• Drug use among American teenagers has fallen 23% over the past five years, although there was little improvement in the last year. U.S. officials hailed the overall findings as a vindication of anti-drug policies, saying they had nearly reached President George W. Bush's goal of a 25% drop over five years. But some voiced concern that budget cuts may be hurting the campaign against drugs.
  Abuse of almost every illegal drug fell, although use of the prescription painkiller OxyContin rose among teenagers. These decreases are an encouraging sign that the administration's ongoing efforts to combat drug abuse are helping American children stay away from drugs," said Attorney General Alberto Gonzales.The 23% decline meant 840,000 fewer students were using illegal drugs this year than in 2001. Despite the five-year drop, the study found little change in drug use among teenagers during the past year. Marijuana use among older teens was down but it remained steady among younger teens for a second straight year. Use of LSD, cocaine, crystal methamphetamine, heroin, inhalants, tranquilizers and sedatives showed little or no change. The survey also found little change in teen attitudes about the harmfulness of drugs, a key predictor of future use. The survey found consumption of marijuana, the drug most widely used by teens, had fallen 25% over the past five years. Thirteen percent of the students said they had used marijuana in the past 30 days, versus 26% in 2001. Use of amphetamines, especially methamphetamine, also plummeted since 2001. Less than 1% of students said they had used methamphetamine at least once in the last 30 days. One area of growth was abuse of prescription drugs. Four percent of all of the teenagers said they had used OxyContin at least once in the last year, a 30% rise over the past four years. Use of the narcotic painkiller Vicodin remained steady, with 10% of the older students reporting they had tried it at least once in the past year. In addition to dramatic drops in the use of illegal drugs like LSD and ecstasy, the study also reported a fall in the use of cigarettes, alcohol and steroids.
• "Depressive symptoms are present in more than half of patients with chronic cough. Depression seems to lift as the cough improves.
  Cough is the most common reason people in the US seek medical attention, and several reports have shown that chronic cough can significantly impinge on quality of life. Physicians and caregivers must be cognizant of the significant risk of clinical depression in this patient population. Furthermore, clinicians should exercise judgment in deciding whether appropriate mental health referral is necessary, regardless of the outcome of treatment for chronic cough." Chest 2006;130:1839-1843.
• "Researchers have identified a polymorphism that reduces the promoter activity of the human norepinephrine transporter gene and may predispose individuals to attention-deficit hyperactivity disorder (ADHD). The norepinephrine transporter is known to play a key role in the regulation of norepinephrine levels in the nervous system. In the present study, researchers found that a common polymorphism in the transporter gene, denoted -3081(A/T), is associated with ADHD. The presence of the -3081(T) allele reduced the promotor activity of the transporter gene relative to the A allele, according to the report. Further analysis showed that the T allele interacts with transcription repressors called Slug and Scratch. Moreover, Slug and Scratch were only able to repress the promotor activity of the transporter gene when the T allele was present. The findings suggest that "the anomalous transcription factor-based repression of the (norepinephrine transporter gene) may increase risk for the development of ADHD and other neuropsychiatric diseases," the researchers conclude." Proc Natl Acad Sci USA 2006
• "People with depression who take selective serotonin reuptake inhibitors (SSRIs) may start to feel a lessening of symptoms by the end of the first week of treatment, with further improvements developing over the following weeks. These findings are derived from pooled estimates of the anti-depressant treatment effect of SSRI therapy for weeks 1 through 6 derived from 28 randomized placebo-controlled trials involving 5872 patients. Treatment with SSRIs rather than placebo was associated with clinical improvement by the end of the first week of use. Data analysis showed increased odds of achieving a 50% reduction in Hamilton Depression Rating Scale scores by 1 week (relative risk, 1.64) with SSRI treatment compared with placebo. ...will help my patients...make better informed decisions about treatment. Previously, if a patient had started taking an SSRI and described feeling better after only a week of treatment, we might have thought that response was too quick, and perhaps they would have improved even without the medication. Clearly, an early response to an SSRI is not necessarily a placebo response, the authors conclude in their report.
  Arch Gen Psychiatry 2006;63:1217-1223.
• Multi-step treatment for depression can be effective in about two-thirds of patients. Patients who did not achieve remission with, or were unable to tolerate a treatment step, were asked to continue on to the next step. Subjects who experienced an acceptable benefit -- preferably remission from depressive symptoms -- from any specific step could enter a 12-month naturalistic follow-up arm. Remission was defined as a score of no more than 5 on the Quick Inventory of Depressive Symptomatology-Self Report (QIDS-SR16). Relapse was defined as a QIDS-SR16 total score of at least 11. Relapse rates during the naturalistic follow-up period were higher among patients who required more treatment steps. Subjects who were in remission at follow-up entry had lower relapse rates than those who were not in remission after the first three treatment steps. The more steps it takes to get better or to remission, the more carefully a patient needs to be followed, because the more likely that individual is to have a relapse. Am J Psychiatry 2006;163:1905-1917.
• The combination of a selective serotonin reuptake inhibitor (SSRI) and cognitive behavioral therapy (CBT) resulted in remission of pathological gambling for gamblers who had no other comorbidities. One of the specific comorbidities that presents with pathological gambling is depression, which has prompted clinicians to use SSRIs as a therapy for some pathological gamblers. It would seem intuitive that the combination of CBT and medication would prove most effective, but studies have not clearly demonstrated the benefit of combination therapy. But the combination of CBT and medication is likely to act quicker than CBT alone or medication alone.
