‘Cannabis Use Disorder’ Up in States That Legalized Recreational Pot

WEDNESDAY, Nov. 13, 2019 — States that legalized recreational marijuana have seen an increase in problematic pot use among teens and adults aged 26 and older, a new study finds.

The researchers compared marijuana use in Colorado, Washington, Alaska and Oregon — the first four states to legalize recreational marijuana — before and after legalization. The investigators also compared trends in those states with states that did not legalize recreational marijuana.

“There are, indeed, important social benefits that legalizing marijuana can provide, particularly around issues of equity in criminal justice,” said lead author Magdalena Cerda. She’s director of the Center for Opioid Epidemiology and Policy at NYU Langone Health, in New York City.

However, “our findings suggest that as more states move toward legalizing marijuana for recreational use, we also need to think about investing in substance use prevention and treatment to prevent unintended harms — particularly among adolescents,” Cerda added in an NYU news release.

The study authors examined marijuana use and frequent use (more than 20 days) in the past month, and problematic marijuana use (also called “cannabis use disorder”) over the past year. Signs of problematic use include increased tolerance, repeated attempts to control use or quit, spending a lot of time using, social problems due to use, and ignoring other activities in order to use.

The rate of problematic use among teens aged 12 to 17 rose from 2.18% to 2.72% after legalization, and was 25% higher than in non-recreational states. But there was no change in rates of past-month or frequent use.

Among adults 26 or older, past-month marijuana use after legalization was 26% higher than in non-recreational states. Past-month frequent use rose by 23% and past-year problematic use rose by 37%.

Among young adults aged 18 to 25, there was no increase in past-month, frequent or problematic marijuana use after legalization, according to the study. The findings were published online Nov. 13 in JAMA Psychiatry.

According to study senior author Dr. Silvia Martins, “Cannabis use disorder in adolescence is associated with long-term adverse health, economic and social consequences.” She is an associate professor of epidemiology at Columbia University Mailman School of Public Health, in New York City.

“Given our findings on problematic use across age groups, legalization efforts should coincide with prevention and treatment,” Martins said in the news release.

“The general public should be informed about both benefits and potential harms of marijuana products to make informed decisions,” Martins added.

Recreational marijuana use is legal in 11 states and Washington, D.C. Medical marijuana use is legal in 33 states, the study authors noted.

More information

The U.S. National Institute on Drug Abuse has more about marijuana.

© 2019 HealthDay. All rights reserved.

Posted: November 2019

Drugs.com – Daily MedNews

CSU Launches Texting Program to Counsel Cannabis Use Disorder

Some cannabis users consider addiction to the plant to be a myth, but researchers at Colorado State University and the University of Tennessee, Knoxville, disagree. The two universities are now working together to deliver a texting-based counseling program for young adults with cannabis use disorder.

The new program, reserved for adults ages eighteen to 25, is funded by a $ 3.2 million grant from the National Institute on Drug Abuse; the study will last for six months and enroll 1,000 young adults from Colorado and Tennessee. Participants will first fill out a questionnaire about how often they use cannabis, and if they’ve ever wanted to stop or lessen cannabis use.

“The main question we’re looking at is how does this text-based study work in comparison to what students may typically access on a college campus through counseling,” explains Dr. Doug Coatsworth, the study’s lead researcher at CSU. “Texting has become a part of our lives today, especially with young adults, and a program that allows them to use something they’re comfortable with may help them with treating cannabis use disorder.”

The text messages will be tailored to each individual participant, reminding them of where they’re most likely to use while also asking about their cravings and stress levels. If participants report a higher level of stress or a heavier rate of cannabis consumption, the text messages will then change to a more serious tone about the participant’s pot use.

Marijuana Deals Near You

“This particular counseling program is unique in that it activates their motivation and targets where they hang out with their peers,” says Dr. Michael Mason, a researcher at the University of Tennessee. “It gets them to think about who they hang out with, think about spending time with their friends in non-smoking environments, and look for improvements over time beyond just reducing their level of consumption. It also looks at improving factors such as their grades or relationships.”

But what exactly is cannabis use disorder? According to Dr. Amber McGregor at substance abuse center 1st Priority Institute for Better Living in Denver, symptoms include social or interpersonal problems caused by cannabis abuse, such as failure to fulfill major obligations at work or school. Those suffering from cannabis use disorder find themselves using more cannabis over a period of time, she says, consuming cannabis in larger amounts than originally intended.

The THC level in cannabis today is different than it was twenty years ago, she adds, which can be one factor in developing the disorder. “The concentration of THC [in cannabis flower] was 2 to 3 percent twenty years ago, but has risen to around 20 percent today,” McGregor says. “Parents don’t really know much about it, and with the legal system and changing societal perception of weed, it’s hard for them to teach their kids about cannabis use and not abusing it.”

Individual therapy has been the number-one treatment of cannabis use disorder, according to McGregor, as being in a safe space for young adults to be heard and talk freely can help them understand why they use cannabis in the first place. However, she also supports other avenues, such as CSU’s texting program, and believes it can be a stepping stone for young adults who are addicted to cannabis.

“If they’re volunteering to come in and address substance use, anything to help them with it is wonderful,” she says. “A text can bring the goal of stopping to the front of their minds.”

Coatsworth and Mason hope the texting program is effective enough to eventually become integrated into recovery strategies throughout the community. “The text-based strategy could be an alternative one that counseling centers could offer,” Coatsworth says. “It might help those who could be nervous about seeing a therapist or don’t want to go that route.”

Mason adds that counseling via texting could also be more cost effective than in-person treatment, and hopes to make it available for anyone who wants to try it. “It’d be great to scale it up and get into places like universities and health-care systems,” he says. “That way, it can be made more available for people who want it.”

Enrollment for the study at CSU will start during the 2020 spring semester for anyone ages 18 to 25 in the Fort Collins area. Participants under the age of 21 will not be prosecuted by law enforcement, nor will participants in Tennessee, where cannabis is illegal.


Toke of the Town

Bipolar Disorder a Risk Factor for Parkinson’s?

