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Atlanta Medical
Psychology
 The clinical
practice of Dr. David B. Adams is located in The Medical Quarters in
the northside of Atlanta at the junction of Scottish Rite, Northside
and Saint Joseph's Hospitals. Dr. Adams consults to occupational
medicine, surgeons, nurse case managers, insurers and employers
regarding the psychological impact of work-related injury and the
role of psychological factors in short- and long-term
disability.
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| PSYCHOLOGICAL REALITIES |
- Results of a study suggest an
association between greater seafood consumption and lower rates
of bipolar disorders. Increased seafood consumption was
predictive of lower lifetime prevalence rates of bipolar I
disorder, bipolar II disorder, and bipolar spectrum disorder.
The most precipitous rise in prevalence rates for the bipolar
disorders generally occurs in countries having a seafood
consumption of less than 50 lb per person (per year).
Lifetime prevalence of schizophrenia was not correlated with
seafood consumption. This finding suggests a specificity to
affective disorders, according to the investigators. Am J
Psychiatry 2003;160:2222-2227.
- The incidence of illness and
persistence of symptoms remain higher in British veterans of the
1990-1991 Gulf War than among veterans not deployed to that
region. However, their symptoms have not worsened over time, and
these soldiers do not appear to be at any greater risk for
cancer than their counterparts,
a study of Gulf War veterans initiated
in 1997.
Using the National Health Services central register, the
investigators analyzed data on the incidence of cancer before
July 2002. After adjusting for tobacco and alcohol intake, the
incidence of cancer was nearly identical. After the Gulf war,
they were particularly likely to have chronic somatic symptoms.
The Vietnam war was associated with a very high incidence of
posttraumatic stress disorder and mood disorders. Iraq could be
"almost the worst combination of Vietnam and the first Gulf war.
The same types of things are happening [as in the first Gulf
war], but above and beyond that, there is the guerilla warfare
and the fact that many soldiers are being exposed to very
dramatic, acutely stressful events. BMJ
2003;327:1357-1358,1370-1375.
- Susceptibility to psychological
distress seems to be associated with the risk of Alzheimer's
disease (AD). If so, it is possible that antidepressants or
other drugs could attenuate the effects of stressful experience
on brain structure and function. Because chronic stressful
experience is linked to structural changes in the hippocampus
and with impaired learning and memory, and it is hypothesized
that propensity to experience psychological distress is related
to risk of AD. Episodic memory, which the investigators note is
primarily mediated by hippocampal formation, was more affected
by Neuroticism Scale scores than were other cognitive systems,
such as semantic memory and visuospatial ability. This trait was
not associated with quantitative measures of AD pathology --
plaques and neurofibrillary tangles -- assessed in autopsy
material. They suggest that the association between chronic
psychological distress and AD "probably reflects neurobiologic
mechanisms other than the pathologic hallmarks of AD."
Neurology 2003;61:1479-1485.
- Researchers report that patients
with anorexia nervosa are at increased risk of developing
emphysema. Malnutrition will cause destruction of the lungs to
create emphysema, and renourishment will cause the emphysema to
reverse and the lung will become more normal. The changes were
similar to changes seen in people with emphysema caused by
smoking. Up to 4% of American women will develop anorexia at
some point in their lives, according to the National Institute
for Mental Health. Previous studies have shown that malnourished
animals that get back on a healthy diet eventually recover
normal lung function.
- Results of a study suggest an
association between asthma and a range of mental disorders. The
researchers report that asthma prevalence was 2.7% (current) and
5.74% (lifetime). Patients with current severe asthma were
significantly more likely to have any anxiety disorder (odds
ratio [OR] 2.65) and specific phobia (OR 4.78). In addition,
current severe asthma was associated with a significantly
increased likelihood of panic disorder (OR 4.61) and panic
attacks (OR 4.12). A diagnosis of lifetime severe asthma was
associated with an increased likelihood of any anxiety disorder
(OR 2.09), panic disorder (OR 2.61), panic attacks (OR 2.84),
social phobia (OR 3.28), and specific phobia (OR 2.93). Patients
with this diagnosis were also more likely to experience
generalized anxiety disorder (OR 5.51) and bipolar disorder (OR
5.64). Arch Gen Psychiatry 2003;60:1125-1130.
- Maternal smoking during pregnancy
is associated with attention deficit hyperactivity disorder
(ADHD) symptoms in offspring.
Genetic factors accounted for most of the variance in offspring
ADHD, the investigators report in the November issue of the
American Journal of Psychiatry. However, maternal smoking during
pregnancy showed a significant environmentally mediated
association with ADHD symptoms. The association of prenatal
smoking with ADHD remains even when the additional substantial
genetic contribution to ADHD symptoms is included and when we
examine association between data from different raters in a
populations-based sample. Am J Psychiatry 160:1985-1989.
