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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 |
June 30, 2003
Q
"My husband is now convinced that he, as an adult, has
attention deficit disorder. Can this be tested?."
A
Please note: A new
adult ADHD Self-Report Scale (ASRS) developed by experts in
attention deficit hyperactivity disorder (ADHD), in conjunction with
the World Health Organization, is designed to assist primary care
physicians in diagnosing the disorder in adult patients.
The questions in the Adult ASRS scale "match the
full 18 items of the DSM IV."
Patients with ADHD come to the attention of their doctor when
they recognize symptoms in themselves that were used for diagnosing their
offspring. "Forty percent of the time, one of the two parents will have ADHD if
it is diagnosed in their child. Or patients may also notice cognitive symptoms
as they are promoted and must deal with a "higher cognitive load."
The ASRS, endorsed by the World Health Organization, can be
downloaded from the Web site: www.med.nyu.edu/Psych/training/adhd.html
June 23, 2003
Q
"My wife is on antidepressants, and I have read that this can
lead to breast cancer."
A
Antidepressant use in general does not appear to increase the risk
of breast cancer, according to a report in the May issue of
Epidemiology.
Their analysis is based on data from 938 cases of
invasive breast cancer and 771 controls, along with 507 cases of
carcinoma in situ and 455 controls.
There was no evidence of increased risk of breast cancer
(invasive or in situ) with any previous use of antidepressants, the authors
report, and there was no consistent relation between the duration of
antidepressant use and the development of breast cancer.
There was a suggestion that the use of selective serotonin
reuptake inhibitors (SSRIs) for at least 36 months increased the risk of
invasive breast cancer, the researchers note, but there were only 13 cases and 5
controls available for this comparison.
Consistent with earlier studies, invasive breast cancer was
more common in women with early age at menarche, nulliparity, no history of
breastfeeding, family history of breast cancer, past smoking, and high
waist-to-hip ratio, the report indicates. Similarly, nulliparity, family history
of breast cancer, higher education level, low waist-to-hip ratio, and higher
alcohol consumption were associated with a higher carcinoma in situ risk.
Epidemiology 2003;14:307-314.
June 16, 2003
Q
"My son is 12 years old. He is small and not athletic. He has
been picked on since elementary school. He has grown quiet and does
not want to talk about it and certainly does not want us to tell his
school. Should we be concerned."
A You
may find this helpful: "Bullied
youngsters, especially girls, are far more likely than other
children to be depressed or even suicidal. The numbers were only
slightly lower when more indirect forms of bullying occurred, such
as ignoring, excluding and backbiting. The new results show that
teachers and other school personnel need to pay more attention to
the various forms of bullying. Bullying also caused distress to
boys, but not as often. Among boys who were frequent victims of more
direct forms of bullying, 22.4% said they were depressed. Just under
28% of those who were indirectly bullied reported depression. About
3% of the non-bullied boys felt depressed.
Just over 13% of boys who were often the target of
direct bullying and almost 18% of those who were often the target of
indirect bullying said they thought of suicide.
The researchers also looked at the psychology of the bullies.
Just over 10% of boys who bullied--whether it was direct or indirect
bullying--said they thought about suicide. Only about 3% of boys who did not
bully their classmates reported suicidal ideation."
Pediatrics 2003;111:1312-1317.
June 9, 2003
Q
"My wife smokes two packs of cigarettes a day, and we have
found out that she is pregnant. She insists that alcohol is a risk
factor for the baby but not smoking."
A Have
her read this: "Smoking
during pregnancy appears to affect a newborn's behavior in ways
similar to heroin and crack cocaine exposure, new study findings
suggest.
Smoking between 6 and 7 cigarettes per day
throughout pregnancy was associated with infants that were more
excitable, less consolable and more rigid than their unexposed peers.
Several reports have shown that women who smoke while pregnant
are twice as likely to have a low-birth weight infant compared to their
non-smoking peers. But, according to the new report, few studies have examined
how prenatal tobacco exposure may affect neurobehavior.
Babies born to mothers who smoked showed more signs of stress
in their central nervous, gastrointestinal and visual systems, required more
handling and were more rigid than unexposed infants, the authors report.
The findings suggest that exposed infants may have been
undergoing nicotine withdrawal, they note.
Furthermore, the authors found that the extent of behavioral
stress observed in exposed infants was comparable to that seen in infants born
to mothers who use heroin and other opiate drugs. Also, the stress behaviors of
exposed infants were similar to those seen in preterm infants."
