Nearly one third of patients who said they were forced to cut back on their medications due to out-of-pocket costs eventually experienced a decline in their health status, especially those who were taking drugs to treat cardiovascular disease. At a time when the cost of prescription drugs continues to increase at double-digit rates and many individuals lack a drug benefit, the findings should prompt patients to be "very proactive in asking physicians if there is a cheaper substitute available" if they can't afford a particular medication. At the same time, physicians themselves should be more judicious about writing prescriptions for the latest drug that may be no more effective than one that is already available at a lower cost. Health outcomes as a result of restricting medication use varied, depending on patients' condition. For example, respondents with cardiovascular disease who restricted their medication use reported higher rates of angina and experienced higher rates of nonfatal myocardial infarction and stroke  than those who did not change their medication use. On the other hand, there were no significant differences between respondents who restricted the use of medication for diabetes and those who did not; the same finding applied to respondents with arthritis, according to the study.
Med Care. 2004;42:626-634

Several common diseases, such as heart failure and COPD, appear to be independent risk factors for suicide in elderly patients. The most common cause of suicide was by firearm, accounting for 28% of all deaths. Hanging and self-poisoning were the next most common causes, responsible for 24% and 21% of all cases, respectively. Illnesses associated with a heightened risk of suicide included heart failure, COPD, seizure disorder, urinary incontinence, anxiety disorders, depression, psychotic disorders, bipolar disorder, moderate pain, and severe pain. The increased risks ranged from 1.6-fold for COPD to 9.2-fold for bipolar disorder. The risk of suicide was greatest when more than one of these diseases was present. Nearly half of the suicide patients had visited a physician in the week before death. Arch Intern Med 2004;164:1171-1172,1179-1184.

Alzheimer’s patients may be capable of learning new ways to use their brains. It may be possible to help loved ones and caregivers better cope with their disease. The brains of Alzheimer’s patients are more intact than had been thought, at least early on in the disease. They may retain what is known as implicit, or unconscious, memory. Alzheimer’s is an incurable, fatal condition that eventually destroys the brain, leaving patients helpless before they finally die.
But it can take years to become seriously ill from Alzheimer’s. Some drugs may slow its progression.

A number of studies have observed a lower occurrence of cancer in patients with schizophrenia. A possible explanation is an increased rate of apoptosis found in schizophrenia, thus protecting against cancer. If this is so, the lower risk for cancer could be hypothesized to also be apparent in first-degree relatives of persons with schizophrenia. Overall, there was no difference in the risk of cancer in the parents of schizophrenic children compared with parents of non-schizophrenic children. Mothers of schizophrenic children had an increased risk of lung cancer and both mothers and fathers of schizophrenic children showed a tendency toward a decreased risk of leukemia. Parents of schizophrenics appeared to have no consistently different pattern of cancer risk compared with other parents. Am J Psychiatry 2004;161:903-908.

Food additives are associated with symptoms of attention deficit hyperactivity disorder (ADHD). Findings therefore suggest that "significant changes in children's hyperactive behavior could be produced by the removal of artificial colorings and sodium benzoate from their diet," the authors conclude. Arch Dis Child. 2004;89:506-511

Higher diabetic rates, inadequate health insurance and a rapidly growing population of older Hispanics will result in a much higher incidence of Alzheimer's disease among the nation's Hispanics, according to a compilation of studies by the Alzheimer's Association. The sixfold growth rate is double that expected in the overall population. Today, Hispanics make up 12 percent of the U.S. population and 5 percent of those over age 65; by 2050, they're projected to make up 22 percent of the population and 16 percent of those over 65. Alzheimer's hits primarily the elderly, doubling every five years past age 65.

Children undergoing cardiac surgery have a clinically significant risk of developing post-traumatic stress disorder (PTSD), particularly if they require more than 48 hours in the intensive care unit (ICU).
According to the team, the only predictor of PTSD was an ICU stay of more than 48 hours. The fact that the incidence of PTSD increases with length of ICU stay is an issue that doctors need to be aware of in terms of minimizing stressful procedures and expediting discharge from the ICU as soon as medically possible. It is impressive that roughly 1 in 10 children develop full blown PTSD after undergoing heart surgery. J Pediatr 2004;144:480-484.

