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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 |
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Illicit use of heroin, cocaine and other drugs
helped fuel a dramatic rise in the number of accidental and unexplained
poisoning deaths in the United States. Narcotics and hallucinogens accounted for
51% of these deaths. There were 22,242 poisoning deaths in 2001 in the
United States, 63% of which were unintentional. The overall death rate from
poisonings - either intentional or unintentional - rose 56% between 1990 and
2001. Poisonings cost the nation untold billions every year in medical costs and
lost productivity. A 1997 study put the cost at about $925 per incident.
Researchers could not explain why Americans between the ages of 45 and 54 posted
the biggest increase - a 359% rise - in unintentional poisoning fatalities
during the 1990-2001 period. Equally puzzling was the discovery that the rate of
increase among women was almost double that of men in Colorado, Delaware,
Florida, Kentucky, Massachusetts, New Mexico, North Carolina, Oregon, Utah,
Washington and Wisconsin.
Mor Mortal Wkly Rep CDC Surveill Summ 2004;53:233-238.
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A study shows a high prevalence of anxiety among
patients after a recent coronary artery disease event. Levels of anxiety improve
"markedly," however, after cardiac rehabilitation and exercise training. The
researchers observed a very high prevalence of anxiety (40%) and moderate to
severe anxiety symptoms (19%) in patients younger than 55 years. The prevalence
in this age group was almost twice as high in the older patients. Men and women
had a similar prevalence of anxiety and high anxiety symptoms. The investigators
call for greater attention to detecting and treating chronic anxiety in coronary
patients, especially with formal cardiac rehabilitation, in order to aid in the
secondary prevention of CAD. Am J Cardiol 2004;93:336-339.
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Psychological stress has been linked to the
development of multiple sclerosis (MS), and parents who experience the death of
a child are at increased risk for MS. The researchers compared the occurrence of
MS in 21,062 parents who lost a child with that in 293,745 matched control
parents. The risk of MS was particularly high in parents who lost a child
unexpectedly--more than double the risk of control parents. The new findings
could provide a better understanding of how MS evolves and may lead to
preventive treatments. Neurology 2004;62:726-729.
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Women with high levels of phobic anxiety are at
increased risk of fatal coronary heart disease (CHD) and sudden cardiac death.
Phobic anxiety is also linked to elevated risk of CHD in men. There were
significant trends for increased risk of sudden cardiac death and fatal CHD with
increasing phobic anxiety scores. Not all of this risk can be accounted for by
CHD risk factors and lifestyle factors associated with phobic anxiety." After
adjusting for CHD risk factors, alcohol intake, exercise, hormone therapy and
aspirin use, the risk ratios for sudden cardiac death and fatal CHD were
associated with high phobic anxiety scores.
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Patients with restless legs syndrome
exhibit relatively high levels of anxiety and depression.
"Restless legs syndrome (RLS) is an important and common cause
of insomnia. Compared with controls, RLS patients had
significantly greater anxiety and depression symptoms. A
correlation was observed between the severity of RLS and of
anxiety and depression symptoms. A longitudinal assessment would
be necessary to establish temporality; ie, to determine whether
anxiety or depression are a consequence of RLS. J Neurol
Neurosurg Psychiatry 2004;75:226-230.
- Researchers in Hong Kong and
China hope to persuade Chinese people to donate their grey
matter to medical science. Hong Kong University says the project
will help scientists to gain an understanding of the differences
between the brains of different races. However, many Chinese
believe it is important to dispose of the body intact after
death - which might make it hard to recruit potential donors for
the new facility. The biological basis of human emotion and
personality has long been the source of intense study.The brain
has been described as the last frontier of the human body. The
complexities of human thought and emotion and the diseases that
affect the central nervous system are still not fully
understood. The brain bank will be located at the Xiangya
Medical School in Hunan and the Faculty of Medicine, the
University of Hong Kong.
- People with hostile or
aggressive personality traits may have genetic tendencies that
make them "born to smoke," U.S. researchers reported. Brain
imaging studies suggest that the same genetic variations that
give people hostile personality traits may also make them more
likely to become addicted to nicotine, evidence suggesting that
people with hostile personality traits are more likely to become
addicted to cigarettes and have trouble kicking the habit.
They tested volunteers separating them into two groups -- those
with higher tendencies to anger, aggression and anxiety, and
those with low-hostility traits. Both groups included smokers
and nonsmokers.
They were given nicotine patches to wear and their brains were
imaged using positron emission tomography, or PET scans. The
scans showed no metabolic changes in the brain cells of the
low-hostility volunteers but the response of the "hostile"
personalities was clear. And the hostile smokers needed a higher
dose of nicotine to get the same response that nonsmokers had to
the nicotine patch -- suggesting they had become habituated to
nicotine. If you have hostile, aggressive personality traits, in
all likelihood you have a predisposition to cigarette addiction
without ever having even touched a cigarette. In turn, this
might also help explain why other people have no compelling
drive to smoke or can quit smoking with relative ease.
