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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 |
March 31, 2003
Q
"With all of these antidepressants...and some respond to one
and some respond to others...is there no way to determine what
effect a particular antidepressant has?"
A
There are some encouraging
research in this area. You may find the following helpful:
"PET
scanning can predict which patients with major depression or
obsessive-compulsive disorder (OCD) are likely to respond to
treatment with serotonin reuptake inhibitors (SRIs),.
However, the PET findings that predict a response in
depressed patients are not the same as the response predictors seen in
patients with OCD. Specifically, elevated right caudate activity is
associated with treatment response in OCD patients, while decreased
right amygdala activity and increased midline prefrontal activity are
associated with a response in depressed patients.
This suggests that, although both OCD and major depressive
disorder respond to SRIs, the two syndromes have different neurobiological
substrates for response.
Pretreatment brain scans hold promise for accelerating the
sometimes painstaking process of identifying the best treatment for an
individual patient and speeding development of new interventions.
Am J Psychiatry 2003;160:522-532.
March 24, 2003
Q
"I am pregnant with my third child and working part time. I am
having a terrible time with my memory. I am told that this is due to
hormones."
A You
may find this helpful:
Some women swear they have memory lapses during pregnancy. But new
research challenges that notion -- finding that it's just not true.
They're likely just feeling a bit overwhelmed by new
responsibilities, says one expert.
Magazine articles,
childcare books, midwives -- even pregnant women themselves have
contributed to the belief that women's memories weaken after they
learn they are pregnant.
What women experience is competition
for their attention. Suddenly, they've got more going on. They're responsible
for this other entity.
March 14, 2003, Psychology and
Psychotherapy.
March 17, 2003
Q
"I told my husband that my father is under a great deal of
stress and that I worry about his health. My husband said that there
is little real evidence that stress causes disease. I cannot
believe that is true."
A There
may be a more complex relationship between stress and disease than
we ordinarily think, yet the relationship exists. In a recent
article: "People who
report high levels of stress appear to be more likely to experience
a fatal stroke than their peers who report no stress...
Lay people often mention stress as one of the most
important risk factors for stroke, often before well-established
stroke risk factors such as hypertension and smoking... Although
stress is often mentioned in studies evaluating stroke risk, "there
is little agreement on what it actually means or how it should be
measured."
However, no significant trends were observed between
self-reported stress levels and the risk of all stroke, nonfatal stroke, and
fatal stroke, the authors note.
Stressed subjects were also more likely than were unstressed
subjects to have unfavorable risk factor profile for stroke. "Thus, asking a
relatively simple question about perceived level of stress may identify subjects
who could benefit from intensified prevention," the researchers suggest.
Stroke 2003;34:000-000.
March 10, 2003
Q
"My wife wants breast augmentation. I have no problem with that
at all. My only concern is that she has never felt good about
herself in general and has several times been on antidepressants. Is
there something that I should check into...are there other concerns
which I need to be aware of....?"
A You
might want to look up this article:
BMJ
2003;326:527-528.
"Women who
opt for cosmetic breast implants are more likely to commit
suicide....Breast enlargement is one of the most popular types of
cosmetic surgery but researchers at the University Medical Centre in
Utrecht believe it could be linked to problems such as lack of self
esteem or poor body image.
"Our findings suggest there might be a
psychological problem in some women," Dr. Veronica Koot, an
epidemiologist at the centre, said in an interview.
In a study of 3,521 women in Sweden who had breast
augmentation surgery for cosmetic reasons between 1965 and 1993, Dr. Koot and
her colleagues found a higher than expected suicide rate after an average
11-year follow-up. Fifteen women in the research group committed suicide, three
times more than expected in the general population.
As reported in the British Medical Journal for March 8, the
researchers also found an excess number of lung cancer deaths, most likely due
to smoking.
Women who had implants following surgery for breast cancer
were not included in the study.
The scientists suggested that cosmetic surgeons should
evaluate women who want breast enlargement for any signs of psychological
problems. "If women have a psychological problem and they are given breast
implants they will still have that problem," said Dr. Koot.
Nearly 250,000 women in the United States had their breasts
enlarged in 2002, a substantial increase since 1997, according to the American
Society for Aesthetic Plastic Surgery."
March 3, 2003
Q
"I had been extremely depressed. I have been on Zoloft for
three months and feel much better. I see no need to continue the
medication?"
A The use of antidepressants for 1 year or
more, in addition to a 4- to 6-month standard treatment,
significantly reduces the relapse rate in people with depressive
disorders.
According to the report, further antidepressant
treatment for 1 to 2 years reduced the odds of relapse by about 66%.
The average relapse rate was 18% for patients who continued
treatment compared with 40% for the placebo patients.
