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July 3, 2000
Q
"If schizophrenia is a biological illness, do schizophrenic women
become pregnant. I mean is there not a risk that schizophrenic men or
women will simply pass on the genes for schizophrenia?"
A "It
is somewhat more complex. Schizophrenic men tend to lose their sexual
drive early after onset of their disorder. Women seem to maintain
their sexual drive and are at risk for pregnancy and disease.
Additionally, since the women have no means of generating income, many
may exchange sex for income and run increased risk."
July 17, 2000
Q
"I have had physical complaints for which my physician has not
found a cause and said something about somatization. I read about this
on psychological.com but can you give me a brief overview of what can
be done if this is my problem?"
A
In the journal, American Family Physician, you can find an excellent
overview and discussion of the somatoform disorders. Allow me to quote
from that article:'
"Somatization is the experiencing
of physical symptoms in response to emotional distress. It is a common
and costly disorder that is frustrating to patients and physicians.
Successful treatment of somatization requires giving an acceptable
explanation of the symptoms to the patient, avoiding unwarranted
interventions and arranging brief but regular office visits so that
the patient does not need to develop new symptoms in order to receive
medical attention. Antidepressants may be helpful in many patients, as
well as cognitive psychotherapy when patients are willing to
participate in it. Typical problems in managing such patients can be
addressed by relying on the continuity established through regular
visits to the same primary care physician." (Am Fam Physician
2000;61:1423-8,1431-2.)
July 24, 2000
Q
"I have been diagnosed with bulimia since I was a teenage. Now I
am pregnant and was told that I run increased health risks. Is this
accurate?"
A
Active bulimia nervosa (BN) during pregnancy appears to be linked to
an increased risk of miscarriage, premature birth, postnatal
depression, and the development of diabetes during pregnancy. Bulimia
is the most common eating disorder, with a prevalence of roughly 1 in
20 women, research of ours suggests that a large number of women with
BN may actually be cured by the experience of pregnancy.
Physicians need to be
asking their pregnant patients questions about eating. Unlike women
with anorexia nervosa, women with BN will talk about their disorder if
they're asked the right questions.
July 31, 2000
Q
"Why doesn't everyone who is depressed commit suicide?"
A In an
unusual approach to the difficult problem of assessing suicidal
patients, investigators are looking at what factors determine why
depressed patients want to live, rather than why they might try to
commit suicide. Among patients with major depression, those who
reported strong reasons for living were less likely to be suicidal
than those without such motivation, according to a study in July's American
Journal of Psychiatry.
August 7, 2000
Q
"I have had injured
workers who complain of severe headaches and say they cannot work.
Often these individuals have had no head injury. The neurologists seem
to feel the headaches are disabling, but I wonder what the research is
on this…I mean – are there psychological factors in all of
this?"
A
There is a recent article in the journal
Headache. In that article, there is a lengthy discuss of depression
and anxiety as being among the psychological symptoms that accompany
frequent headache and headache-associated disability.
The
presence of psychological comorbidity (that is, concurrent anxiety and
depression as well as headache) with headache predicts a longer
lifetime duration of headache and a poorer prognosis for headache
reduction.
Subjects
who had headaches more than 4 days a week and those with
headache-associated activity limitation for 3 or more days a week
showed significantly greater depression and anxiety.
Anxiety
and depression were not believed to result from or cause the headaches
but to co-exist in many headache sufferers.
These
symptoms were not directly associated with headache severity. However,
compared with typically mild or moderate headache, severe headache was
associated with reductions in role and social functioning.
Frequent
headache and frequent headache-associated disability were also linked
to reduced quality of life in areas including physical and social
functioning.
The
article concluded that that patients with such symptoms "should
be further evaluated for the presence of psychological
disturbance." Headache
2000;40:373-376.
August
14, 2000
Q
"Are there any data regarding permanent problems associated with
pre-mature birth?"
A
Children who are born preterm or at
low birth weights were nearly three times as likely to be low
achievers or special needs children once they reached school age
compared with children born at full-term, according to findings
reported by the American Psychological Association.Although the
majority of preterm infants in the general population will not
experience severe, global dysfunction, the results of the current
study suggest that impaired functioning is prevalent among children
born preterm.
Preterm children not only scored lower
on intelligence and achievement tests compared with full-term
children, but parents and teachers rated preterm youngsters lower on
social and behavioral functioning measures. Furthermore, the preterm
children needed more educational support, were held back a grade level
and were diagnosed with learning disabilities more often than the
other children, the researchers found.
The preterm children were also
diagnosed with attention deficit hyperactivity disorder at rates four-
to six-times higher than the national estimates of 3% to 5% in the
general population.
August 21, 2000
Q
"Do women do better with illness and injury than do men...do
young do better than old...is physical coping the same as
psychological coping?"
A
We know that the incidence of depression is greater in women. The rate
of recovery from disease or injury may be more complex.
For
example, men with coronary
artery disease have significantly higher levels of mental well-being 3
years after their initial diagnosis compared with women, but women
have higher levels of physical recovery, according to research
results.
The researchers
found that male gender, older age, college education, status as part
of a minority group, less disease severity and increased social
support were associated with improvement on the mental component.
Social support positively influenced patients' mental health, but was
considered a negative influence on physical health. This may be
because all social relationships are supportive, in that some may
cause patients to become too dependent on others or limit their
physical domains.
