• Psychotherapy is useful in stabilizing daily routines in Bipolar Disorder. Interpersonal and social rhythm therapy to stabilize sleep, wake, and meal times improved outcomes in bipolar patients. The clinical implications are that without necessarily trying to provide patients with the full interpersonal and social rhythm therapy protocol, which so far only a small number of people in the United States are trained to do, any clinician treating someone with bipolar disorder can encourage them to lead lives characterized by regular routines, and in particular, regular wake times, bedtimes, and mealtimes. Individuals with bipolar disorder or recurring unipolar disorder have particularly sensitive biological clocks, so that events that disrupt their daily routines and sleep-wake cycles are associated with new onsets of illness. Treatment that helped patients lead lives with very regular wake times, bedtimes, mealtimes, and other routines could protect these delicate clocks, and paying attention to potential changes in routine and avoiding drastic changes could protect patients from new episodes. Establishing and maintaining a regular routine take discipline but require less effort than making and keeping health-related changes in diet and exercise, especially with the support of family members or other people living with the patient. The patient can have as many interesting and exciting experiences as he wants, as long as he manages to get to bed at the same time pretty much every night and get up at the same time pretty much every morning."
• "Subjects with obsessive-compulsive disorder (OCD) and their close family members have distinctive brain structure patterns, according to a study in the December issue of Brain. These results provide the first evidence for a neurocognitive endophenotype of OCD. Endophenotypes (intermediate phenotypes) are objective, heritable, quantitative traits hypothesized to represent genetic risk for polygenic disorders at more biologically tractable levels than distal behavioral and clinical phenotypes. It is theorized that endophenotype models of disease will help to clarify both diagnostic classification and etiological understanding of complex brain disorders such as obsessive-compulsive disorder. A significant association was observed between behavioral impairment on the Stop-Signal task, which occurred mostly in patients and relatives, and increased grey matter in cingulate, parietal and striatal regions and reduced grey matter in orbitofrontal and right inferior frontal regions. These brain changes appear to run in families and may represent a genetic risk factor for developing the condition.  The diagnosis of OCD is subjective and therefore knowledge of the underlying causes may lead to better diagnosis and ultimately improved clinical treatments." Brain 2007;130:3223-3236.
• Physicians and other healthcare providers are increasingly being called on to play a new role in dealing with men and women's sexual problems. In the past 5 years, new biomedical and pharmaceutical approaches to sexuality problems have emerged and more are in development. There is a risk, however, that an overemphasis on such approaches will fail to address patients' fundamental problems with their sexuality and sexual relationships and perhaps medicalize our approach to problems in human sexuality to an extent that will prove unhelpful and possibly harmful. Indeed, when it comes to women's sexual health, it has been argued that female sexual dysfunction "is the freshest, clearest example we have" of a "corporate-sponsored creation of a disease."[1] It is thus imperative that clinicians who are called upon to treat women's sexual problems attempt to develop a sophisticated approach that brings to bear the relevance of the psychosocial, sociocultural, and socioeconomic contexts of human sexuality and sexual problems as well as an understanding of the physiologic and biological aspects. One such approach has been developed by a group of clinicians, sex therapists, and social scientists in response to what they see as a growing medicalization of sexuality in clinical settings, particularly within urology. The purpose of this CME program is to familiarize clinicians with their "New View" approach[2] to treating women who present with sexual problems. The foundation of the approach is the consideration of the relational and sociocultural factors that contribute to women's expressions about their sexual problems.
• "...psychosocial treatments do have an impact on methamphetamine abuse, so they may be just as useful as they are for other stimulants. We have assumed that methamphetamine is a long-acting form of cocaine and what might work for cocaine would also work for methamphetamine. Both drugs block neurotransmitter transporters. A fair number of medications have been tested for treatment of methamphetamine abuse. Antidepressants do not work. Baclofen showed a possible effect in adherent subjects. Vigabatrin, which is approved as an anticonvulsant in other countries, showed promise for cocaine and methamphetamine in 1 study. A mixture of 3 medications — flumazenil, gabapentin, and hydroxyzine — is being investigated. A recent study in Finland looked at aripiprazole, methylphenidate, and placebo. Another study found that sustained-release bupropion showed promise for some patients.
  