THURSDAY, May 23, 2019 — Struggling with bipolar disorder is hard enough, but now a new study from Taiwan suggests these patients are seven times more likely to develop Parkinson’s disease.

But U.S. experts cautioned that the absolute risk of developing Parkinson’s — an incurable movement disease — is still very low for those with the mood disorder.

“I wasn’t surprised [by the study’s findings], because similar disorders like major depression and anxiety disorder convey a similar increased risk of Parkinson’s later in life,” said Dr. Gregory Pontone, director of the Parkinson’s disease research center at Johns Hopkins Medicine in Baltimore.

“This gives you two reasons to treat bipolar disorder aggressively,” he added.

Also known as manic-depressive illness, bipolar disorder is a mood disorder marked by swings from elated, energized behavior to feelings of sadness and hopelessness. It affects about 2.6% of American adults, according to the U.S. National Institute of Mental Health.

Parkinson’s is a progressive condition causing tremors, rigid muscles and slowed movement, among other symptoms. By 2030, the Parkinson’s Foundation projects 1.2 million Americans will be living with the disease.

For the study, researchers led by Dr. Mu-Hong Chen of Taipei Veterans General Hospital, reviewed health records for 56,000 people in Taiwan who were diagnosed with bipolar disorder between 2001 and 2009. They were compared to 225,000 people with no history of bipolar or Parkinson’s. Both groups were tracked until late 2011.

During the study period, 372 people with bipolar disorder — or 0.7% — developed Parkinson’s. This compared to 222 — or 0.1% — of those who didn’t have bipolar disorder.

Those with bipolar who developed Parkinson’s were nine years younger — average age 64 — than others who also developed Parkinson’s, the study found.

“When you say there’s seven times the risk, it gets scary. But it’s still very few [bipolar] patients who get Parkinson’s,” said Dr. Justin Martello, who reviewed the findings. He’s a neurologist specializing in movement disorders and Parkinson’s disease at Christiana Care Health System in Wilmington, Del.

Martello pointed out that while the study was large, it was limited by including only people in Taiwan.

“We don’t know how this would apply more globally or broadly,” Martello said. “I think it’s more interesting for physicians to know this and be more aware of the association.”

The study was published online May 22 in the journal Neurology.

Pontone, who cowrote an accompanying editorial, and Martello said scientists have many theories — still unproven — about how bipolar disorder might be connected to the development of Parkinson’s.

“A depressive or manic episode may do something to the brain that renders it more vulnerable” to Parkinson’s over time, Pontone said.

And Martello noted that many medications used to treat bipolar disorder can trigger Parkinson’s-like symptoms.

Many experts think Parkinson’s is active years or decades before movement problems show up, and mood disorders such as bipolar may actually be an early symptom of Parkinson’s, Pontone and Martello said.

Much more research is still needed, they agreed.

“We definitely need to look more at a global population,” Martello said. “The researchers here did follow patients for 10 years, but it needs to be extended longer to see how many of these patients convert to Parkinson’s down the road.”

More information

The U.S. National Institute of Mental Health has more about bipolar disorder.

© 2019 HealthDay. All rights reserved.

Posted: May 2019

Drugs.com – Daily MedNews

Border Disorder: Cannabis Workers Face Higher Risks Entering U.S.

By, Kate Robertson Cheryl Shuman has been called the “Martha Stewart of marijuana” because of her dominance in the global cannabis industry, a role that has her traveling about 200,000 miles each year for work. But Shuman says she still feels terrified every time she has to interact with border agents. “I wouldn’t say it’s […]
Marijuana

WHO Calls ‘Gaming Disorder’ Mental Health Condition

June 20, 2018 — The World Health Organization is recognizing “gaming disorder” as a diagnosable condition.

But the organization’s decision to include the new term in the 11th edition of its International Classification of Diseases (ICD), which it released Monday, has sparked controversy among psychiatric experts who question whether there’s enough research to call it a true disorder.

According to the American Psychological Association, an estimated 160 million American adults play video games, but the percentage of people that could qualify for the disorder is extremely small. Players’ ages range from under 18 to over 50, and the male-to-female ratio is almost equal.

The WHO’s official definition of “gaming disorder” includes:

  • A pattern of behavior for at least 12 months in which gaming is out of control
  • The pattern of behavior must show an “increased priority given to gaming” to the point that gaming “takes precedence over other interests and daily activities.”
  • A “continuation or escalation of gaming despite the occurrence of negative consequences,” or behavior that affects one’s relationships, education, or occupation. This could mean that a teenager may play video games instead of doing homework and end up failing a test.

Child and adolescent psychiatrist Victor Fornari, MD, sees many families who struggle to control the amount of time their children spend in front of a screen.

“A family usually has rules about TV time. Here, a child wouldn’t stop, despite the promise of negative consequences,” he says.

Fornari says aggressive games involving teamwork and killing enemies tend to be the most addictive for young people. He also says some games have become so popular that schools around the world are warning parents to monitor their child’s access to them.

Including gaming disorder in the ICD-11 could mean health insurance coverage for people seeking treatment.

“I think the ICD-11 category will give us a chance to learn how to identify and diagnose the disorder. Now that there’s an ICD-11 code, health care providers will be able to ask for reimbursement from health insurance companies,” Fornari says.

People who do seek help right now likely find it difficult. Fornari says that there are few treatment programs around because mental health professionals really don’t know how to treat the disorder yet. Rehab centers and wilderness camps exist, but there is little proof of how well they work, and they are often expensive.

He says it is unclear if gaming disorder will require treatment similar to other mental disorders or addictions.

“You always have to wonder when someone’s behavior is obsessive. It’s possible that someone with obsessive-compulsive disorder would compulsively play the game, but they would likely show other compulsions as well, like checking things, counting things, and washing hands,” Fornari says.

Doubts About Defining the Condition

Some experts are reluctant to include gaming disorder in the ICD.

The Society for Media Psychology and Technology, a division of the American Psychological Association, said in a statement that the “current research base is not sufficient” enough to classify the disorder.

