaurants.”
However, to fight the obesity epidemic, Davies added that it’s important to know why young people choose to eat fast food so often. Legislators could help tackle the problem by banning trans fats, which have no nutritional value and can increase the risk for heart disease, she said.
Visit Harvard Medical School for more on children and fast food.
Posted: May 2013
WEDNESDAY May 22, 2013 — People who endure chronic migraines or back pain are more likely to attempt suicide, whether or not they also suffer from depression or another psychiatric condition, according to a new study.
“Clinicians who are seeing patients with certain pain conditions should be aware they are at increased risk of suicide,” said study co-author Mark Ilgen, of the Veterans Affairs Serious Mental Illness Treatment Resource and Evaluation Center in Ann Arbor, Mich.
“Although undoubtedly psychiatric factors are important, there might be aspects of the pain that in and of themselves increase a person’s risk,” Ilgen said. “There might be something about someone with significant pain that puts them at increased risk.”
The wide-ranging study, published online May 22 in the journal JAMA Psychiatry, involved more than 4.8 million people who received care from the U.S. Veterans Health Administration during fiscal year 2005. Researchers identified those suffering from chronic pain and tracked them for the next three years to see if any died from suicide.
The research team then looked for associations between suicide death — the 10th most common cause of death in the United States — and clinical diagnoses of chronic pain conditions, such as arthritis, back pain, migraines, neuropathy, headaches or tension headaches, fibromyalgia and psychogenic pain.
They found that all pain conditions except arthritis and neuropathy were associated with elevated suicide risk. But when they took into account the mental-health problems that chronic pain patients also had, the associations reduced for all but three types of chronic pain: back pain, migraines and psychogenic pain, which stems from psychological factors.
Dr. Elspeth Cameron Ritchie, a retired Army colonel and psychiatrist living in Washington, D.C., said the study clearly reinforces the anecdotal link between pain and suicide.
“It makes sense that pain is a risk factor for suicide,” she said. “Often, suicide has several different things going on, but pain can be the straw that breaks the camel’s back in terms of a person’s decision not to go on.”
Therapists performing a suicide-risk evaluation should consider adding a question regarding pain to the standard questions aimed at suicidal thoughts and planning, she said.
“It’s not a standard question: ‘Are you in pain?’” Ritchie said. “I would ask, ‘Are you in pain?,’ or ‘Is pain an issue for you?’”
Psychogenic pain increased people’s risk of suicide the most, followed by migraines and back pain. Psychogenic pain is chronic pain caused or exacerbated by mental or emotional problems, and Ilgen said it is a rare and not well understood condition.
“We think that’s not so much about psychogenic pain per se, but the fact that the pain itself is poorly understood and may be poorly managed,” Ilgen said. “There’s not a clear treatment plan for that type of pain. It’s likely that patients with this type of pain may be frustrated with their care and more hopeless and more at risk for suicide.”
Hopelessness also could play a part in the elevated risk of suicide for migraine and chronic back pain sufferers — two common problems in the United States. Back pain, for instance, is the second most common pain complaint among Veterans Health Administration patients, behind only arthritis.
“Patients with these pain conditions also may be more likely to feel hopeless and to have impairments in occupational or social functioning that could lead more directly to suicidal thoughts and behaviors,” according to the study.
“Negative expectations about one’s ability to effectively manage or treat pain could lead to suicidal ideation, and these effects might be greatest for certain conditions, such as psychogenic pain, that do not have clear or effective treatments and may be stigmatized,” the researchers said.
Disability also could be a factor in the increased suicide risk, particularly for people with back pain who used to be healthy and active, Ritchie said.
Ilgen said it is not known whether there are unique warning signs of suicide for chronic pain patients. He urged family and friends of patients to keep a close eye out for standard warning signs, such as intense depression, expressions of hopelessness, statements about suicidal thoughts or plans, or any indication that the person is not oriented toward the future.
“My best recommendation is to encourage the patient to reach out for professional help,” Ilgen said. “Ask about their suicidal thoughts. Don’t just skirt the issue; directly ask.”
The U.S. National Institute of Mental Health has more about suicide prevention.
Posted: May 2013
WEDNESDAY May 22, 2013 — Roughly four in 10 uninsured patients who have been diagnosed with chronic obstructive pulmonary disease (COPD) actually do not have the lung disease, a small new study suggests.
At issue: Faulty diagnoses were made based on an evaluation of symptoms, rather than by means of the so-called “gold standard” disease test known as spirometry, which shows how well a patient’s lungs are working by measuring the amount of air they can exhale and how long that takes.
The study is scheduled for presentation Wednesday at the American Thoracic Society annual meeting in Philadelphia. The data and conclusions should be viewed as preliminary until published in a peer-reviewed journal.