  A different approach is to investigate medications that would improve cognition in people who stop using methamphetamine and have worse cognitive ability. Many abuse treatments rely on verbal memory, but this is impaired in many users seeking treatment. If we're delivering psychotherapies, maybe our pharmacotherapies should be an attempt to improve their cognition so that they can respond better."
• "Investigators have identified the first biomarker that allows them to noninvasively detect and track neural stem and progenitor cells (NPCs) in the living human brain — a finding that could lead to significantly better diagnosis, prognosis, and treatment of brain tumors as well as a range of disorders.
  
  Using magnetic resonance spectroscopy (MRS), researchers were able to consistently detect the biomarker — thought to be a lipid molecule — in the hippocampus of rodents and live humans.
  
  This is the first noninvasive approach to identify neural progenitor cells in the human brain. Until now, there was no way to identify and track these cells in living people to get a dynamic picture of neurogenesis.
  
  It is clear that this biomarker may have promise in identifying cell proliferation in the brain, which can be a sign of cancer. In other patients, it could show us how neurogenesis is related to the course of diseases such as depression, bipolar disorder, Alzheimer's, Parkinson's, multiple sclerosis, and posttraumatic stress disorder.
  
  The ability to track these cells in living people would be major breakthrough in understanding brain development in children and continued maturation of the adult brain." 
  Science. 2007:318:980-985
• "The characteristics of young patients who commit acts of deliberate self-harm varies widely. Deliberate self-harm and suicide are both major problems in young people. Rates of deliberate self-harm (DSH), the term used for the intentional self-poisoning or self-injury in many European countries because of the mixed motivation that is often involved, are highest in young persons.
  
  Overdoses accounted for the majority of DSH episodes (90.5%). These most often involved acetaminophen (44.0%). Increases in acetaminophen overdoses (from 33.3% to 53.4%) and antidepressant overdoses (9.3% to 11.9%) were observed during the study period.
  
  Overdoses of minor tranquilizers and sedatives decreased (18.8% to 7.7%) decreased during the study. Of 708 self-injuries, self-cuts (88.5%) accounted for the majority of them. Overall, 36.1% of subjects had drunk alcohol immediately before DSH.
  
  The most common problems faced by patients at the time of the DSH included difficulty with family (50.9%), problems in the relationship with a partner (45.7%), employment problems or problems with studies (41.9%), and difficulties with friends (22.5%). A prior history of DSH was observed in 26.3% of patients.
  
  Risk factors for suicide included male sex, previous DSH, psychiatric history (in females), and high suicide intent. There were excess numbers of deaths from respiratory disorders, circulatory disorders, and accidents that did not involve poisoning.
  
  Assessment of young DSH patients must include close attention to interpersonal problems, previous self-harm, previous and current psychiatric problems, alcohol and drug misuse, history of violence and criminality, and suicidal intent. Treatment interventions for young DSH patients should especially focus on improving interpersonal difficulties by employing strategies such as problem-solving therapy and treatment for substance misuse and psychiatric disorders."  J Clin Psychiatry 2007;68:1574-1583.
• "Patients with posttraumatic stress disorder (PTSD) who received 8 weeks of Internet-delivered self-management cognitive behavior therapy had greater reductions in symptoms than patients in a comparison group who received Internet-delivered nontrauma-focused supportive counseling.
  
  Authors comment that "If resources were unlimited, of course we would want everyone who was traumatized to be treated by an individual psychotherapist... We're encouraged that there are technologies that we might be able to use to get people the care they need when they are reluctant to get it or it's not available.
  
  The DE-STRESS website was well received by the participants in the self-management cognitive behavior therapy group. Patients in this treatment group had a sharper decline in mean total PTSD symptom severity. One third of patients who completed this program were considered to have high end-state functioning at 6 months, whereas none of the participants who completed the supportive counseling program were. Patients in both groups, however, were considered to have significant declines in PTSD symptoms and depression at 6 months.
  