It argues that although video game addiction research has been going on for nearly 30 years, it’s not clear how to define the condition, the symptoms, how common it is, or if it is an independent disorder or a symptom of a pre-existing disorder.

The European Games Developer Federation (EGDF) also criticized the move.

The group said in a statement it was “concerned” by the WHO’s action to include it, “despite significant opposition from the medical and scientific community. The evidence for its inclusion remains highly contested and inconclusive.”

In the U.S., the American Psychological Association has proposed adding gaming disorder to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). Although it’s not yet an official condition, the association recognizes the following symptoms:

  • Heavy focus on Internet gaming
  • Withdrawal symptoms when Internet gaming is taken away (sadness, anxiety, irritability)
  • Tolerance, the need to spend more time gaming
  • Not being able to play less, unsuccessful attempts to quit playing
  • Giving up other activities, and loss of interest in activities that were once enjoyed
  • Continuing to play despite problems
  • Deceiving family members or others about the amount of time spent on Internet gaming
  • The use of Internet gaming to relieve negative moods, such as guilt or hopelessness
  • Risk, having jeopardized or lost a job or relationship due to Internet gaming

To be diagnosed with gaming disorder, a patient must have at least five of the listed symptoms.

In a 2017 study done in the U.S., United Kingdom, Canada, and Germany, close to 19,000 gamers completed a survey about symptoms of gaming disorder. More than 65% of participants did not report any symptoms of gaming disorder. Only 2.4% of the sample endorsed at least five of the symptoms needed to be diagnosed.

In a commentary on that study, Patrick M. Markey, PhD, a psychology professor at Villanova University, and Christopher J. Ferguson, PhD, department chairman of psychology at Stetson University, questioned gaming disorder as a condition.

“Current data suggest that the proposed Internet gaming disorder category is a poor indicator of actual problems,” they wrote. “Therefore, its use in clinical settings, as presently delineated, may ultimately cause more harm than good.”

They also asked why the DSM-5 singles out gaming disorder as a proposed category, but not other things that could be addictive, including working, exercising, or eating.

“This important study suggests that video game addiction might be a real thing, but it is not the epidemic that some have made it out to be.”

Fornari says the WHO action will bring about research on diagnosed cases that will help doctors understand more about the condition.

“I think any time changes like this occur, an initial period of time will be needed to test it out,” he says. “How often the diagnosis is made and the range of clinical cases, like in any other mental disorder, will have to be studied. When a new disorder is proposed, we need to see if it will survive the test of time.”

Sources

Victor Fornari, MD, child and adolescent psychiatrist, Zucker Hillside Hospital.

World Health Organization: “ICD Classifications.”

World Health Organization: “Gaming disorder.”

Statista: “Age breakdown of video game players in the United States in 2018.”

The Guardian: “Fortnite: schools warn parents of ‘negative effects’ of video game on students.”

The Sun: “Fortnite addiction leaving pupils bleary-eyed in class after all-night binges sparking calls for lessons in online safety.”

The New York Times: “Parenting the Fortnite Addict.”

American Psychiatric Association: “Internet Gaming — Addictive Potential?”

News release, APA Media Psychology and Technology Division (Div 46).

Journal of Behavioral Addictions: “Do gaming disorder and hazardous gaming belong in the ICD-11? Considerations regarding the death of a hospitalized patient that was reported to have occurred while a care provider was gaming.”

American Journal of Psychiatry: “Internet Gaming Addiction: Disorder or Moral Panic?”

 

© 2018 WebMD, LLC. All rights reserved.

WebMD Health

Chilean ‘Alien’ Was a Human With Bone Disorder: Study

THURSDAY, March 22, 2018 — Puzzling skeletal remains found in Chile 15 years ago — and rumored to be “alien” — are, in fact, from a human fetus with rare bone anomalies, researchers say.

The findings may or may not put to rest any internet-driven alien theories.

But the researchers said their discoveries could potentially aid in diagnosing rare bone disorders. They were able to identify several previously unknown genetic mutations behind the fetus’s bone abnormalities.

“DNA differences like this are useful to help us diagnose children and adults with ‘undiagnosed’ disorders,” said Dr. Atul Butte, one of the researchers on the work.

“More and more children’s hospitals are able to study patients and better understand what differences in their DNA might be leading to their conditions or disorders,” explained Butte, a professor at the University of California, San Francisco.

“And the ones we learned here can get added to the catalogues for future reference,” he said.

The story goes back to 2003, when scientists discovered a mysterious mummified skeleton in Chile’s Atacama Desert.

Nicknamed “Ata,” the skeleton stood just 6 inches tall, with a cone-shaped head and slanted eye sockets, and 10 pairs of ribs — versus the normal 12 in humans. Beyond that, despite the skeleton’s tiny size, it had the bone composition of a 6-year-old.

The unusual array of features triggered online rumors of an alien discovery.

And Ata does seem unique — but definitely earthly, according to the new analysis.

The skeleton was most likely a fetus, the researchers noted, and it had severe mutations in seven genes that regulate bone development.

Many of the mutations were already known, and related to disorders like dwarfism and various bone deformities and facial malformations. But several mutations have never been recognized, Butte and his colleagues reported.

The investigators found four mutations in genes that are known to contribute to bone diseases, and two mutations in genes that help produce collagen — a structural protein in the body’s connective tissue.

Some of Ata’s individual anomalies have been seen before, Butte said, such as the abnormal number of ribs and short stature.

“It’s just that this particular girl seemed to have many of these anomalies at the same time, and of a more severe nature,” he explained.

The findings were published online March 22 in Genome Research.

The researchers made their discoveries after extracting a small amount of DNA from Ata’s ribs and analyzing the entire genome — the complete set of genetic material.

Almost all of Ata’s DNA was “matchable” to human DNA, said Garry Nolan, a researcher at Stanford University who also worked on the study.

There is a simple explanation for the small amount that wasn’t pinpointed as human, Nolan said in a Stanford news release: The sample was simply too degraded.