COPD is a progressive disease that makes it hard to breathe. Symptoms include coughing, wheezing, shortness of breath and chest tightness, according to the U.S. National Heart, Lung, and Blood Institute. Cigarette smoking is the top cause of COPD.
“While there have been many studies of the under-diagnosis of COPD, there has not been a U.S.-based study that has quantified the problem of over-diagnosis,” Dr. Christian Ghattas, a second-year medical resident at Saint Elizabeth Health Center in Youngstown, Ohio, said in a society news release. “And yet, the cost of treating someone for COPD is high.”
How high? The study team cited statistics suggesting the cost exceeds $ 4,100 per year.
The researchers re-evaluated 80 patients, average age 53, being treated at a federally funded health center based in Akron, Ohio, that is designed to offer medical care to the uninsured and Medicaid patients. All the patients had been diagnosed in 2011 or 2012 as having COPD or as needing an inhaler device often given to treat COPD.
Investigators found that less than 18 percent of the patients had undergone spirometry testing, despite a Global Obstructive Lung Disease recommendation that COPD not be diagnosed without such a test.
Once conducted, spirometry testing revealed that nearly 43 percent of the patients did not have any obstruction that could be construed as COPD.
What’s more, another quarter of the patients had a reversible condition that is more typical of asthma than COPD.
“We were shocked at the percentage,” Ghattas said. He noted that, overall, probably half the patients were misdiagnosed.
“Although the number of patients in our study was small, I believe this study is representative of an uninsured and underserved patient population,” he added. “However, the findings might be different among patients who are insured. They might be higher or lower. We simply don’t know,” Ghattas said.
But, “it is obviously detrimental to be on medications that won’t work for you,” Ghattas cautioned. “You won’t feel better — and that by itself can take a psychological toll — and you may experience side effects that can compromise other aspects of your health.”
For more on COPD, visit the U.S. National Heart, Lung, and Blood Institute.
Posted: May 2013
TUESDAY May 21, 2013 — Less is more when it comes to steroid therapy for patients having severe bouts of chronic obstructive pulmonary disease (COPD), according to Swiss investigators.
Five days of glucocorticoid treatment with prednisone to treat COPD flare-ups was as good as the standard 14 days, but with fewer chances for adverse side effects, they said.
“We wanted to show that a shorter period of treatment was not less effective than 14 days,” said lead researcher Dr. Jorg Leuppi, with the department of medicine at the University Hospital of Basel.
The shorter course of treatment had the same outcome as the longer course of treatment, the study found. “There is exactly the same time to recovery and exactly the same number of re-exacerbations,” Leuppi said.
In addition, the shorter course of treatment meant fewer side effects from the drug, such as increased blood pressure and elevated blood sugar, he said.
The report was published May 21 in the online edition of the Journal of the American Medical Association to coincide with its Tuesday presentation at the American Thoracic Society meeting in Philadelphia.
COPD is a progressive disease involving bronchitis and emphysema — often tied to smoking — that makes it hard for patients to breathe. Patients periodically have flare-ups or exacerbations, when symptoms are at their worst.
Prednisone is a glucocorticoid pill that acts as an anti-inflammatory. Since a generic version is available, it is a relatively low-cost therapy.
“COPD exacerbations, which are the leading cause of medical hospitalization in the U.S. and elsewhere, can be treated with a five-day course of prednisone, which is a corticosteroid, not 10 to 14 days as recommended by most national and international guidelines,” said Dr. Don Sin, a professor of medicine at the University of British Columbia, in Vancouver, and co-author of an accompanying journal editorial.
Corticosteroids are highly toxic drugs, he said. “Thus, by using a five-day versus a 10- to 14-day [course], we will prevent many steroid-related complications — such as diabetes, osteoporosis and adrenal insufficiency — without sacrificing any of the benefits of steroids for management of COPD exacerbations,” he said. “There is no rationale for giving more steroids than this.”
For the study, Leuppi’s team randomly assigned more than 300 patients suffering from an acute COPD exacerbation to daily doses of prednisone for either five or 14 days.
The goal of the study was to see whether either treatment resulted in fewer new exacerbations of COPD over six months.
The researchers found that prednisone treatment resulted in about the same number of patients having new bouts of COPD. Among those who got five days of therapy, 56 had a new bout within six months; 57 patients given 14 days of therapy had a new flare-up.
The average time to a new exacerbation of COPD was 43.5 days in the short-term treatment group and 29 days in the standard treatment group, the researchers said.
Dr. Len Horovitz, a pulmonary specialist at Lenox Hill Hospital in New York City, said that “while treatment with corticosteroids is often necessary in exacerbations of COPD, it has not been clear how long the treatment should be given.”
“The authors found that a shorter duration of treatment with steroids was possible,” he said. “The accompanying side effects were less, and total dose of steroids was less long term.”
To learn more about COPD, visit the American Lung Association.
Posted: May 2013