• Behavioral approaches for the treatment of chronic insomnia are effective, produce longer-lasting effects than medication, and should be used as first-line treatment. Treatments such as cognitive behavioral therapy (CBT) and relaxation were effective for primary insomnia as well as insomnia associated with some medical conditions and, to a lesser extent, some psychiatric illnesses. CBT is an effective therapy for insomnia, but it is underutilized, largely because there is a misperception by clinicians that it takes too much time to implement. But the fact is, there are some CBT methods that can be efficiently integrated into clinical practice that do not take an undue amount of a practitioner's time. Insomnia rarely comes in isolation, but the direction of the relationship between it and other conditions is often unclear. Previously it was assumed insomnia was always the result of another condition, but there is now evidence showing it may actually be a risk factor for some conditions. While medication remains first-line therapy, CBT will help change practice. CBT offers physicians who are not comfortable prescribing sleep medication an effective alternative therapy. Sleep. 2006;29:1415-1419.
• Individuals with high stress and high hostility have an increased risk for insulin resistance. There is a statistical interaction between hostility and stress level in predicting insulin resistance. In other words, people with higher hostility don't always have worse insulin resistance, but they do when they are under stress, especially high levels of chronic stress. Cynicism is a particularly vulnerable personality trait that is strongly related to insulin resistance. Clinically, because people with high hostility (especially high cynicism) tend to have worse insulin resistance under stress, it is important to target this population for preventive interventions. Psychotherapy and behavioral interventions may be helpful in reducing stress and physiological arousal, and perhaps prevent insulin resistance in the long run, although so far there is no study testing this yet. Psychosom Med 2006;68:718-726.
• Four out of ten children with mental retardation also have severe emotional and behavioral problems, which often persist into adulthood. The psychopathology that often affects people with intellectual disability limits their ability to live in the community, participate in social activities or gain employment. The overall severity of psychopathology was similar across mild to severe ranges of developmental disability. Nevertheless, distinct differences were observed. Subjects with mild intellectual disability scored significantly higher for disruptive behavior and communication disturbance, while those with severe or profound intellectual disability had highest scores for self-absorbed behavior and social maladjustment. Despite the high prevalence of severe psychological and behavioral disorders, the survey results showed that only about 10% of those with severe psychopathology received any specialist mental health interventions. JAMA 2006;296:1981-1989.
• Among a group of patients treated for depression, more than a third were later diagnosed with the metabolic syndrome during follow-up. Patients with prolonged depressive symptoms seem to be at markedly increased risk of metabolic syndrome; in other words, risk factor clustering related to central obesity and increased risk of type 2 diabetes and cardiovascular events. The connection between depression and insulin resistance has been under scrutiny, particularly in the last few years. Researchers followed 121 outpatients who had depressive symptoms. At baseline 87 (72%) had major depression. At follow-up of 6 years, the prevalence of the metabolic syndrome was 36%. In addition, the prevalence of the metabolic syndrome was greatest (58%) in the subgroup of 19 patients who were diagnosed as still having major depression. Early treatment of depression is important with respect to physical health and on the other hand, prolonged symptoms of depression require assessment of associated physical health risks.  J Clin Psychiatry 2006;67:1422-1427.
• Roughly a third of patients who take antidepressants and undergo cosmetic plastic surgery discontinue these medications after the operation. While the cosmetic procedures were associated with marked improvements in self-esteem, this did not explain why many antidepressant users were able to stop taking the drugs after surgery. The percentage of patients reporting an improvement in self-esteem was similar among patients who were and were not able to stop their antidepressants. So, it appears that it wasn't a self-esteem effect. Instead, it may relate to a separate effect on quality of life. In the study, xixty-one patients (17%) were antidepressant users before surgery. By 6 months after surgery, the number of antidepressant users had dropped 31% to 42 patients. Ninety-eight percent of patients reported a marked improvement in self-esteem following surgery. But not all research has linked cosmetic surgery with beneficial effects on mental health. A number of studies have come out in recent years showing an increased risk of suicide in women who undergo breast augmentation. This may be because the operation selects patients who are at heightened risk for suicide, rather than the procedure having any adverse effects that cause them to commit suicide.
• Men with major depression and increased early life stress have increased inflammatory responses to psychosocial stress. Once manifested, major depression has been associated with enhanced tonic activation of the innate immune system, including increased plasma proinflammatory cytokines such as interleukin (IL)-6. These increases were also independently correlated with depression severity, but not with early life stress. Although natural killer (NK) cell percentages also increased following stress, there were no differences between groups and no correlation between NK cell percentage and stress-induced NF-?B DNA-binding or IL-6. Male major depression patients with increased early life stress exhibit enhanced inflammatory responsiveness to psychosocial stress, providing preliminary indication of a link between major depression, early life stress and adverse health outcomes in diseases associated with inflammation. The mechanisms of the observed effects may relate to changes in neuroendocrine function, including increased sympathetic nervous system responses and/or altered glucocorticoid feedback regulation. Sympathetic nervous system activation has been shown to enhance inflammatory responses, and major depression patients with early life stress have been shown to exhibit enhanced sympathetic nervous system responses to stressor challenge. Am J Psychiatry. 2006;163:1630-1633

• Molecular studies show no evidence for the persistence of measles virus following MMR immunization in peripheral blood mononuclear cells (PBMCs) of children with autism spectrum disorder. Despite mounting epidemiologic evidence against an association between MMR vaccination and autism, several molecular investigations have been used to implicate MMR vaccination in the development of autism spectrum disorder in at least a subset of affected children. In 2000, the presence in PBMCs of one or more vaccine-strain measles virus gene in three of nine children with autism compared with none of eight healthy children. But new  data are a direct refutation of the reports of persistence of measles virus in the tissues of autistic children. Pediatrics 2006;118:1664-1675.

   

©2006 David B. Adams, Ph.D.