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Clinical
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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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| PAST QUESTIONS OF THE WEEK |
December 27, 2004
Q
"Do you get diabetes because you are depressed or become
depressed because you are diabetic?"
A Many become depressed after being
diagnosed with diabetes, feeling overwhelmed by the responsibilities for
self-care that diabetes demands.
There are some data
to suggest that diabetes may follow, or be worsened by depression, in some
populations: "Results of a new study provide more evidence that depression
influences glucose metabolism and risk of diabetes...observed an association
between depression and higher homeostasis model assessment of insulin resistance
values (HOMA-IR) and incident diabetes.
These associations are mediated largely through central adiposity. With the
exception of African-American women, the link between depression and HOMA-IR
values disappeared in analyses adjusting for central adiposity. Likewise,
depression, which predicted a 1.66-fold greater risk of diabetes, became
nonsignificant after factoring in central adiposity.
African-American women with depression were at increased risk of diabetes
"independent of central adiposity and other risk factors," according to
investigators.
The incidence of diabetes was highest in African-American women in the 3 years
of follow-up and was more than twice that of white women. This suggests to the
team that factors other than central adiposity may contribute to the excess risk
of diabetes in African-American women."
Diabetes Care 2004;27:2856-2862.
December 20, 2004
Q My mother just
died in assisted living for the memory impaired. My father also died of probable
Alzheimer's disease. Have they come up with a way to predict the risk factors
for me and my children?"
A Research appears to be heading that
direction. You can seek out and read the complete article that contains the
following: "PET
scan testing during a nonverbal memory task can identify
people with the APOE-e4 genotype, a well-known risk factor
for Alzheimer's disease. It is possible that what we're seeing tin the APOE-e4
carriers are early changes in the brain caused by
Alzheimer's disease...it's
also possible that the brain differences we see are related
to the APOE gene by are not necessarily directly related to
incipient Alzheimer's.
Compared with non-carrier, e4 carriers showed increased
brain activation on a memory task called simple demand,
involving a single shape, but decreased activation on
another task called titrated demand, involving a sequence of
shapes.
The differences we've found may provide information on how
the e4 allele predisposes carriers to Alzheimer's disease."
Am J Geriatr Psychiatry 2004;12:596-605.
December 13, 2004
Q My son is tired all of the
time, but he does not seem to be depressed. His medical
doctor says that he is completely healthy. Any thoughts?
A It
is difficult to determine the cause of his fatigue whether
it is too little sleep, too much activity, etc. There
was interesting research out of the Netherlands which your
doctor may wish to review: "Cognitive behavior therapy (CBT)
is effective treatment for adolescents with chronic fatigue
syndrome. Patients with chronic fatigue syndrome have
debilitating unexplained severe fatigue that is not the
result of an organic disease or ongoing exertion and is not
alleviated by rest. Development of potentially effective
interventions is especially important in young people to
avoid prolonged absence from school and restricted social
activities, which threaten healthy development. As the
prevalence of chronic fatigue syndrome seems to be lower
than previously thought, they do not recommend widespread
implementation of cognitive behavior therapy but suggest
that treatment should be centralized in specialized medical
centers so that therapists can accumulate knowledge and
maintain proficiency."
December 6, 2004
Q
Could you tell me about the depression that occurs in cold
weather?
A "It is not the cold weather that is
the cause of the mood disorder. "Possibly as many as one in five Americans
suffer from seasonal affective disorder (SAD), or the winter blues, a condition
that is linked to the decreased daylight hours and longer periods of darkness
during the fall and winter months. These people "are vulnerable to changes in,
basically, light that occurs during the winter months. The exact cause of the
disorder is unknown, but it is thought to have something to do with a
biochemical imbalance of the hormones melatonin and serotonin in the brains of
susceptible people. Women are known to be more vulnerable to the disorder than
men.
Symptoms of SAD include excessive sleeping, overeating, and a lack of interest
in social interactions as well as sadness or other depressive feelings combined
with irritability -- all of which go into remission with the return of longer
daylight hours.
Generally, such symptoms are less severe than those experienced by people with
clinical depression. People who are severely impacted by SAD may, in some cases,
also develop suicidal feelings.