- Heart attacks surged at one
Brooklyn hospital after the September 11, 2001, attacks, which
supports the idea that psychological stress can be a trigger,
researchers reported at the annual meeting of the American Heart
Association in Orlando. New York Methodist Hospital in Brooklyn
treated 35% more heart attacks than usual in the 60 days after
the attacks and 40% more cases of serious arrhythmia. Before
Sept. 11, 11.2% of the patients actually had a heart attack,
compared with 15.3% afterward. That represents a 35% increase.
There was a 40% increase in arrhythmias, from 13% in the weeks
before the attack to 18.8% afterward. There is a clear
biological explanation. "Any time a person experiences
psychological or emotional stress, catecholamine levels rise,
which increases heart rate and blood pressure.
- Depressed women have more
sexual dysfunction than do depressed men. Paroxetine adversely
affected men more than it did women, whereas bupropion did not
seem to affect sexual function in either men or women. Rates of
sexual dysfunction are different in depressed men and women,
both before and during antidepressant treatment. Although sexual
dysfunction scores in women and men treated with bupropion did
not change significantly, men treated with paroxetine reported
significantly higher rates of sexual dysfunction, especially
orgasmic difficulties. Women consistently reported higher levels
of sexual dysfunction, but sexual dysfunction induced or
exacerbated by antidepressant treatment was only apparent in
depressed men who received paroxetine. Despite the fact that
both drugs were equally effective in treatment of depression,
only paroxetine treatment in men was associated with
significantly higher rates of sexual dysfunction.
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Children of older men are at
increased risk of schizophrenia in later life, possibly because
of mutations in their father's DNA.
A link between advancing paternal age and schizophrenia has been
reported before, but it has been unclear whether this is due to
increasing mutations in the male germ line with advancing age,
or the result of inherited personality traits.The study found
that the odds of developing schizophrenia increased by 30% for
each 10-year increase in paternal age. Adjusting for poor social
integration had only a minimal effect on the findings,
suggesting personality traits were not a major factor. "This
supports the hypothesis that accumulating germ cell mutations
may lead to an increase in genetic liability to schizophrenia in
the offspring," the investigators conclude. Br J Psychiatry
2003.
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U.S. and Japanese researchers
reported they have found a genetic mutation in patients with
obsessive-compulsive disorder and other mental illnesses, and
that some patients carry a second mutation that makes their
condition worse. They identified a mutation located in the human
serotonin transporter gene (hSERT), which helps control
transport and regulation. They also found that the presence of a
second hSERT variant appears to promote greater biomedical
effects and more severe symptoms. They interviewed relatives of
the patients and found six of the seven people with the mutation
had an obsessive-compulsive disorder, and some also had
anorexia, Asperger's syndrome, social phobia, or were abusers of
alcohol. A second hSERT mutation was found in two patients,
giving them a "double hit." These patients and their siblings
had especially difficult to treat versions of OCD. Mol
Psychiatry 2003;8:000-000
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Among patients at very high
risk for psychosis, impaired olfactory identification ability
often develops prior to diagnosis of schizophrenia. The subjects
who developed schizophrenia had significantly poorer olfaction
ability than other psychotic patients, those who did not develop
psychosis. Onset of schizophrenia compromises normal frontal
lobe development and therefore interferes with the development
of neuropsychological functions mediated by these regions." Am J
Psychiatry 2003:160:1790-1794.
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Young adults exposed to an
enriched, stimulating environment during childhood may be at
decreased risk for schizophrenia and criminal behavior. The
enrichment program emphasized a stimulating environment and
focused on three key elements-nutrition, education, and physical
exercise. Program participants scored lower on tests of
schizotypal personality and antisocial behavior at age 17 years
and were less likely to have a history of criminal behavior. The
strongest benefits were seen among children with evidence of
malnutrition at age 3 years. The findings may be particularly
relevant to poor rural areas of the US...and also to US inner
cities, where rates of both malnutrition and behavioral problems
in children are relatively high. Am J Psychiatry
2003;160:1627-1635.
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More than 50% of patients who
experience an episode of depression are likely to have a
recurrence. Patients with three or more episodes of depression
have an 80% to 90% likelihood of recurrent episodes. These
statistics point to the importance of treating depression to the
point of remission rather than just to the point of symptom
relief. A kindling effect occurs when patients have repeated
episodes of depression — to the point where life stressors are
no longer triggers. The patient just gets depressed.
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