And while the skeleton was once hypothesized to be ancient, it is actually about 40 years old, the findings showed.

Even though Ata was discovered 15 years ago, it’s only in recent years that this kind of genome analysis — done on the researchers’ own time — has become feasible, Butte said.

“Every year the cost to sequence genomes continues to drop, with the current price around $ 1,000,” he said. “At a certain point, the price and availability of sequencing reached the right amount, making it possible to sequence the Ata mummy genome.”

According to Butte, there is a wider lesson to learn from Ata’s genome analysis.

“Sometimes there might actually be more than one major DNA difference involved in explaining a particularly hard-to-explain patient,” Butte said. “We shouldn’t stop a search when we’ve found the first relevant mutation. Indeed, there might be many others also involved.”

Getting such a “full explanation” will become increasingly important, Butte added, as researchers develop gene therapies aimed at correcting some of these rare disorders.

More information

The International Osteoporosis Foundation has more on rare bone disorders.

© 2018 HealthDay. All rights reserved.

Posted: March 2018

Drugs.com – Daily MedNews

Is Strep Linked to Scary Kids’ Behavior Disorder?

Nov. 10, 2017 — When Garrett Pohlman was diagnosed with strep throat in 2007, his illness didn’t respond to antibiotics. Then the strange behaviors began.

Diana Pohlman says her son, who was 7 years old at the time, had been easygoing up to that point. But he developed severe obsessive compulsive disorder (OCD) symptoms overnight. He became paranoidworrying about things like radiation from the TV and light switches. He had tics and anorexia and started having frequent episodes of rage.

“He was not anyone I recognized. He was a completely different child,” she says. “It was a nightmare. At first I thought maybe he had been molested. Then I thought he had a brain tumor.

“He became so delusional he would climb on the roof thinking it was the front door. He would jump in front of cars and out of moving cars, and he had self-harm fantasies. He was afraid to leave the house. We had to pick him up and wrap him in a sheet to get him out of the house. At the age of 7,” Pohlman says.

The search for answers was long and expensive. After many months, the family found their way to a psychiatrist who knew about a disorder called pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections, or PANDAS, a condition she says several specialists didn’t know about. That led to medical treatment that included long-term antibiotics, having his tonsils and adenoids removed, and eventually two rounds of immunoglobulin, or IVIG treatments.

Recovery was slow, but after 2 years, by the age of 9, Pohlman says the severe symptoms stopped. For another 2 years, he had what she calls mild and manageable symptoms that eventually dissipated.

But rather than move on from PANDAS, the boy’s mother decided she needed to help other parents trying to figure out these mysterious symptoms. She founded the nonprofit PANDAS Network in 2009 to raise awareness, support families, and push for more research to better understand how to diagnose and treat the condition.

“When I realized doctors didn’t understand it, I thought I better not quit working on this because how will anyone else ever get help,” Pohlman explains. “It is abysmal. It has been shocking how misinformed doctors are about the term ‘PANDAS.’ ”

Little is known about how or why the syndrome happens, and not all doctors believe there is a connection. The American Academy of Pediatrics does not recognize a link between strep and the syndrome.

“You will not find consensus from pediatric infectious disease doctors that PANDAS even exists, much less what to do about it and how to manage the patients,” says Meg Fisher, MD, a pediatrician and infectious disease specialist at Unterberg Children’s Hospital at Monmouth Medical Center in Long Branch, NJ. “We still haven’t had the definitive article or study or demonstration to really get some solid clinical evidence behind this. My problem is, even if you believe in the syndrome, it’s totally unclear what you should do to help those patients. All of the information is anecdotal.”

What Is PANDAS/PANS?

Susan E. Swedo, MD, at the National Institute of Mental Health (NIMH), first identified PANDAS in the 1990s after she reported on a link between the fast onset of OCD and group A streptococcus, more commonly known as strep.

PANDAS happens when strep triggers a misdirected immune response that causes inflammation in a child’s brain. Pediatric acute-onset neuropsychiatric syndrome, or PANS, is a larger umbrella term that has to do with cases with a trigger other than strep, including infections like walking pneumonia or the flu.

Both disorders appear in childhood, typically between the ages of 3 and 12. While blood tests may help identify infections, there are no lab tests or other indicators for PANDAS or PANS.

Doctors diagnose the syndrome when children suddenly get severe OCD or eat a lot less food, along with at least two of the following symptoms: anxiety, depression, irritability or aggression, behavioral regression, ADD- or ADHD-like symptoms affecting schoolwork, sensory or motor problems, troubled sleep, and frequent urination.

The PANDAS Network says in some cases, the emotional symptoms can weaken children and make them homebound. Other children are OK at school but fall apart at home. The NIMH describes the start of symptoms as “dramatic,” happening “overnight and out of the blue.”

“The consensus of scientists and clinicians is that it needs to be sudden and severe,” says Margo Thienemann, MD, co-director of the PANS program at Stanford University Medical Center in California. “Sudden can be overnight. Some people can say exactly what time it started or that it happened over a couple of days. But they all say this isn’t their child anymore. Even if they don’t believe someone can be possessed, it feels that way. What happened? Why are they doing these things? Why can’t they stop?”

Swedo estimates that it impacts about 1% of elementary school-aged children and is likely under-diagnosed. The PANDAS Network estimates 1 in 200 children have it. Thienemann says her program at Stanford has seen more than 250 patients since it started in 2012. But she says that since their staff is small, they have to narrow down who gets in. One year, they turned away 1,000 patients because they couldn’t handle any more.

Thienemann says this is why they have helped write guidelines to allow health care providers to identify and treat these children. “It takes a multidisciplinary team to manage. A psychiatrist, pediatrician, or rheumatologist can’t do it alone. You need all these different vantage points to diagnose and coordinate care,” she says.

There are now PANS centers in California and Arizona, and some doctors around the country treat the disorder.

Controversy

Not all in the medical community agree that strep or other infections can trigger these kinds of behaviors. There is also much debate about whether treatments are effective.