Treatment for seasonal affective disorder can be as simple as taking a long walk
outside during daylight hours, or otherwise increasing one's exposure to the
sun. More severe cases of SAD may require several hours of daily light therapy,
psychotherapy or antidepressants."
November 29, 2004
Q My son is
asthmatic. There is a bully at school who makes fun of him. His asthma attacks
are becoming more frequent. Is he just upset or is this making his asthma worse?
A You should find this helpful"
"Stressful life events increase the likelihood of a new asthma attack in
children...While the role of stress in the pathogenesis of childhood asthma
still remains controversial, a growing body of research suggests that
psychosocial stress is likely to be a factor contributing to the development of
wheezing illnesses and asthma, especially during early childhood...High levels
of psychosocial stress have also been shown to predict greater morbidity in
children who already have asthma, and to correlate with poorer quality of life.
...A severely negative life event increased the risk of a new asthma attack
following within two days by a factor of 4.69 (P = .00). At three to 10 days
after a severe event, there was no increased risk of an asthma attack (P = .50),
but risk increased by 1.81-fold five to seven weeks after a severe event (P =
.002)....Many of the same autonomic mechanisms thought to have a role in asthma
are involved in the activation and regulation of physiological responses to
stress....
Thorax. 2004;59:1046-1051
November 22, 2004
Q
"There is a link between
depression and Alzheimer's Disease is there not?"
A No one can say that with certainty
at this time. However "In patients with depression or bipolar disorder, the
number of affective episodes resulting in hospital admission is directly related
to the risk of dementia. These findings support the results of epidemiologic
studies linking depressive symptoms with an increased risk of cognitive decline
or dementia.
The risk of dementia
increased as the number of hospitalizations for affective episodes rose. The
study supports the possibility of a direct association between affective
disorder and dementia without any intermittent cerebral disorder and further
supports the hypothesis that affective episodes may cause permanent affection of
the brain. If results can be confirmed in future studies they underscore the
importance of early sustained prophylaxis of the evolving process of the illness
in depressive and bipolar disorders."
J Neurol Neurosurg Psychiatry 2004;75:1662-1666.
November 15, 2004
Q
"I once read that psychologists
feel that asthma is really a "call for mother's lost love."
Is that true?"
A No, but it was once part of a larger
complex theory. There is, however, a psychological component to being
asthmatic since the asthma attacks can be quite frightening to the patient and
those around him/her.
"Asthmatic
patients often experience psychological distress and decreased feelings of
control, which are significantly associated with physical health status.
Asthmatic patients experienced psychological distress more frequently than
non-asthmatics (17.9% versus 12.2%, respectively; p < 0.01). Asthmatics were
also more likely to experience anxiety or depression (40.5% versus 31.2%, p <
0.01).
Mental health conditions were also more common in patients with asthma than in
those without asthma (16.2% versus 10.8%, respectively; p < 0.01). The frequency
of subjects who sometimes or always felt a lack of control over their health was
higher in asthmatics (33.5% versus 24.3%, p < 0.01).
Scores on the SF-12 physical component summary were significantly lower in
people with both asthma and psychological distress than in those with either
asthma or distress alone. Among subjects who reported psychological distress, no
significant differences in mental component summary scores were observed between
asthmatics and nonashtmatics.
"These findings have "considerable implications for asthma management and
clinical guidelines," the researchers conclude. "A greater focus on anxiety,
depression, and perceptions of control seems justified as central to asthma
management."
Thorax 2004;59:930-935.
November 8, 2004
Q "I
have a neighbor who babbles on and on about how acupuncture
helped her with headaches, backaches, and breathing
problems. Is that not all just osychological?"
A
You may find the following of interest "Acupuncture is
effective in decreasing the severity of daily symptoms and
increasing the number of symptom-free days in children with
persistent allergic rhinitis.
Rhinitis scores were assessed twice daily in four parameters
(nasal pruritis, nasal obstruction, rhinorrhea, and
sneezing) using a four-point severity scoring scale, for a
maximal daily severity score of 24.
Acupuncture
treatment was associated with lower mean daily rhinitis scores and a
significantly increased mean number of symptom-free days compared with placebo.
During the three-month follow-up, acupuncture therapy continued to be associated
with significantly lower mean daily rhinitis scores and significantly increased
mean number of symptom-free days.