  Self-managed cognitive behavior therapy is a potential solution to meet the need for efficient, low-cost, and stigma-reducing interventions for traumatic stress.
  
  The rationale behind the self-management cognitive behavior therapy that was used is based on a fear-conditioning model, which is widely accepted in the PTSD literature. The study used graduated exposure to trauma triggers, with the goal of extinguishing the association between previously neutral stimuli and the conditioned response.
  
  However, insofar as exposure therapy failed to eliminate all PTSD symptoms." Am J Psychiatry. 2007; 164:1676-1684 and 1628-1630.
• "Girls with attention-deficit/hyperactivity disorder (ADHD) were more likely to develop an eating disorder or to develop major depression. Two studies showed that girls with ADHD can have eating-disorder problems that are not seen in boys, and they can also have life-threatening depression. People who have certain characteristics with ADHD such as conduct disorders, eating disorders, or depression require very different treatment and follow a more complicated path as they grow into adulthood.
  
  Compared with the controls, the girls with ADHD were 5.6 times more likely to develop bulimia and 2.7 times more likely to develop anorexia nervosa. They also had significantly higher rates of depression, anxiety disorders, and disruptive behavior.
  
  Treatment for ADHD should be considered in patients with eating disorders, adding the caveat that such treatment can be complicated by the adverse effects of medication.
  
  Girls with ADHD were 5.4 times more likely to develop major depression than girls without ADHD. Prior mania and parental major depression independently predicted depression among the girls with ADHD.
  
  These findings indicate that major depression emerging in the context of ADHD is an impairing and severe comorbidity worthy of further clinical and scientific interest."
• "About 3.4 million Americans aged 71 years and older — almost 14% — have dementia, and 2.4 million of them (9.7%) have Alzheimer's disease (AD).
  
  The prevalence of dementia increased with age. Dementia affects some 5% of people aged 71 to 79 years but 37.4% of those aged 90 years and older.
  
  As the population ages in the next few decades, the prevalence of Alzheimer's disease will increase severalfold unless effective interventions are discovered and implemented.
  
  The percentage of AD among dementia cases increases with age. Overall, AD accounted for about 69.9% of all dementia; however, in the age group 90 years and older, AD accounted for 79.5% of dementias compared with 46.7% among those aged 71 to 79 years.
  
  In addition to age, less education and the presence of at least 1 APOE e4 allele (a genetic risk factor for AD) were strong predictors for all types of dementia.
  
  Men had about the same dementia risk as women. African Americans had a higher frequency of dementia and AD, but after researchers controlled for education, sex, and genotype, the difference was no longer statistically significant."
  
  Neuroepidemiology. 2007;29:125-132.
   
• "Parts of the brain governing emotional responses were much more active in people who had skipped a night's sleep and were exposed to disturbing images than in a control group of individuals exposed to the same pictures.
  
  The study provides a new foundation of evidence on which to consider more seriously that sleep may play a significant role in regulating our emotional stability.
  
  When the researchers quantified and compared brain activity in the amygdala, the area of the brain that oversees emotional reactions, they found significant differences in the brains of the sleep-deprived group when they were exposed to the negative pictures. Rather than the brain being dulled or suppressed in its activity when you're sleep deprived, the deep emotional centers of the brain were approximately 60% more reactive when you're sleep deprived.
  
  The amygdala serves to alert the body to protect itself in times of danger. In the setting of sleep deprivation, the amygdala goes into overdrive in response to emotional images — for example, shutting down the prefrontal cortex, the area of the brain that governs logical reasoning. Instead, it activates the locus coeruleus, which releases noradrenaline to ward off imminent threats to survival, a potentially volatile mix.
  
  In the past, most people assumed that sleep disorders were an offshoot of emotional problems, but this study casts doubt on that assumption. It shows that emotional reactions of healthy but sleep-deprived people are similar to those seen in disorders. The patterns of brain activity that you see in those healthy people who have had a lack of sleep are not dissimilar to the patterns of brain activity that you see in people suffering things like depression and posttraumatic stress disorder.
  
