|
|
 |
Clinical
Services / Educational
Services / Organizations /
E-Mail
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. |
|
|
|
| PAST QUESTIONS OF THE WEEK |
December 30, 2002
Q
"Is asthma a psychological or a physical problem?"
A
It is a physical problem that can
be complicated further by psychosocial and health behavior problems.
Results of a study published in the December issue of Thorax suggest
an association between psychosocial problems, health behavior and
asthma death, but these associations are "varied and complex."
Repeated nonattendance at clinical appointments and
poor inhaler technique were found to correlate with asthma deaths.
Other factors linked with asthma death included psychosis or
antipsychotic drug therapy, drug or alcohol abuse and economic
problems.
Compared with controls, cases had an earlier age of asthma
onset, higher incidence of chronic obstructive lung disease, and were more often
obese. Overall, a health behavior problem was observed in 48% and 42% of cases
and controls, respectively.
The team found an association between poor inhaler technique
and repeated non-attendance for hospital asthma appointments and an increased
risk of asthma death. However, non-compliance with taking asthma drugs was not
associated with asthma death.
Family problems, domestic abuse, bereavement, and social
isolation were not significantly associated with risk of asthma death.
These findings support the importance of some psychosocial
problems and patient management factors in premature death from asthma, they
point out.
Thorax 2002;57:1034-1039
December 23, 2002
Q
"I do not hear much reference to hypnosis any more...has it
fallen out of favor now that we have so many drugs?"
A
You may be interested in reading this: "Hypnotherapy was better than
medical or supportive care for the management of functional
dyspepsia, according to the results of a randomized trial published
in the December issue of Gastroenterology.
Hypnotherapy is highly effective in the long-term
management of functional dyspepsia...Furthermore, the dramatic
reduction in medication use and consultation rate provide major
economic advantages.
None of the patients in the hypnotherapy group required
medication use during follow-up, compared with 90% of patients in the medical
group. There are research questions that remain unanswered concerning
hypnotherapy in functional gastrointestinal disorders. These include the unknown
mechanism of action, lack of parallel comparisons with other psychological
treatments, failure to test hypnotherapy combined with medications, and unknown
efficacy of hypnotherapy when administered in an automated home-treatment
format.
Gastroenterology.
2002;123:1778-1785, 2132-2147
December 16, 2002
Q
"Our daughter has a
seizure disorder. She has had this for years, and she is currently
very depressed. I think she is depressed over having her epilepsy,
but someone told me that it might not be a reaction to the epilepsy
but actually part of her brain chemistry."
A
Hope this will help: "Depression
is more prevalent in individuals with epilepsy than in those with
asthma or no chronic illnesses, a new study reports. Depressed
patients also exhibit poorer seizure control and are less likely to
comply with prescribed treatments.
Depression in the preceding 12 months was
identified in 35% of the patients with epilepsy, as opposed to 22%
with asthma. 73.1% of depressed epilepsy patients showed CESD scores
consistent with ongoing moderate or major depressive symptomatology.
Even among those without a diagnosis of depression, 13.3% had CESD
scores that were consistent with ongoing moderate or major
depression.
Epilepsy patients were more likely to be prescribed
antidepressant medications and to have visited a mental health practitioner.
Approximately 10% of depressed patients with epilepsy visited a psychiatrist
and/or a psychologist within the prior 12 months, compared with 6.3% of asthma
patients, and 2.3% of those without any illnesses.
Nearly 44% of depressed epilepsy patients reported delays in
taking their medication because of concerns about side effects, compared with
19% of those without depression, and 30% of asthma patients.
"Depression occurs with significant frequency in community
based epilepsy populations...And should not be dismissed as just having a
chronic disorder."
December 9, 2002
Q
"My husband has begun using Viagra and has been very, very
aggressive not only with me but with the children and his coworkers.
Has anyone else reported this?"
A You
might want to read this: "A
debate has begun among researchers about whether Pfizer's impotence
drug Viagra (sildenafil) might be associated with instances of
aggressive behavior and sexual violence.
One researcher has concluded that doctors should
begin warning Viagra users about the possibility of psychological and
emotional side effects. But other scientists, as well as officials at
Pfizer, reject the claim as unsound.
More than 270 of the reports, collected and archived by the US
Food and Drug Administration (FDA), detailed psychological side effects,
including dizziness, disorientation and amnesia. The drug was also listed as a
suspect in 22 reports involving aggression, 13 involving rape, and six involving
murder.
FDA officials said that they have no plans to change Viagra's.
But one top agency official said that the study was important to scientific
debate about the drug.
The theory that the drug may cause aggression has formed the
basis of the so-called "Viagra defense," a claim made by half a dozen defendants
since 1998 that the drug caused them to commit violent crimes. The Viagra
defense has not been successful so far, but an Israeli court did mention in a
1999 ruling against a rapist that the drug had played a role in the attack.