- While maternal depressive
symptoms are not associated with child asthma morbidity, they
may significantly influence adherence to asthma treatment and
illness management. Asthma morbidity did not differ between
children with mothers with high or low depressive symptoms.
However, mothers with high depressive symptoms reported
significantly more problems with their child using inhalers
properly. The investigators also observed an association between
depressive symptoms and greater emotional stress and
interference with daily activities caused by the child's asthma.
In addition, mothers with high levels of depressive symptoms had
less confidence in asthma medication, more problems in their
ability to control asthma symptoms and in their ability to cope
with acute asthma episodes. Mothers with depressive symptoms
also reported less understanding about the asthma medications
and their use.
Pediatrics 2004;113:229-237.
- A signaling pathway linked to
mood disorders may also play a role in schizophrenia. Because it
is a target for lithium, AKT1-GSK3beta signaling has been
implicated in the pathogenesis of bipolar disorder. In the
current study, evidence of impaired AKT1-GSK3beta signaling was
found in the brains of individuals with schizophrenia. AKT1
protein levels were reduced and decreased GSK3beta
phosphorylation was seen. An AKT1 haplotype associated with
lower AKT1 protein levels was tied to an increased risk of
schizophrenia, the researchers found.Treatment with the
well-known antipsychotic drug haloperidol seemed to normalize
AKT1 activity.
Findings support the proposal that alterations in AKT1-GSK3beta
signaling contribute to schizophrenia pathogenesis and identify
AKT1 as a potential schizophrenia susceptibility gene. Nat Genet
2004;January 25, 2004.
- Males born with severe phallic
inadequacy are often assigned at birth to the female sex. Over
time, many of these individuals assume a male identity, despite
hormonal treatments and rearing practices. "For genetic males
exposed to normal amounts of male hormones in utero, it looks
like a substantial number of them are going to recognize that
they are male, no matter what you do. Those wishing to live as
males used male restrooms when they were away from their
families and school, and all eight expressed a desire for
surgical penis construction. Moreover, parents found that
children seemed to be happier since undergoing transition to the
male sex.
Genital reconstruction surgery be delayed in these infants. The
only way to substantiate anything in a newborn is to wait until
they're older.Waiting also means that more of these patients
will have their natural testes, he added, thus avoiding the need
for lifelong hormone replacement therapy. N Engl J Med
2004;350:323-324,333-341.
- Morning headache may be a good
indicator of depression and insomnia and is not specific to
sleep-disordered breathing. Conditions associated with chronic
morning headaches were comorbid anxiety and depressive
disorders, sleep-related breathing disorders, hypertension,
musculoskeletal diseases , use of anxiolytic medication, and
heavy alcohol consumption. Morning headache affects one
individual in 13 in the general population. Recurrent morning
headaches in about 80% of cases are related to an identifiable
organic, mental or sleep disorder. Arch Intern Med.
2004;164:97-102
- Parents of children with
attention deficit–hyperactivity disorder (ADHD) are likely to
have the disorder themselves and may benefit from treatment.
Based on interviews with the biological mothers, the
investigators concluded that ADHD in the children was associated
with a 24-fold increase in rates of maternal and paternal
childhood ADHD compared with rates in parents of control
children. ADHD+ODD/CD was associated with maternal mood
disorders, anxiety disorders, and dependence on stimulants or
cocaine, as well as childhood disruptive behavior disorders and
alcohol problems in the biological fathers. Because treatments
for children with ADHD rely heavily on parental support, mental
health problems in the parents can interfere with the child's
treatment and recovery, the authors note. Young children with
ADHD, especially those with comorbid ODD/CD, require
comprehensive services to address both their ADHD and the mental
health needs of their parents. J Am Acad Child Adolesc
Psychiatry. 2003;42:1424-1432
- Cigarette smoking at age 18-20
seems to be associated with a reduced risk of subsequently
developing schizophrenia. In a longitudinal study, the
researchers examined whether smoking alters the risk of
subsequently developing schizophrenia. A linear relationship was
found between the number of cigarettes smoked and a lower risk
of schizophrenia (adjusted hazard ratio for linear trend across
smoking categories, 0.8). The adjusted hazard ratio for heavy
smokers was 0.5. While the investigators caution that the
harmful effects of smoking outweigh any possible benefits, they
note that further investigation may lead to important findings
about the etiology of schizophrenia at the molecular level. Am J
Psychiatry 2003;160:2216-2221.
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