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Clinical
Services / Educational
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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 |
March 18, 2002
Q
"My son is 14 and came home drunk. I was alarmed. My husband
says it is harmless. Which of us is correct?"
A
Findings are that "some 3.3 million students ages 12 to 17 start
drinking each year, with 8 million high school students currently
using alcohol.
Young people are starting to consume alcohol at an
earlier age. About 36 percent of the high school graduating class of
1999 began using alcohol in eighth grade or earlier, compared with
27 percent for the class of 1975.
Persons who begin drinking before age 15 are four times more
likely to become alcohol-dependent than are those who begin at 21, while the
prevalence of lifetime alcohol abuse is greatest for those who begin drinking at
age 14."
March 11, 2002
Q
"I think there is less harm done to me from smoking marijuana than
my folks get from having wine with dinner each evening."
A
Results of a new neuropsychological study indicate that long-term
use is associated with impaired memory and attention, which lasts
beyond intoxication and becomes worse with continued use.
Compared with
short-term marijuana users and controls, subjects who were long-tern
marijuana users performed significantly worse on the tests that
examined memory and attention.
Performance measures often correlated significantly with the
duration of cannabis use, being worse with increasing years of use,
but were unrelated to withdrawal symptoms and persisted after
controlling for recent cannabis use and other drug use.
JAMA 2002;287:1123-1131,1172-1174.
March 4, 2002
Q "My
son has a tic disorder. Can you direct me to an article about
medication and such a disorder?"
A A
new study published in February 26 issue of Neurology shows both
Ritalin and Catapres -- especially when used together -- are
effective in treating these children. Children who have attention
deficit hyperactivity disorder (ADHD) and suffer from uncontrolled
tics or Tourette's syndrome may find relief from stimulants. New
research shows that stimulant drugs, such as Ritalin
(methylphenidate), may actually minimize the unwanted movements
rather than make them worse. Until now, treating these children with
the drug most commonly prescribed for ADHD, Ritalin, has been
discouraged because stimulants have been shown to make tics worse.
Little was also known about the effectiveness of the most popular
prescription alternative to Ritalin, Catapres (clonidine), in
reducing tics.
Researchers also found improvements in attentiveness and behavior
among those treated with Ritalin. Those treated with Catapres also
showed less crying, frustration, restlessness, excitability, and
impulsiveness. The most common adverse effect was sedation and was
related to the use of Catapres.
Neurology. 2002;58:527-536
February 11, 2002
Q
"We have a son with pervasive developmental
disorder...autism...he has been tried on a lot of medications but
has not responded. Is there any recent research we should read?"
A
You might want to discuss the findings in the
February issue of
the Journal of the American Academy of Child and Adolescent
Psychiatry with your son's pediatrician. Risperidone shows
promise as a treatment in autism The Study may help reassure
pediatricians prescribing risperidone to autistic children and
adolescents.
Although educational and behavioral approaches are
the primary treatments for this childhood disorder of communication
and social interaction, adjunctive drug therapy may facilitate these
treatments by reducing hyperactivity and angry or aggressive
behavior. Risperidone is an atypical neuroleptic especially
attractive for long-term use in children and adolescents, as it is
believed to cause fewer dyskinesias than conventional neuroleptics
such as haloperidol.
Overall, the children hfunctioned better at home and in school,
were less disruptive and more focused, had fewer severe tantrums, were more
compliant with family routines, and developed better sleep patterns.
Adverse effects included sedation, increased appetite, and
weight gain. Two of 13 children (15.4%) treated long-term developed mild,
reversible withdrawal dyskinesias, but none developed dyskinesias while on
risperidone.
Although it appears that the risk for dyskinesias with
risperidone may be less than with conventional neuroleptic agents such as
haloperidol, more research into the risk of dyskinesias and other untoward
effects associated with risperidone treatment is required.
February 4, 2002
Q
"I am a black female with both parents having had Alzheimer's
Disease prior to death. Are blacks at more risk for AD than whites?"
A
First-degree relatives of blacks with Alzheimer's disease (AD) have
a higher risk of developing dementia by the age of 85 than their
white counterparts, according to an article in the Jan. 16 issue of
The Journal of the American Medical Association. But
additional risk associated with family history, female sex, or APOE
genetic variant is similar for both racial groups.
By age 85 years, cumulative risk
of dementia in first-degree biological relatives was 43.7% for black
AD probands and 26.9% for white AD probands. Relatives of black AD
patients were 1.6 times more likely than relatives of white patients
to become demented by age 85.
Dementia risk in spouses was 18.5% for black
probands and 10.4% for white probands, but this difference was not statistically
significant, probably because of the smaller sample size of blacks. Spouses of
black patients with AD were 1.8 times more likely to develop dementia than
spouses of white patients, but the proportionate additional risk conferred by
being a first-degree relative was similar in both groups (2.6 in white vs. 2.4
in blacks).