Pediatrics. 2004;114:1242-1247
October 30, 2004
Q "People
in mental hospitals seem to smoke a lot. Do they get cancer
less or more often than the rest of us?"
A
"Patients with mental
disorders may develop cancer at a younger age and may be at
increased risk of certain malignancies. Patients with mental
disorders developed cancer at a significantly younger age
than controls (women: 47.0 versus 49.9 years; men: 51.5
years versus 53.2 years.)
Men in the mental disorder cohort had more than twice the
risk of brain and central nervous system tumors and more the
50% the risk of respiratory system tumors. Similar increased
risks were seen among women with existing mental disorders,
the researchers report.
"he increased odds of respiratory tumors are likely
secondary to increased rates of smoking among people with
mental disorders and support use of smoking cessation
interventions in this population. The increase in brain
malignancies could reflect the presence of mental symptoms
or a "true association between the two conditions."
Psychosom Med 2004;66:735-743.
October 11, 2004
Q "I
have been epileptic all of my life. I have often been
depressed. I doubt that this is unusual, but I wondered if
it was due to another brain problem?"
A "Depression is common in people with
epilepsy.
The people with epilepsy who completed the survey had a much higher rate of
depression: about 36%. Nearly 30% of asthma patients showed signs of depression.
Close to 12% of the survey respondents without chronic diseases were depressed.
That's close to estimates that say nearly one in 10 American adults per year
have depression.
Severe depression affected almost 26% of people with epilepsy, compared with 20%
of asthma patients and only 5% of those without chronic health conditions. Lower
quality of life and higher unemployment also affected more epilepsy patients
than people with asthma.
Among epilepsy patients, depression was
significantly more common among women, low-income patients, and young people.
Depressed epilepsy patients were also more likely to have experienced side
effects from their epilepsy medication than those who were not depressed, but
people with epilepsy were more likely to have sought help for depression or
taken antidepressants in the past.
People with epilepsy may experience depression differently, with "high rates of
irritability, anxiety, and a tendency toward alternation with occasional
euphoric periods" seen in a previous study, say the researchers."
Ettinger, A., Neurology, September 2004; vol 63: pp 1008-1014. News release,
Long Island Jewish Medical Center.
October 4, 2004
Q
"My husband had problems
with awakening during the night and could not fall back to
sleep. His internist started him on (anti-depressant) and
that seemed to help. I have problems falling asleep
but not staying asleep; should I be taking the medicine too?"
A You should also consider the
following option: "Cognitive behavior therapy (CBT) should be the first line of
therapy for sleep-onset insomnia...Sleeping pills are the most frequent
treatment for insomnia, yet CBT techniques clearly were more successful in
helping the majority of study participants to become normal sleepers.
For most outcomes, CBT was the most sleep effective intervention, producing the
greatest changes in sleep-onset latency and sleep efficiency. CBT resulted in
the greatest number of normal sleepers after treatment, as measured by
subjective and objective sleep-onset latency of 30 minutes or less, and sleep
efficiency of 85% or more. CBT maintained therapeutic gains at long-term
follow-up, with a posttreatment mean of less than 30 minutes on
Nightcap-measured sleep-onset latency.
Combined treatment (with medication) provided no benefit over CBT alone. At
midtreatment, CBT and combination groups both had a 44% reduction in sleep-onset
latency compared with 29% in the pharmacotherapy group and 10% for the placebo
group. After eight weeks of treatment, the CBT and combination treatment groups
had a 52% reduction in sleep-onset latency.
Pharmacotherapy produced moderate improvements during drug administration, but
sleep measures returned toward their baseline values when patients discontinued
the drug. Treatment was unsuccessful in 38% of the pharmacotherapy group and in
43% of the placebo group.
Because CBT required about two hours of treatment time by predoctoral and
postdoctoral psychologists, the authors suggest that CBT is cost-effective
relative to pharmacotherapy.
These findings suggest that young and middle-age patients with sleep-onset
insomnia can derive significantly greater benefit from CBT than pharmacotherapy
and that CBT should be considered a firstline intervention for chronic insomnia.
Arch Intern Med. 2004;164:1888-1896
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