Some newly approved agents and new formulations of existing agents can aid patients recovering from addiction by reducing sensations of craving. Alcoholism is a disease of the brain that doesn't go away with abstinence. At least 50% of alcoholics could be helped with craving sensations by naltrexone. It has been used for some time to treat heroin addiction, but the newly available sustained-release formulation is more accessible and is also effective in treating alcoholism. It is easy to use, nontoxic, and not damaging to the liver. For alcohol-dependent patients, alcohol consumption interacts with the dopamine system in a manner similar to that of opioids, Only 5% are treated with naltrexone. This low rate of treatment reflects American attitudes that alcoholism "is a disease of willpower Naltrexone should be given in conjunction with supportive therapy, such as counseling, cognitive behaviorial therapy, or therapy from self-help groups such as Alcoholics Anonymous. Other medications that block craving include bupropion, used in smoking cessation; the experimental agent rimonabant, used to treat both excessive eating and smoking cessation; and acamprosate, which is also being used to treat the cravings of alcoholism.

Writing about emotional topics appears to reduce stress in HIV patients and may improve immune responses, according to researchers. Emotional disclosure by patients with diseases such as asthma and arthritis has shown "consistent and significant improvements in health outcomes after written emotional expression." Control participants were asked to write objectively about how they occupied their time. Subjects in the emotional group rated the experience as being more valuable than did those in the control group. "The CD4+ positive lymphocyte count increased gradually and continuously in the emotional writing group in the 6 months after the sessions. However, there was no change in the control group." The findings are consistent with those of other studies which indicate that patients with HIV, "who don't get to discuss their feelings, have a faster decline in their health." Psychosom Med 2004;66:272-275.

A significant proportion of older bipolar patients show neuropsychological deficits, according to the findings of a small study. Findings suggests that additional research "to understand how bipolar disorder affects cognitive function in older adults and whether bipolar disorder is a risk factor for subsequent dementia."
Older bipolar disorder patients reflect a heterogenous group. Neurodevelopmental anomalies, the 'toxicity' of mood episodes, vascular disease, comorbid history of substance abuse, and medication side effects are all potential contributors to cognitive dysfunction," they add, "as well as potential targets for intervention to alleviate an important component of disability among older adults with bipolar disorder." Am J Psychiatry 2004;161:736-738.

Physicians neither adequately detect nor refer for treatment inpatients with alcohol use disorders. Diagnoses of alcohol-related problems documented in the patient chart accounted for only 40% to 42% of cases of alcohol use disorder detected by interview. Of cases diagnosed by interview, 21% had inpatient interventions and 24% had treatment referral. Cases detected in hospital as well as by interview had an estimated rate of intervention of 50% and an estimated rate of referral of 53%. Effective treatment options for alcohol dependence now include medications, in addition to physician counseling and other brief interventions. Because hospitalization offers an excellent opportunity for diagnosis and intervention, screening patients for alcohol problems should be a routine part of hospital admission. Medical education and continuing medical education also need to address this problem. Arch Intern Med. 2004;164:749-756

"Atherosclerosis and depression are linked in the elderly. Several studies have demonstrated that persons with brain infarcts are more likely to have depressive disorders. Furthermore, depression is related to the subsequent development of ischemic heart disease.
Subjects with atherosclerosis were more likely to be depressed. More severe extracoronary atherosclerosis was associated with a higher prevalence of depressive disorders, with an increase in prevalence by 30% for every one standard deviation increase in atherosclerosis. Patients with severe coronary calcifications were almost four times as likely to have depressive symptoms, and patients with aortic calcifications were twice as likely to have depressive symptoms. If substantiated through further research, this knowledge may allow the prevention of the physical consequences of depression or new treatment strategies for late-life depression."
Arch Gen Psychiatry. 2004;61:369-376

Depressive symptoms are common after stroke, and the time course of these symptoms varies and depends on the patients' cognitive status. In one study, the only predictor of depressive symptoms at month 6 was the severity of the neurologic deficit at admission. Patients with previous depression, dementia, and right superficial lesions were more likely to have at month 6. The investigators found that younger age and right superficial lesions were independently associated with the presence of depressive symptoms at 36 months. "The time course of the various depressive symptoms differed, sadness remaining frequent 3 years after stroke (50%), whereas slowness, psychic slowness, lack of energy, and concentration difficulties remained frequent at month 36 in patients with dementia." Because the time course of depressive symptoms is variable and linked with a patient's cognitive status, "this might partly explain the discrepancies observed in previous studies on poststroke depression and associated factors." Neurology 20004;62:905-911.