While the American Academy of Pediatrics does not recognize a link between strep and PANDAS, a March 2017 article in AAP News, sent to the group’s 66,000 pediatrician members, discusses the disorders and the controversy around them. While it’s not the group’s official policy, the article says pediatricians should consider PANS anytime a child “has an abrupt behavior change with obsessive thoughts,” and it points them to material that shows them how to diagnose it.

Fisher says it’s complicated for pediatricians, since there is no evidence that taking out tonsils and adenoids is helpful or that antibiotics work. She says many pediatricians worry that young patients will become resistant to antibiotics if you prescribe them long-term, and many have concerns about IVIG side effects.

“I understand the parents’ frustration, because finding a physician for these patients is very difficult. There are a lot of doctors who are, quote unquote, PANDAS specialists, but there is nothing that is evidence-based about what they are doing,” she says. “Our goal is first do no harm, and it is hard to know how best to help these patients. It is a very frustrating thing. I wish someone would come up with some solutions.”

Thienemann says most parents who find their way to her program are frantic because they can’t get help anywhere else. “Part of that desperation is nobody would listen to them. People say my pediatrician won’t do anything, and my child is trying to jump out of moving cars or a window. They can’t get out of the house, can’t sleep, are urinating on themselves, and have severe separation anxiety,” she says.

Parents say it is obvious something isn’t right.

“I thought she had schizophrenia or severe mental illness,” says Kelly, a mother in Maryland who asked that we not use her last name to protect the privacy of her 7-year-old daughter, Maggie, who has PANDAS. “It was rapid-onset OCD, and then we were spending our entire life trying to keep her from jumping out of cars, hurting herself, biting us, and losing her mind.”

“There is something medically wrong. There isn’t a finger to be pointed. There are questions to be asked and answered,” adds Ali Claypoole, whose son, now 9 years old, first showed PANDAS symptoms at the age of 6. “Our world is turned upside down, and from where I am, it’s almost like parents are more informed than the doctors. I find the civilian community is much more understanding, interested, and willing to learn about this than the medical community. It makes me mad.”

Going Forward

More research is now being done.

In a 2017 large-scale study of key parts of the PANDAS theory, researchers looked at 17 years of data out of Denmark and found that young patients with a positive strep test had higher chances of having of mental disorders, especially OCD and tic disorders, compared with those without a positive strep test. Non-strep throat infections also carried a higher chance of these types of mental disorders in children, although it was less — perhaps pointing to the chance that other infections can trigger the symptoms.

In 2016,  Dritan Agalliu, PhD, an assistant professor in the Department of Neurology at Columbia University Medical Center in New York City, published a study showing that immune cells produced in the nose after multiple strep infections appear to be the culprit for the disease. These cells enter the brain via the nerves that are responsible for the sense of smell, and they damage the blood vessels and synapses in the brain.

Agalliu says this research helped explain a crucial step in the disease: how antibodies that the body makes to attack strep or other infections cross the blood/brain barrier in these children and attack parts of their brain by mistake; similar to what happens in other autoimmune diseases of the brain, like multiple sclerosis.

The NIHM recently awarded Agalliu nearly $ 2 million to keep studying the disorder. He says it should be called post-streptococcal basal ganglia encephalitis, or inflammation of the brain. He’s also doing research funded by a private donor, looking at genetic chances of having the disorders to understand why a small number of children who get multiple strep infections are prone to get the disease. 

“It is really the brain inflammation that is central to this disease. If we think about PANDAS/PANS this way, it will relieve a lot of controversy and make therapies more acceptable for patients,” Agalliu says. “I am hoping with our next publication, we can alleviate any potential question that this is an autoimmune disease.”

There’s also increasing interest in looking at PANDAS as a type of Sydenham chorea, defined by abnormal movements, OCD, mood swings, and other emotional symptoms that follow strep infection.

The NIMH now has a group for PANDAS and PANS. The PANDAS Network is working to make information about the disorders part of continuing medical education for pediatricians, and a working group has created handouts to educate school personnel nationwide to help children with these disorders get back to their classrooms.

So will children outgrow PANDAS? Like most other things associated with this disorder, there is no consensus.

Doctors who focus on the disorders say when patients can get to them, improvement is possible. “If we get people as early as possible, maybe even at the onset of illness, I think we do a good job of being able to tamp down inflammation and help them a lot and maybe get them all the way better,” Thienemann says. “If someone has been dealing with it for 10 years, I think they may develop ongoing autoimmune problems and there may be damage to their brain. Recovery might not be as complete, but I think we can still help them.”

Three years after he first showed symptoms, Claypoole’s son had a full remission at the age of 9 after IVIG treatments. But after a few months, he got strep again and the PANDAS symptoms returned, but they were less severe. Kelly’s daughter Maggie has seen her symptoms subside for a while, only to return. Her doctors prescribe antibiotics and anti-inflammatories after each new episode. She takes both medications daily for months on end. She has also had two rounds of IVIG. “Every time we do an intervention, the baseline gets better, but it doesn’t end the problem. She is not symptom-free,” Kelly says.

Pohlman says her son, now 17, is a straight-A student who plays football and the cello and is applying to college. He is symptom-free.

“Once I understood that Garrett’s brain was on fire from an infectious illness, I barely could believe his body would have the capacity for a full recovery,” she says. “Could he have the normal life I had expected for my child? So I look at him now in amazement.”

Sources

Ali Claypoole, Maryland.

Kelly, Maryland. (Requested not using last name)

Dritan Agalliu, PhD, Columbia University Medical Center, New York City.

Meg Fisher, MD, Unterberg Children’s Hospital at Monmouth Medical Center, Long Branch, NJ.

Diana Pohlman, executive director, PANDAS Network, Stanford, CA.

Patricia Rice Doran, EdD, associate professor, Department of Special Education, Towson University, Maryland.

Margo Thienemann, MD, Stanford University School of Medicine, Stanford, CA.

AAP News: “PANDAS/PANS treatments, awareness evolve, but some experts skeptical.”