Pediatrics 2003;111:1318-1323.
June 2, 2003
Q
"My husband has adult onset diabetes. He is also depressed. Did
the diabetes cause his depression?"
A "Chronic
complications increase by four-fold the prevalence of moderate to
severe depression among type I and II diabetic patients, Argentine
researchers found.
The relationship between higher scores on the Beck
Depression Inventory and moderate to severe depression remained
statistically significant after adjustment for age and adherence to
therapy.
According to Dr. Stolarza, the Beck Depression Inventory or
other related scales to evaluate depression might become a regular tool of
clinicians attending diabetic patients. "Early detection and treatment of
depression will certainly improve the metabolic control of diabetes," she said.
It is still unknown whether depression appears mainly as a
result of complications or preexisting depression fuels the development of
complications, but some doctors think that it is more likely a combination of
both factors.
May 26, 2003
Q
"My two children have snored since early childhood, and I was
told that this is their tonsils....I do not know if this is true or
if it represents more of concern socially than physically..."
A Here
is a report which may interest you: "Children who snore are at
heightened risk for a host of learning and psychological problems,
from poor verbal and spatial skills to anxiety and depression,
Kentucky researchers report.The new study shows that snoring
presents a health risk even in children who don't have obstructive
sleep apnea (OSA), said study author at the University of
Louisville. About 10% of children snore, and 3% have OSA, she said.
The children who snored performed worse on just about every measure
than those who didn't. "While their scores were still within the
normal range, they were more hyperactive, more impulsive, and had
more social problems. And they were more anxious and depressed than
children who didn't snore." The biggest differences were seen on the
cognitive test scores, she said, with children who snored having
significantly worse verbal, language and spatial skills than the
non-snorers. "We need to find a way to determine which kids who
snore are vulnerable to neuropsychological problems."
May 19, 2003
Q
"With these heinous crimes that occur...can we not predict
people with these character problems (sic) before adulthood?"
A Please note this: "Personality disorders
exist and can be diagnosed in adolescents. Existing data suggest
that despite substantial developmental changes in adolescence,
enduring maladaptive personality characteristics can be assessed in
the teen years, are not reducible to axis I disorders, and show
predictive value above and beyond axis I diagnoses. For the most
part, axis II diagnoses in adolescents resembled those in adults.
However, application of Diagnostic and Statistical Manual of
Mental Disorders, Fourth Edition, criteria appeared to
overdiagnose antisocial and avoidant personality disorder in
adolescents. With some exceptions, personality pathology in
adolescence resembles that in adults and is diagnosable in
adolescents ages 14-18. Categories and criteria developed for adults
may not be the optimal way of diagnosing adolescents. Data from
samples of adolescents may prove useful in developing an empirically
and clinically grounded classification of personality pathology in
adolescents. Problems with applying axis II to adolescents include
high rates of comorbidity and the high percentage of patients
diagnosed with antisocial and avoidant personality disorders (more
than 30% each). Am J Psychiatry.
2003;160:952-966
May 12, 2003
Q
"Can you give me some current thinking on ADHD? Thanks you."
A
"According to experts at the Duke University Medical Center, the
number of elementary school-aged children diagnosed with
attention-deficit/hyperactivity disorder (ADHD) has risen steadily
during the last ten years. The Center for Disease Control (CDC)
reports that as many as 1.6 million children carry an ADHD
diagnosis. Methods for dealing with this growing problem have
focused on medication. The Drug Enforcement Administration (DEA)
reveals that prescriptions for pharmacologic agents to treat ADHD
have increased 500 percent since 1991.
Treatment methods are intended to identify
appropriate coping mechanisms to compensate for and accommodate
developmental deficiencies, rather than cure ADHD. As a supplement,
medications may provide symptomatic relief as well. Three psychosocial
strategies that have demonstrated efficacy in controlling the symptoms
of ADHD: 1) parent training in effective child behavior management
methods; 2) classroom behavior modification techniques and academic
interventions; and 3) special educational placement.
Other supplemental programs, including family therapy sessions
in problem solving and communication skills as well as the coordination of
multiple school resources, may enhance the effectiveness of these three
behavioral management strategies. One of the key factors in the success of any
of these methods."
May 5, 2003
Q
"My wife has been depressed since the birth of our second
daughter. They have her on a lot of medication, but I really see
this as merely putting her to sleep...it is not helping."