Lancet 2003:361;653-661.
February 24, 2003
Q
"My son is about to go off to college. We were very close. Now
he spends most of the time with a small group of gloomy friends,
listening to dark and disturbing music. Is this just another of his
stages?"
A
"Nearly all US parents believe they can spot
depression in their teenagers, but in fact two thirds of adolescents
are never diagnosed and are at increased risk for suicide, according
to survey results released Thursday.
In the survey of 900 parents of adolescents, 90%
said they were confident they could tell if their own child was
depressed or suicidal. But researchers from Columbia University in
New York, which helped sponsor the survey, said statistics show that
only a third of depressed teenagers are ever diagnosed by a parent,
a physician, a teacher or other adult.
An estimated 4% to 5% of adolescents are depressed.
In the US that works out to 750,000 adolescents at any one time.
500,000 make a serious attempt at suicide requiring medical attention,
and 1700 succeed every year. Parents usually do not read the symptoms
correctly because they can be subtle. And teenagers will go to great
lengths to conceal their distress.
At the news conference, the researchers announced
the release of a screening test that will be made available free of
charge to certain schools to help screen adolescents for depression.
The test, which starts out with a self-administered questionnaire,
would take less than an hour to complete."
February 17, 2003
Q
"I have just come out of an abusive marriage, and my son was
also abused...I have read that my son will grow up to be an abusive
adult...is that true?"
A "Some
experts suspect that boys who were sexually abused are at risk of
becoming abusers themselves in adulthood. However, findings from a
new study indicate that other childhood factors must also be present
to increase the risk.
Specifically, basic needs going unmet in childhood
and the presence of violence in the home are needed to push victims
towards becoming future abusers.
Most boys who experience sexual abuse do not go on to become
abusers. The authors found that former victims who spent their childhood in
homes that lacked material necessities like clothing, heat, or experienced other
deprivations were 3.4 times as likely as others to become abusers.
Victims who became abusers also tended to receive less
supervision during childhood and to have experienced abuse from a female
perpetrator.
Later abusers were 3.1 times as likely as nonabusers to have
witnessed serious intrafamilial violence--a factor that likely played an
especially significant role in raising male victims to become abusers.
Lancet
2003;361:471-476,443,446-447.
February 10, 2003
Q
"My husband is definitely not an alcoholic, but he does drink
about two cocktails per night, and I have read that this can cause a
stroke. Do you know of any research in this area?"
A "People who consume more than 60 g of
alcohol per day are 64% more likely to experience a stroke than
abstainers, according to a report published in the February 5th
issue of the Journal of the American Medical Association.
However, light-to-moderate alcohol consumption
appears to protect against stroke, lead author Kristi Reynolds and
colleagues, from Tulane University in New Orleans, note.
The researchers conducted a meta-analysis of data from 35
studies reported between 1983 and 2002. All of the studies included stroke as an
endpoint and evaluated the effect of alcohol consumption on stroke occurrence.
They found that heavy alcohol use was tied to an increased
risk of stroke, especially hemorrhagic stroke. While heavy drinkers had a 1.69
relative risk of ischemic stroke compared with abstainers, the relative risk of
hemorrhagic stroke in heavy drinkers increased to 2.18.
Consumption of less than 12 g of alcohol per day and
consumption of 12 to 24 g per day were associated with reduced risks of total
and ischemic stroke compared with abstinence. For example, moderate drinkers
were 28% less likely to experience an ischemic stroke than abstainers.
"Our study strongly suggests that reducing alcohol consumption
in heavy drinkers should be an important approach to prevention of stroke in the
general population," the investigators note.
Although moderate alcohol use may reduce the risk of ischemic
stroke, the authors urge caution in interpreting this finding. "Any advice
regarding the consumption of alcohol should be tailored to the individual
patient's risks and potential benefits," they add.
JAMA 2003;289:579-588."
February 3, 2003
Q
"My son and my neighbor's son and several other children in our
area are on Ritalin for ADHD. Is the condition becoming more
prevalent or more readily recognized."
A It
is doubtful that it is more prevalent. It may be detected more
frequently with proper screening. But there is concern that it is
also being diagnosed and treated with stimulants in the absence of
hard data in some children.
You may be
interested in this: "The
head of one of Germany's major public health insurance providers has
warned of an "alarming increase" of prescriptions in Germany of the
stimulant Ritalin for pediatric attention-deficit/hyperactivity
disorder (ADHD).
Ritalin poses a risk of addiction. A portion of
children and youths in Germany are being incorrectly diagnosed as
having ADHD and are then prescribed Ritalin.As many as 50% of German
children and youths taking Ritalin might have been misdiagnosed as
having ADHD.