American Academy of Pediatrics Red Book: “Group A Streptococcal Infections.”

National Institute of Mental Health: “PANDAS, Questions and Answers.”

National Institute of Mental Health: “Guidelines published for treating PANS/PANDAS.”

PANDASNetwork.org: “What is PANS?” “What is PANDAS?” Symptoms,” “Statistics,” “Our Mission.”

K. Chang, Journal of Child and Adolescent Psychopharmacology, Feb. 1, 2015.

R. Kurlan, Pediatrics, June 2008.

S Orlovska, JAMA Psychiatry, July 1, 2017.

K.A. Williams, Brain Research, August 18, 2015.

T Dileepan, The Journal of Clinical Investigation, January 4, 2016.

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Light Therapy May Help Some With Bipolar Disorder

By Robert Preidt

HealthDay Reporter

THURSDAY, Oct. 12, 2017 (HealthDay News) — People afflicted with bipolar disorder may find some relief from depression with daily doses of light therapy, new research suggests.

With light therapy, people spend time sitting in close proximity to a light-emitting box — in this case, bright white light — with exposures increasing from 15 minutes per day to a full hour over a period of weeks.

The study found that within a month the therapy helped treat depression in people with bipolar disorder.

“Effective treatments for bipolar depression are very limited,” noted lead researcher Dr. Dorothy Sit.

“This gives us a new treatment option for bipolar patients that we know gets us a robust response within four to six weeks,” said Sit, who is associate professor of psychiatry at Northwestern University in Chicago.

According to the Brain & Behavior Research Foundation, bipolar disorder “is a brain and behavior disorder characterized by severe shifts in a person’s mood and energy, making it difficult for the person to function.” Over 5.7 million Americans are thought to have the disorder, which often involves depressive episodes.

As Sit’s team noted, prior research had shown that morning light therapy reduces symptoms of depression in people with seasonal affective disorder (SAD), a condition where winter’s reduced light spurs depression.

However, it’s also been noted that light therapy can sometimes cause side effects, such as mania, in people with bipolar disorder.

Still, the Northwestern team wondered if the treatment might not have a role for bipolar patients with at least moderate depression who were also taking a mood stabilizer drug.

In the study, 46 patients received either a 7,000 lux bright white light or a 50 lux light (acting as the “placebo arm” of the trial).

The study participants were told to place the light box about one foot from their face for 15 minutes between noon and 2:30 p.m. each day at the start of the study.

Over six weeks, the patients increased their light therapy “doses” in 15-minute increments until they reached a dose of 60 minutes per day — or had a significant change in their mood.

Continued

Compared with people in the placebo group, those in the treatment group were more likely to have significant improvements, Sit’s team said.

More than 68 percent of patients in the treatment group achieved a normal mood versus 22 percent of those in the placebo group, the findings showed. Patients in the treatment group also had a much lower average depression score than those in the placebo group, and significantly higher functioning, meaning they could return to work or complete household tasks they hadn’t been able to finish before treatment.

Significantly, none of the patients experienced mania or hypomania, a condition that includes a period of elation, euphoria, irritability, agitation, rapid speech, racing thoughts, a lack of focus and risk-taking behaviors.

“As clinicians, we need to find treatments that avoid these side effects and allow for a nice, stable response. Treatment with bright light at midday can provide this,” Sit said in a university news release.

Two psychiatrists agreed that the therapy may have merit for patients, who often have few options.

“No standard antidepressants are approved for treatment of bipolar depression,” said Dr. Seth Mandel, who directs psychiatry at Northwell Health’s Huntington Hospital in Huntington, N.Y. He added that antipsychotics that are approved for bipolar disorder often come with side effects that cause many patients to stop using them.

Light therapy “offers us another option, one that certainly appears to do no harm,” Mandel said.

Still, he noted that patients with more severe symptoms weren’t included in the Chicago study, and he also believes many people won’t be able to adhere to the hour-long, daily dosage required.

Dr. Ami Baxi is a psychiatrist who directs adult inpatient services at Lenox Hill Hospital in New York City. She agreed that light therapy may be “a welcome addition to our limited treatment options for bipolar depression.”

The study was funded by the U.S. National Institute of Mental Health and published Oct. 3 in the American Journal of Psychiatry.

WebMD News from HealthDay

Sources

SOURCES: Seth Mandel, M.D., chairman of psychiatry, Northwell Health’s Huntington Hospital, Huntington, N.Y.; Ami Baxi, M.D., director of adult inpatient services, Lenox Hill Hospital, New York City; Northwestern University, news release, Oct. 10, 2017

Copyright © 2013-2017 HealthDay. All rights reserved.

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New Bowel Disorder Treatments Needed, FDA Says

MONDAY, April 17, 2017 — There’s no known cause or cure for irritable bowel syndrome (IBS), which affects more than 15 million Americans, according to the U.S. Food and Drug Administration.

The disorder involves the large intestine (colon). It causes symptoms such as abdominal pain, bloating, cramping, excessive gas, mucus in the stool, and changes in bowel habits (constipation and/or diarrhea).

No single treatment is effective in all IBS patients, so there’s a need to develop new therapies for the condition, said Dr. Tara Altepeter.

Altepeter, an FDA gastroenterologist, noted that the agency is working to make more treatments available to patients.

“There’s a lot of new research about the role of carbohydrates, and specifically a nutrient called polyols, in triggering irritable bowel syndrome in some patients,” Altepeter said in an FDA news release.

“In addition, researchers are more closely examining the role of dietary modification as a treatment for patients with IBS,” she added.

Current treatments for IBS include changes in diet and nutrition, and exercise. Some patients take medications to manage their symptoms, but there are no medications to cure IBS.

“IBS is not like other chronic conditions, such as hypertension, which is constant. IBS is a variable condition. Even without treatment, the problem might go away in some patients. But the symptoms might return after a few months,” Altepeter said.

IBS symptoms can be triggered by certain foods, including those high in carbohydrates, spicy or fatty foods, milk products, coffee, alcohol and caffeine.