A
You
might want to review this:
Postpartum
depression can be alleviated, at least in the short term, by
counseling or psychological therapy given at home. Three different
forms of psychological treatment found that all helped women to
recover faster from the depression, which often resolves
spontaneously after 4 or 5 months.
Counseling is like supportive listening. The
cognitive-behavioural treatment adopts a problem-solving approach
oriented to here-and-now difficulties, while psychodynamic treatment
is a more psychoanalytic approach. There was a substantial effect on
maternal mood for all treatments. The counseling treatment seemed to
have slightly more benefit than the others, she said. But the benefits
of the treatment were not sustained in the longer term, and did not
preventing the women developing depression subsequently.
Some of the women received their counseling and
cognitive-behavioural therapy from midwives, who routinely visit new
mothers in Britain, and the researchers found that they got as much
benefit as did women treated by experts.
Br J Psychiatry
2003;182:412-427
April 28, 2003
Q "My
son is in college. He also races a car that uses nitrous oxide.
Lately his behavior has been very strange. My husband suggested that
he may be using his car hobby to hide a more serious concern."
A
You may wish to read this: "Many university students are using
nitrous oxide gas as a recreational drug -- a habit that in extreme
cases can cause spinal degeneration
Students told the researchers they bought the gas
from local shops and supermarkets, where it is available in gas bulbs
for whipping cream.
The same group reported in The Lancet last year that a man who
had been inhaling the gas daily for six months had developed degeneration of the
spinal cord. The gas causes this damage by depriving the body of vitamin B12,
Frith's team notes.
Although the university student community doesn't reflect the
wider population, the latest findings could have implications for public health,
according to the researchers.
They said the findings should alert doctors to the possibility
of laughing-gas abuse in young people who have spinal degeneration but are
otherwise healthy.
Lancet 2003;19:1349-1350."
April 14, 2003
Q
"This may not be an appropriate question, but are there any
data suggesting the psychological needs of Iraqi children?"
A "Half a
million or more Iraqi children caught in fighting may be left so
traumatized they will need psychological help, the United Nations
children's agency said ...the Iraqi cities that have witnessed the
heaviest aerial bombardments or ground fighting since the US-led
invasion began...There are 5.7 million children of primary school
age in the country...A minimum figure of 10% of these children would
need support. It could be much bigger...The United Nations pulled
its entire international aid staff out of Iraq before the assault.
The World Health Organisation (WHO) has also expressed concern at
the psychological effect bombing may have on children, the elderly
and the physically and mentally disabled.
April 7, 2003
Q
"My dad served in Vietnam and is a disabled American veteran.
He has a fascination with guns and gun shows, gets very depressed,
does not always take his medication, and I am worried about my mom's
safety."
A
Prediction
of violence is quite difficult, but you may want to read the
following: "Combat veterans who are diagnosed with post traumatic
stress disorder (PTSD) appear to be more likely than others to own
guns and participate in potentially dangerous behavior with their
weapons, according to a report published in the March issue of the
Southern Medical Journal.
As a result, physicians at Veterans Affairs
hospitals should ask their patients about gun ownership, lead author
Dr. Thomas W. Freeman, from the Central Arkansas Veterans Healthcare
System in Little Rock, and colleagues write.
In a previous study, Dr. Freeman's team found that veterans
with PTSD often own large numbers of weapons and may engage in potentially
dangerous behavior, such as pointing guns at family and friends.
To further investigate, the researchers surveyed three
different groups of veterans on weapons use and conducted psychiatric tests that
measure hostility and aggression. The groups included 33 veterans diagnosed with
PTSD, 23 with schizophrenia and 22 with substance abuse disorder. The PTSD group
was primarily composed of Vietnam-era combat veterans.
Veterans with PTSD owned four times as many firearms as other
veterans, the authors report. They were also more likely to report dangerous
firearm related behaviors, such as aiming loaded guns at family members or
friends, patrolling home property with loaded guns and contemplating suicide
with a gun.
The PTSD group also showed the highest levels of aggression
and hostility, the investigators note.
More research is needed, the authors conclude, to see whether
combat veterans with PTSD who own weapons and engage in dangerous behaviors are
actually more likely to commit violent acts.
Although the authors advise physicians to ask veterans about
their use of guns, they caution that the findings may not apply to the larger
population of PTSD patients. Everyone in the study was a male veteran, they
point out, and most were unemployed and had experienced PTSD symptoms for at
least 30 years.
South Med J 2003;96:240-243."
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