Female first-degree biological relatives of
white probands had 1.5 times higher risk of developing dementia than did their
male counterparts, whereas those of black probands had 1.2 times higher risk.
Patterns of risk among first-degree biological relatives stratified by APOE
genotype of the probands were similar in both groups.
January 28, 2002
Q
"My husband is a business traveler, and, sadly, he is afraid of
flying. He also flies business class and has leg pain. He says that
the pain and the fear are associated, but I thought research showed
that the leg pain was just related to the cramped quarters."
A
Fear of flying may be the main cause of deep vein thrombosis, which
affects up to 30,000 long-haul travellers a year.
Until now, it was believed that cramped conditions
coupled with long periods of immobility, often dubbed "economy class
syndrome," could cause clots to form in the veins of passengers'
legs.
The primary cause may be the anxiety and stress of flying.
This anxiety and stress is often exacerbated by the necessity to meet a
departure deadline in circumstances where they may suffer serious delay due to
congestion on the roads and railways leading to the airport. The arrival at the
airport may result in additional stress due to crowded terminals and excessive
waiting to check in with the latest heightened security measures following
September 11, and a further lengthy wait in the departure lounge and yet again
at the boarding gate."
Passengers are loaded into a very cramped and claustrophobic
seat with yet more waiting during which time their blood supply was pooled into
their legs. At this point the passengers who are already suffering stress and
anxiety are subjected to take off. This leads to very high secretion of
adrenaline resulting in the constriction of the venous blood supply, which can
result in the formation of thrombosis in the legs of vulnerable passengers. It
is already know that stress increases production of blood clotting factors. This
also fits in with the "fight or flight" theory of stress.
January 21, 2002
Q
"My husband seems to have trouble breathing when on his back
and not only does he snore but he seems to gasp for air. He says
that he is extremely tired and has no stamina. Is he getting enough
sleep? We have a sleep lab in our community."
A Results
of a recent study suggest there is a high prevalence of problematic
insomnia symptoms among patients with objectively diagnosed
sleep-disordered breathing (SDB). SDB-plus patients reported
significantly worse mean sleep characteristics consistent with
insomnia, including sleep latency (17 min versus 65 min), total
sleep time (7.2 h versus 5.6 h), and sleep efficiency (92% versus
75%)," the researchers report.
"SDB-plus patients experienced significantly more
disorders, cognitive-emotional symptoms, and physical and mental
symptoms that disrupted or prevented sleep."
SDB-plus patients reported greater use of psychotropic
medications than SDB-only patients, at 29% and 15%, respectively. They were also
more than twice as likely to use prescription or nonprescription sleeping aid
medications.
While patients in both groups had similar referral rates for
sleep apnea or complaints of loud snoring, the SDB-plus patients reported
significantly more primary complaints of insomnia, restless legs or leg jerks,
and poor sleep quality.
Chest 2001;120:1923-1929.
January 14, 2002
Q
"Are more or less people being treated for depression in recent
years?"
A
Among people treated for depression in the US, the percentage of
those on antidepressants has risen dramatically, while fewer are
receiving psychotherapy, according to a report in the January 9th
issue of The Journal of the American Medical Association.
And more people are being treated for depression
than ever before, the study finds, suggesting that the stigma
associated with depression may be declining.
In 1987, roughly 7 of every 1000 people received outpatient
treatment for depression, according to the report. This number rose to 23 per
1000 in 1997.
Thirty-seven percent of people being treated for depression in
1987 took antidepressant drugs, compared with nearly 75% in 1997. About 71% of
people being treated for depression in 1987 received psychotherapy. By 1997 that
percentage had fallen to about 60%. The percentage of people who received their
depression treatment from doctors increased from about 70% to nearly 90%, the
report indicates.
The researchers also found that more insurers were paying for
depression treatment; 55% of these costs were covered by third-party payers in
1997, versus 39% in 1987.
These changes suggest that access to mental health services
has increased and that there has been an increased emphasis on [drug]
treatments.
JAMA 2002;287:203-209.
January 7, 2002
Q
"My husband has a longstanding problem with cocaine. He will
not enter a treatment program but says he is willing to try
accupuncture. I have read that this is a very effective way of
treating cocaine problems."
A
Although other studies have shown that acupuncture is an effective
method for treating cocaine dependence, a new study finds it to be
of little or no value.
As reported in The Journal of the American
Medical Association for January 2, 2002.
On the basis of two studies, it cannot be said that
acupuncture is either an effective or ineffective treatment for cocaine
addiction.
This study we concluded that when acupuncture is offered as a
primary treatment or in conditions when patients do not receive much
psychosocial treatment it is ineffective.
JAMA 2002;287:55-63.
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