“Drugs are a last option. Patients should try dietary modifications, relaxation techniques, and other lifestyle changes, such as exercise, before resorting to medication,” Altepeter said.

Many people with IBS also have to deal with depression, anxiety and other mental health problems.

“Some people suffer from depression and IBS. The question is what’s primary or secondary — what came first?” Altepeter said. “Either way, antidepressants are not a cure for IBS.”

More information

The U.S. National Institute of Diabetes and Digestive and Kidney Diseases has more on IBS.

Posted: April 2017

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Rare Infant Seizure Disorder Often Missed

By Kathleen Doheny

HealthDay Reporter

TUESDAY, Dec. 6, 2016 (HealthDay News) — Many infants with a rare form of epilepsy known as infantile spasms aren’t promptly diagnosed, and that delay can lead to devastating health consequences, new research indicates.

The peculiar clusters of seizures usually strike between 4 and 12 months of age, said study researcher Dr. Shaun Hussain. He is an assistant professor of pediatrics at the University of California, Los Angeles.

“It is completely different from other types of seizures,” Hussain said. They last about a second. Typically, the child drops his head and jerks his arms up. Parents may not notice or might think it’s nothing to worry about, the researcher said.

But untreated, “infantile spasms lead to terrible outcomes,” said Hussain, who’s also director of the UCLA Infantile Spasms Project.

These outcomes can include autism, lifelong epilepsy or mental retardation, he said. Even a delay of a week in getting a diagnosis and treatment may lead to a measurable drop in intelligence, he added.

For this study, Hussain and his UCLA colleagues surveyed the parents of 100 children who suffered the spasms. Nearly half waited a month or longer before getting an accurate diagnosis, the study found.

Only 29 percent of the children were seen by an effective provider within a week of the spasms’ onset, the researchers found.

For some, the delay was several years. Parents’ education levels, household income, insurance or other factors had no effect on the timing, the study determined.

In some cases, doctors and pediatricians didn’t recognize the condition and discounted parents’ concerns, Hussain’s team found.

The parents themselves frequently came up with the diagnosis using sources on the internet.

The subtle spasms can be confused with common childhood problems such as colic, said Dr. Amy Brooks-Kayal, chief of pediatric neurology at Children’s Hospital Colorado.

She and Hussain said infantile spasms can be diagnosed with video EEG (electroencephalography). This refers to 24-hour or overnight monitoring to track and record brain wave patterns.

“If parents are worried, they should request to see a pediatric neurologist for a video EEG and ask that their primary care provider facilitate an urgent appointment so that the child can be seen quickly,” said Brooks-Kayal. She wasn’t involved in the study.

Continued

“The usual recommendation is less than two weeks,” she said.

With this new report, Brooks-Kayal added, “something that has been long suspected has been quantified.”

The infantile seizure disorder strikes about one in 2,500 infants in the United States, according to the study authors. Various brain abnormalities, injuries and damage from stroke or infection can bring on the seizures, Hussain said. In many cases, doctors can’t find a clear cause.

Often, a chaotic brain wave pattern known as hypsarrhythmia accompanies the spasms. The cumulative effect of this combination may be even greater damage, according to Hussain.

Treatment for infantile spasms includes antiepileptic medicine or hormonal therapies. However, these have side effects and don’t always work, Hussain said. Some children may need surgery.

Hussain presented his findings this week at the American Epilepsy Society annual meeting, in Houston. Data and conclusions presented at meetings are usually considered preliminary until published in a peer-reviewed medical journal.

WebMD News from HealthDay

Sources

SOURCES: Shaun Hussain, M.D., M.S., director, Infantile Spasms Project, pediatric neurologist and assistant professor, pediatrics, David Geffen School of Medicine and Mattel Children’s Hospital, University of California, Los Angeles; Amy Brooks-Kayal, M.D., chief, pediatric neurology, Children’s Hospital Colorado and University of Colorado; American Epilepsy Society annual meeting, Dec. 4, 2016, Houston

Copyright © 2013-2016 HealthDay. All rights reserved.

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Lifestyle, Stress May Play Role in Heart Rhythm Disorder

SATURDAY, Nov. 19, 2016 — Stress and poor heart-health habits significantly increase the risk of a common heart rhythm disorder called atrial fibrillation, two preliminary studies suggest.

The irregular or quivering heartbeat associated with atrial fibrillation can lead to blood clots, stroke, heart failure and other heart-related complications, the American Heart Association says.

One new study included more than 6,500 adults without heart disease. They were rated on seven factors related to heart health: smoking, body mass index, physical activity, diet, total cholesterol, blood pressure and blood sugar. The heart association calls these Life’s Simple 7.

Compared to those with the worst scores, adults who scored highest were 41 percent less likely to develop atrial fibrillation. Those with average scores were 8 percent less likely to develop the abnormal heartbeat.

Although the findings don’t establish a direct cause-and-effect relationship, they suggest that promoting good heart health may prevent atrial fibrillation, said the researchers from Baptist Health South Florida in Miami.

The other study examined the link between stress and atrial fibrillation in more than 26,200 women. Sources of stress included work, family, finances, traumatic events (such as the death of a child), and neighborhood issues.

Women with atrial fibrillation had much higher financial, traumatic life-event and neighborhood stress scores than those without the condition. However, only traumatic life events were associated with atrial fibrillation, according to the study.

The University of California, San Francisco researchers said further studies are needed to determine if stress-relieving measures can reduce the risk of the heart rhythm disorder.

Both studies were presented this week at the American Heart Association’s annual meeting, in New Orleans. The results should be considered preliminary until peer-reviewed for publication in a medical journal.

More information

The U.S. National Heart, Lung, and Blood Institute has more on atrial fibrillation.

Posted: November 2016

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Parents Often Miss Post-Traumatic Stress Disorder in Kids

TUESDAY, Nov. 8, 2016 — Parents often fail to recognize post-traumatic stress syndrome (PTSD) in young children, a new British study says.