The latest statistics for German use of methylphenidate are
for the year 2000, when doctors prescribed 13.5 million doses. That compares
with 400,000 doses in 1991.
In the past few years German general practitioners have
increasingly diagnosed children as having ADHD and prescribed Ritalin. The drug
treatment should be accompanied with therapy.
Some of the symptoms of ADHD could be similar to
normal--albeit difficult--phases of children growing up. Children improperly
diagnosed as having ADHD are not at risk of becoming needlessly addicted to
Ritalin, but might as adults believe there is a drug for every problem.
Blame is directed toward the US medical community and its
inclination to overprescribe drugs for helping trigger the increase of Ritalin
prescriptions in Germany. "This is coming over like waves from America."
January 27, 2003
Q
"I am a single mother, and I heard that there is some question
as to whether single parents do as good a job raising their
kids...have you read this?"
A
This was the article to which people are referring:
"Children who grow up in
single-parent homes may be more vulnerable to mental and
drug-related problems than those who live with both parents,
according to study findings published in the January 25th issue of
The Lancet.
Children who lived with only one parent had higher
risks of psychiatric illness, substance abuse and suicide
attempts...despite the higher risk among these children, severe
problems were still relatively rare, the authors note.
The researchers believe that the economic difficulties that
often plague single-earner families may account for much of the effect they
found on children's well being...supports the idea that a lone parent's
financial hardship can trigger anxiety and depression in the home, which in turn
might cause family members to use alcohol and drugs.
Whatever the reasons behind the study findings, though, they
point to the need for different ways to cut risk behavior and improve the health
of children and teens.
Lancet 2003;361:289-295.
January 20, 2003
Q
"Our daughter has been bulimic, a shoplifter, and we believe
that she has been engaged in prostitution. She has been diagnosed
with borderline personality disorder, and has been on an incredible
number of drugs, none of which has worked. Is anyone working on more
approaches?"
A You may find this interesting: "Although
borderline personality disorder is poorly treated with existing
pharmacotherapy, results of a double-blind, placebo-controlled pilot
study reported in the January issue of the American Journal of
Psychiatry suggest that women with this condition may be
partially reponsive to ethyl-eicosapentaenoic acid (E-EPA).
Rresponse to antidepressants and mood stabilizers
has typically been clinically modest in [borderline personality
disorder] Omega-3 fatty acids, such as E-EPA and docosahexaenoic acid,
which are commonly found in seafood and have beneficial effects and
none of the adverse side effects commonly associated with
pharmacotherapy are showing promise.
E-EPA was superior to placebo in decreasing both
aggression and the severity of depressive symptoms. The results of
this study suggest that E-EPA may be a safe and effective form of
monotherapy for women with moderately severe borderline personality
disorder.
Am J Psychiatry.
2003;160(1):167-169
January 13, 2003
Q
"Our daughter has been binge eating and has been in treatment.
Two months ago, she made a suicidal attempt and was hospitalized.
Are others reporting a connection between her bulimia and suicide
attempt?"
A You
may find this interesting: "Adolescents
with binge eating syndrome appear to be at increased risk for
suicide... the study found that more than one quarter of adolescents
diagnosed with binge eating reported attempting suicide in the past.
Adolescents who overate also tended to be overweight
or obese, to say they had tried to diet in the past year, and to feel
that their weight was very important to their self-image. Not
surprisingly, they were less satisfied with their bodies and
themselves and were more depressed than their peers who were not binge
eaters...The findings support previous research showing that
overeating among adolescents is linked with obesity and may reflect a
number of underlying psychological problems.
Adolescents who overate tended to have a higher body mass
index than others and to believe that a person's weight and shape are the most
important factors shaping self-esteem."
Pediatrics 2003;111:67-74.
January 6, 2003
Q
"Our daughter is bulimic, and she has been treated with
cognitive therapy (sic)...she is doing much better...are there data
regarding her chance of relapse?"
A
The severity of illness and the length
of abstinence following successful cognitive behavioral therapy can
help identify bulimia nervosa patients who will need additional
treatment. There has been little information available on relapse in
patients with bulimia nervosa who respond well to cognitive
behavioral therapy. T Predictors for relapse included a higher level
of preoccupation and ritualization of eating and less motivation for
change. In addition, those who relapsed had maintained abstinence
for a shorter time than those who did not relapse had. "Predictors
of relapse can be readily determined by clinicians. A useful
intervention for bulimic patients who meet the criteria for probable
relapse might be fluoxetine hydrochloride (60 mg/d)." The team also
notes that extending the length of treatment with cognitive
behavioral therapy for patients with shorter periods of abstinence
from binging and purging may also be helpful. Arch Gen Psychiatry
200259:1105-1109.
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