  Researchers already believe that there's a closer relationship between sleep disturbance and depression among women than among men.
  Another element of the real world is shift work. There is anecdotal evidence that people who work overnight shifts might be more emotionally unstable than other workers."
  
  Current Biology 2007;17:95-97.
• "Patients with symptoms of physical pain are more likely to be correctly diagnosed as having depression in primary care settings compared with patients without pain. Depression is often not recognized and diagnosed in medical patients by providers although previous studies have shown that pain is correlated with depression.
  
  Other pain-related diagnoses, including back and muscle symptoms, were not significantly related to recognition of depression. Males and minorities were less likely to be recognized as being depressed. Age was not a significant factor. Adjusted data showed self-reported bodily pain to be a stronger predictor of recognition than pain-related diagnoses.
  
  Higher self-reported pain was significantly related to the correct recognition of depression and that certain types of pain, especially chest pain, aided in the recognition of depression. However, males, minorities, and those who report better general health are more likely to be underdiagnosed.
  
  This indicates that primary care physicians are cognizant of the potential mental as well as physical health components of self-reported pain."
• "Negative aspects of a close relationship--such as not confiding and not getting emotional support--can increase the risk of coronary events There is a growing body of literature that shows that being exposed to negative relationships that increase worry, anxiety, and feelings of low self-esteem can in the long term produce emotional effects that may trigger biological changes in the body.
  
  Poor marital quality has previously been reported as an important prognostic factor for MI, heart failure, and metabolic syndrome and that women seem to be more affected by the negative aspects of a close relationship than men. Negative aspects of relationship up CHD risk by 34%
  
  Although women and people in a lower employment grade were more likely to be exposed to negative aspects of a close relationship, sex and social position had no significant interaction effects. This shows that negative interactions in close relationships "produce similar effects on heart disease regardless of sex and social position.
  
  Negative close relationships may be more powerful predictors of health than other aspects of social support because previous research indicates that "individuals tend to mentally replay negative encounters more than they replay positive ones."
  
  Emotional effects could trigger changes in the neuroendocrine, inflammatory, and immunomodulatory systems. And although pharmacological approaches may cure the symptoms, they are just responding to the crisis and not tackling the root causes.
  
  De Vogli R, Chandola T, and Marmot MG. Negative aspects of close relationships and heart disease. Arch Intern Med 2007; 167:1951-1957.
   
• "Trait anger in middle-aged men and long-term stress in men and women predicted the progression from prehypertension to hypertension and incident coronary heart disease (CHD); exercise may reduce trait anger.
  
  Patients with prehypertension are more likely to progress to frank hypertension. The role of various psychosocial factors in cardiovascular disease has been of interest for many years.
  
  Compared with low to moderate levels of trait anger, high levels were associated with progression from prehypertension to hypertension. Trait anger was predictive for men but not for women and trait anger in men was associated with progression to CHD. In both sexes, long-term psychological stress was associated with risk for incident CHD.
  
  High levels of trait anger in middle-aged prehypertensive men were associated with increased risk of progressing to hypertension and incident CHD. Long-term stress was also associated with increased risk of incident CHD in both men and women.
  
  Beyond traditional cardiovascular risk factors, anger and psychological stress play a role in development of CHD in participants with prehypertension."
  
  Ann Fam Med. 2007;5:403-411.
• "Hostility in young adults is inversely associated with pulmonary function in terms of forced expiratory volume in 1 second (FEV1) and forced vital capacity (FVC), according to a report in the May/June issue of Health Psychology.
  
  Previous work has demonstrated that hostility affects coronary heart disease, hypertension, the metabolic syndrome, and all-cause mortality, but little has been done to examine the relationship between hostility and lung function.
  
  Hostility was highest in black men, followed by black women, white men, and white women. Both race and ethnicity were also associated with FEV1 and FVC.
  
  The team observed that the inverse association of hostility with pulmonary function was maintained after controlling for age and height, socioeconomic status, smoking, and asthma.
  
  More research is needed to establish whether hostility is prospectively associated with change in pulmonary function or is associated with pulmonary function at other points in the life course, especially during older adulthood."
  
  Health Psychol 2007;26:333-340.

©2007 David B. Adams, Ph.D.