“When people talk about PTSD they often think about soldiers returning from war zones. But children who experience traumatic events such as car accidents, assaults and natural disasters are also at risk of developing post-traumatic stress disorder,” said lead researcher Richard Meiser-Stedman, from Norwich Medical School at the University of East Anglia.

“Symptoms can include traumatic memories and nightmares, avoiding reminders of the trauma, and feeling like the world is very unsafe,” he explained in a university news release.

Researchers followed more than 100 children aged 2 to 10 who had been in a road collision involving a car crash, or being hit while walking, or getting knocked off their bicycle. All had been taken to the hospital with injuries such as bruising, fractures or loss of consciousness.

They were assessed for PTSD two to four weeks after the incident, and again at six months and then three years later.

The researchers found that those who showed signs of stress soon after the incident didn’t necessarily go on to suffer PTSD after three years, And, while some developed PTSD that persisted for years, this occurred only in a minority of cases. Most “bounce back” naturally in time, the study authors said.

Injury severity was associated with PTSD incidence up to six months after an incident, but not three years after.

However, the researchers added, most parents of children who still had PTSD after three years didn’t recognize their child’s symptoms. This finding suggests that relying on parent reports of PTSD in their children may not be adequate for identifying chronic PTSD in young children, the researchers said.

The researchers also found that children were more likely to suffer PTSD if their parents also suffered PTSD in the short- or long-term. But even these parents may not recognize their child’s PTSD.

“This study reveals some really interesting links between how children and their parents respond to a trauma,” Meiser-Stedman said.

Children may experience PTSD for years without their parents being aware of it. The researchers also found a strong link between parents having PTSD and their children having it as well, even years after the traumatic event.

“This could be because parental stress early on is worsened by their children’s symptoms, or because the child’s responses are shaped by their parents’ initial reactions — or a bit of both, leading to an amplification of symptoms for both parties,” he said.

“Interestingly, even in these cases, the parents were still unlikely to acknowledge their children’s suffering,” Meiser-Stedman added.

“This study strengthens the case for considering parental mental health, and providing support for both children and their parents in the aftermath of a trauma to reduce the long-term effects for both,” he concluded.

The study was published Nov. 8 in the Journal of Clinical Psychiatry.

More information

The U.S. National Center for PTSD has more on PTSD in children and teens.

Posted: November 2016

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Heart Rhythm Disorder May Be Tied to Range of Ills

Review links atrial fibrillation to increased risk for heart and kidney problems, not just stroke

WebMD News from HealthDay

By Robert Preidt

HealthDay Reporter

WEDNESDAY, Sept. 7, 2016 (HealthDay News) — Atrial fibrillation, a common type of heart rhythm disorder, is associated with a wider range of conditions than previously believed, researchers report.

The findings add “to the growing literature on the association between atrial fibrillation and cardiovascular outcomes beyond stroke,” researchers at the University of Oxford in England and the Massachusetts Institute of Technology wrote.

The team reviewed 104 studies involving more than 9 million people, including nearly 590,000 people with atrial fibrillation. They concluded that the heart rhythm disorder was also associated with heart disease, heart failure, kidney disease, sudden cardiac death and death from all causes.

The study did not prove atrial fibrillation caused these additional health risks, just that there was an association.

Risk for heart failure was the most significant of these associations, rising fivefold for people with atrial fibrillation, the study authors said. But atrial fibrillation was also linked with a twofold increased risk of heart-related death and a 2.3-fold increased risk of stroke.

The findings were published Sept. 6 in the journal BMJ.

Besides stroke, atrial fibrillation was already tied to an increased risk of death, higher medical costs and lower quality of life, the study authors said.

Doctors need to take steps to reduce the risk of these newly identified health risks, along with stroke, in patients with atrial fibrillation, the researchers added.

Atrial fibrillation — sometimes called AFib — is a quivering or irregular heartbeat that can cause blood clots, stroke, heart failure and other heart-related complications. The American Heart Association estimates that at least 2.7 million Americans are living with the heart condition.

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Inherited Cholesterol Disorder Significantly Boosts Heart Risks

THURSDAY June 30, 2016, 2016 — People who inherit a genetic disorder that causes high levels of “bad” LDL cholesterol have an increased risk for heart disease and hardened arteries, a new study finds.

The condition is called heterozygous familial hypercholesterolemia. It’s believed to affect about 1.5 million people in the United States, the researchers said.

The genes linked to this condition prevent the liver from removing LDL (low-density lipoprotein) cholesterol from the blood. This allows the bad cholesterol to build up. Doctors suspect this familial condition when LDL levels are above 190 milligrams per deciliter (mg/dL), the study authors explained.

The researchers reviewed data from six groups of people involved in previous studies. Compared to people with average LDL cholesterol levels (less than 130 mg/dL), those with familial hypercholesterolemia had a five times higher risk for heart disease.

Those with genetically inherited high cholesterol were also more likely to have diseases caused by hardening of the arteries, including earlier development of heart disease — up to 20 years earlier in men and 30 years earlier in women, the research revealed.

Even when the researchers included other risk factors for heart disease in their analysis, the risks were still higher for those with the genetic cholesterol disorder.

The findings may help doctors explain the risks of familial hypercholesterolemia more clearly to patients. That’s important because the disorder can be treated with cholesterol-lowering drugs to decrease the risks for coronary heart disease and stroke, the investigators said.

“Clinician-patient discussions about guideline-supported therapies can be informed by this data,” according to the study authors, who were led by Dr. Donald Lloyd-Jones at Northwestern University in Chicago.

Using the data, doctors could present certain scenarios to their patients. For example: if a 25-year-old woman with newly diagnosed familial hypercholesterolemia leaves her cholesterol untreated, her risk of coronary heart disease death or nonfatal heart attack would be comparable to that of a 55-year-old woman, the researchers said.

“Such an analogy, paired with counseling about how to improve risk, may motivate behavioral changes as well as adoption of and adherence to evidence-based medications,” the study authors said.

The findings were published June 29 in the journal Circulation.

More information

The U.S. National Human Genome Research Institute has more on familial hypercholesterolemia.

Posted: June 2016

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