Older people fared better from a mental
health perspective. They note that the onset of chronic illness is
more usual in older adults and "possibly less disruptive"
than in younger adults," and older people may have developed more
effective skills in managing health deficits.
August 28, 2000
Q
"There was a recent report that depression leads to Alzheimer's
Disease. I am wondering if this means that any of us who are depressed
will run an increased risk of Alzheimer's."
A
There
are no data, at this point, to support that depression or anxiety lead
to Alzheimer's Disease or that treatment for anxiety or depression
makes one more vulnerable to any form of dementia.
Now
it may be found, in the future, that depression precedes Alzheimer's
Disease because people feel a sense of futility as symptoms of
dementia begin.
It
is also possible that we shall find that treatment of anxiety or mood
disorders will postpone or eliminate Alzheimer's Disease.
Finally,
it is possible that we may find that the normal progression of
dementia such as Alzheimer's Disease, result in brain changes that
create a mood or anxiety disorder as the dementia increases.
The
best we can say, at present, is that there is concern and ongoing
research regarding the relationship between anxiety disorder, mood
disorders and cognitive disorders such as Alzheimer's Disease.
September 4, 2000
Q
"What are the common causes of sexual dysfunction in women?"
A
Sexual dysfunction includes
desire, arousal, orgasmic and sex pain disorders (dyspareunia and
vaginismus). Long-term medical diseases, minor ailments, medications
and psychosocial difficulties, including prior physical or
sexual abuse, are etiologic factors. Gynecologic maladies and
cancers (including breast cancer) are also frequent sources of sexual
dysfunction. Patient education and reassurance, with early diagnosis
and intervention, are essential for effective treatment. Patient
history and physical examination techniques, normal sexual responses
and the factors that influence these responses, and the application of
medical and gynecologic treatments to sexual issues are discussed.
Basic treatment strategies, which may be successfully provided by
primary care physicians for most sexual dysfunctions, are outlined.
Referral can be reserved for patients who do not respond to therapy.
Although there has been at least one case of improvement in sexual
response following use of a medication for male erectile problems,
overall this is not considered a standard of care at this time. Am Fam
Physician. 2000 Jul 01;62(1):127-136.
September 11, 2000
Q
"Do these health food store remedies help with depression and
anxiety?"
A
This, as you likely know, is a hotly debated and complex issue.
Controlled studies are showing at least
some efficacy of different herbal preparations in treating some
symptoms. But because of the chemical complexity of herbal products,
their lack of standardization, and the paucity of well-controlled
studies comparing them with conventional medications, researchers do
not yet recommend herbal remedies over established conventional
treatments.
In studies using 900 mg/day of an
aqueous methanol extract of St. John's wort, compared either with
placebo or with low dosages of maprotiline, imipramine and
amitriptyline. In the five placebo controlled studies, 61% of subjects
receiving the extract responded with at least a 50% decline in
Hamilton Rating Scale for Depression, compared with 24% of those
receiving placebo.
Studies of kava, ginkgo, and valerian.
Kava was demonstrated to be anxiolytic, but the studies had
"ill-defined patient populations, small sample sizes, and short
treatment duration." Forty controlled trials of gingko extracts
showed significant improvement in memory loss, concentration, fatigue,
anxiety and depressed mood, but the studies suffered limitations
similar to those for kava.
Studies of valerian showed some
efficacy in reducing sleep latency and improving subjective sleep
quality, but placebo effects were also prominent. Psychiatr Serv
2000;51:1130-1134.
September 18, 2000
Q
"I think I have migraine headaches, and I am also depressed. Do
this often occur together?"
A
It is important that you be certain of your diagnosis. There are
tension type headaches, vascular headaches, cluster headaches, etc.
This diagnosis should be made by someone who treats headache patients.
Migraine patients in the general
population report lower levels of mental, physical and social well
being than people who do not experience migraine headaches, and they
are more likely to exhibit symptoms of depression, according to
reports published in the September 1st issue of Neurology.
Migraine patients reported more asthma
and chronic musculoskeletal pain than people who do not have
migraines. The impact of migraine was greater on social and mental
functioning than on physical functioning. In
a population-based case-control study, the investigators determined
that 47% of migraine sufferers experienced depression, compared to 17%
of people without migraine. Neurology 2000;55:624-635.
September 25, 2000
Q
"I am seventeen and smoke a few cigarettes a day. I think that
smoking is psychological and that if I decide I don't like it. I'll
stop. I don't buy that it is addictive?"
A
According
to researchers in Massachusetts and the UK, nearly two thirds of teen
smokers report signs of nicotine dependence, including cravings,
irritability, nervousness and anxiety, and most begin to experience
these symptoms before they start smoking on a daily basis, .
In some cases, teens note these
symptoms within only days of smoking their first cigarette.
In both mice and humans, they say, the
number of high-affinity nicotinic cholinergic receptors has been seen
to increase in the brain after only the second dose of nicotine.
The new findings indicate that there
may be three classes of smokers, the investigators suggest. The
rapid-onset group develops symptoms of nicotine dependence within days
or weeks of monthly use. The second group experiences slower onset of
symptoms, and development of nicotine dependence may require more
prolonged exposure to higher doses. The third group of smokers, whom
the authors label as resistant, are those who smoke up to five
cigarettes per day over many years with no evidence of dependence.
Tob Control 2000;9:313-319.
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