Viagra causes erections by working directly on the blood
vessels of the penis, not through actions in the brain. Clinical studies in more
than 8,000 men showed that the drug caused central nervous system effects in
less than 2% of users, none of whom became violent or disoriented, according to
Pfizer.
Scientists don't consider adverse-event reports to be hard
evidence of a causal link between a drug and an event. The reports don't always
show which other drugs patients were taking or note the state of health they
were in when taking the medication.
Still, adverse-event reports are often used as a way to flag
side effects in the general population that may have been missed during clinical
studies. Effects that fail to show up in several thousand test subjects have a
better chance of being noticed when millions of people have taken a drug.
December 2, 2002
Q
"My daughter and son both have ADHD and both have been on
Ritalin. He has become an excellent student, but now in her late
teens, my daughter has a host of behavioral problems. Has anyone
else reported this?"
A You
might be interested in this:
"Girls may be less likely than boys to develop
attention deficit hyperactivity disorder (ADHD), but those who do
are more likely to be hospitalized with other mental disorders
during adulthood than are boys with ADHD, study findings show.
In fact, girls with ADHD were more than twice as
likely as were boys to be hospitalized in their adult years, the
report indicates.
Children with both ADHD and oppositional defiant disorder or
some conduct disorder were also more than twice as likely as others to be
hospitalized in adulthood. However, girls who had both ADHD and conduct problems
were six times more likely to have an adult psychiatric admission than girls
without conduct problems.
The authors also found that girls with ADHD were almost seven
times more likely than boys to develop schizophrenia during their lifetime, more
than five times as likely to be diagnosed with a mood disorder and 18 times more
likely to have a substance use disorder.
Early intervention specifically aimed at reducing conduct
problems in childhood will reduce the risk."
Br J Psych 2002;181:416-421.
November 25, 2002
Q
"Aside from medication, is there anything that helps the
elderly as their mental functioning declines?"
A
You might be interesting in this: "Cognitive
training interventions with elderly individuals produced significant
improvements in memory, reasoning ability and speed of processing
that were durable for at least 2 years. The magnitude of training
effects suggests that such interventions "have the potential to
reverse age-related decline."
Reliable improvement (defined as improvement over
baseline performance by at least one standard error of the mean) was
documented post-test in 26% of the memory training group, 74% of the
reasoning training group, and 87% of speed training group. Booster
training offered 11 months after the initial sessions enhanced the
training gains in speed and reasoning.
Physicians should be aware that there are ways to maintain and
improve cognitive skills, which has not been the mindset in the past. The
tendency has been to accept that as people age, they have a poor memory and have
slower reaction times. Now we know there are ways to prevent that.
JAMA 2002;288:2271-2281.
November 18, 2002
Q
"My husband does not smoke cigarettes, but he smokes marijuana
several times a day, most days. He insists that this has no impact
upon his health?"
A
Aside from the legal and social risks that arise from illicit drug
use, there are documented health problems associated with smoking
cannabis.
The adverse pulmonary effects of smoking three pure cannabis
cigarettes is equal to that of smoking 20 normal cigarettes. In
addition, marijuana is more dangerous now than it was in the 1960s.
The British Lung Foundation (BLF) said tar from cannabis cigarettes
contained 50% more carcinogens than tar from tobacco. Campaigners
for the legalization of cannabis disputed some of the findings.
These statistics will come as a surprise to many people, especially
those who choose to smoke cannabis rather than tobacco in the belief
it is 'safer' for them. It is vital that people are fully aware of
the dangers so they can make an educated decision and know the
damage they may be causing.
November 11, 2002
Q
"My husband read that drinking wine may help his heart.
However, he drinks a whole lot of wine, seven days a week. He used
to drink beer and says that this amount of wine is healthy?"
A
He may want to
review the published findings that wine drinkers are just as likely
to develop liver cirrhosis if they drink to excess as those who
drink beer or spirits, according to research that contradicts an
earlier study suggesting wine is less hepatotoxic.
A study published earlier this year by Danish
researchers showed that wine drinkers were up to 70% less likely
than drinkers of other alcoholic beverages to develop
life-threatening cirrhosis. It was suggested that antioxidant
properties of wine may exert protective effects to counter the
effects of ethanol.
But a study by French researchers, published in the current
issue of Alcohol and Alcoholism, shows no difference in risk between different
groups of heavy drinkers.
Drinking heavily after the age of 45 might be critical for the
liver, particularly, also in view of age-related immunological disturbances.
Wine, as with other alcoholic beverages, can lead to cirrhosis when consumed
heavily.
Alcohol Alcohol 2002;37:618-621.
November 4, 2002
Q
"I think my son is withdrawn and depressed. I asked his
pediatrician, and the doctor told me that my son has not mentioned
it to him, and he does not think my son is depressed at all. Could
he be missing the signs?"
A
This has been reported: "Although over one-third of adolescents
report an episode of depression, less than 20% seek help for it.
These findings point to the need to understand adolescent reluctance
to report depressive symptoms or ask for help. Among the adolescents
15 to 19 years old, 678 of 1,918 (35.5%) reported at least two weeks
of depressed mood, and another 147 of 1,918 (5.9%) reported at least
two years of depressed mood. Among this age group, 137 of 1,843
(7.43%) met the criteria for severe major depressive disorder. Among
the young adults 20 to 24 years old, 40.5% reported a two-week
period of depressed mood, and 7.95% reported a two-year period of
depressed mood; 9.7% met the criteria for severe major depressive
disorder. Only 32 of the 219 participants 15 to 24 years old (15.1%)
with at least two years of depressed mood told their doctor; as did
31 of 309 (11.6%) with "depressed spells," which were defined as at
least two weeks of depressed mood and two to three other symptoms of
depression. Among those who did not tell someone, seven of 241
(2.2%) took medication more than once to address the depressed
spells. Girls were more likely than boys to seek help, but boys were
more likely than girls to take an over-the-counter (OTC) medication.
Non-Hispanic white respondents were most likely to tell their
doctor, and respondents from other ethnic backgrounds were more
likely to take an OTC medication. The researchers did not identify
which medications the respondents took.
October 29, 2002
Q
"Do children who have ADHD grow up to be drug users or misuse
their own medication?"
A
You might be interested in: "There
is a significant correlation between attention deficit disorder
(ADD) and hospitalization for ingesting prescription drugs. That's
according to a retrospective case-control study presented here
Monday during the American Academy of Pediatrics National
Conference.
Most often the children ingested their own
medications (29%) or their parents medications (29%). The most
commonly ingested medications were psychactive and neurologic drugs.
Both availability of the medication and impulsivity of the
child play a role.
October 22, 2002
Q
"Simple question...my husband and I are divorcing...do you
believe the children should have some form of psychotherapy?"
A
"Active intervention with group and individual sessions reduced the
frequency with which children of divorce developed mental disorders,
according to results of a randomized trial reported in the Oct. 16
of The Journal of the American Medical Association. Although
intervention also reduced use of illegal substances, problem
externalization, drug and alcohol use, and number of sexual
partners, larger trials are necessary to confirm these findings and
to establish public health guidelines.
The interventions were most helpful for those adolescents at high
risk because of increased levels of mental health problems in
childhood. Those in the combined program had fewer externalizing
problems and fewer symptoms of mental disorder than did those
in the self-study program. Compared with the self-study group, those
whose mothers took the parenting class had fewer externalizing
problems, fewer symptoms of mental disorder, and less use of
alcohol, marijuana, and other drugs. Outcomes for the combined
intervention were not significantly different than in the group
receiving only the parenting skills class."
JAMA. 2002;288(15):1874-1881
October 15, 2002
Q
"My husband is a recovering alcoholic and is now very
depressed. His doctor told him that he is depressed because he does
not drink. Is that the reason?"
A
Individuals with a history of alcohol dependence appear to be at
increased risk of a major depressive disorder, even after abstinence
from alcohol, researchers report.
The risk of major depression was increased more than fourfold among
the 836 subjects with a history of alcohol dependence, the
researchers found. When the investigators took into account other
variables, this association remained unchanged.
Most of the subjects with major depression had last used alcohol or
other drugs 2 years before the study, which eliminates acute
intoxication or withdrawal effects as an explanation of their
depressions.
These findings, in conjunction with other findings that depression
during abstinence is a risk factor for relapse, suggest that
treatment for depression should not be withheld from alcoholics in
stable remission on the assumption that any depressions in such
individuals are due to protracted intoxication or withdrawal
effects, they add.
Arch Gen Psychiatry 2002;59:794-800.
October 8, 2002
Q
"Our baby was almost 10 pounds at birth. Has this been
associated with psychological problems."
A
No, but lower birth weight and slower weight gain early in life may
be associated with poorer psychological health in adulthood, new
research suggests. Relatively rapid weight gain after birth may
compensate for the potential adverse effect of lower birth weight on
later psychological health. Small size at birth is usually followed
by some degree of "postnatal catch up. Exactly why lower birth
weight and poorer weight gain might affect future psychological
health is unclear. One hypothesis is that early "growth failure"
leads to changes in stress hormones. When the researchers looked at
participants' birth weights, they found that as these weights
increased, the risk of adulthood psychological distress decreased.
The same was true of weight gain by age 7. BMJ 2002;325:749-751.
|
 |
|
|
|
|
|
