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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 |
September 29, 2003
Q
"I told my wife that women respond better to antidepressants.
Did I not read that somewhere?"
A
"Although certain antidepressants seem to be metabolized differently
in men than in women, the therapeutic effects do not differ by
gender. Although plasma levels of the drug were significantly higher
in female than in male patients, remission rates were nearly the
same - about 30% -- in both sexes. Moreover, post-treatment Hamilton
Depression scores did not differ by gender.
Further analysis revealed no correlation between plasma drug level,
gender, and therapeutic outcome, the researchers note. The current
findings suggest that gender-related pharmacokinetic effects are not
clinically relevant."
Am J Psychiatry 2003;160:1643-1650.
September 22, 2003
Q
"Was there not a study on personality and sleep position?"
A
While the following may be of some interest, it would have to held
up to rigorous examination. So, for now, merely accept it for its
curiosity value. "Whether it's curled up in the fetal position, flat
on the stomach or stretched out across the bed, the way people sleep
reveals their personality...six common sleep positions and what they
mean.
-
Crouched in the fetal
position is the most popular sleep pattern and favored by 51 percent of
women. Fetal sleepers tend to be shy and sensitive while people who assume
the soldier position, flat on their back with arms at their sides, are quiet
and reserved.
-
Sleeping on one's side
with legs outstretched and arms down indicates a social, easy-going
personality. But if the arms are outstretched in the yearner position, the
person tends to be more suspicious.
-
The freefall, flat on
the tummy with the hands at the sides of the head, is the most unusual
position. Only 6.5 percent of people prefer it and they are usually brash
and gregarious.
-
Unassuming, good
listeners usually adopt the starfish position - on the back with
outstretched arms and legs.
Once a sleeping style is adopted it is rarely changed."
September 15, 2003
Q
"Is it true that the drug I take for my cholesterol can make me
less depressed?"
A
That would depend upon both your cholesterol lowering medication and
the cause of your depression, but "Current statin use is associated
with a lower risk of developing depression... adding to
published evidence that statin use does not adversely impact
psychological well-being.
(this) report follows another that suggests statins
may reduce the risk of psychological disorders, independently of
statins' impact on serum cholesterol levels.
"There are some indications that statins are more effective in
treating high cholesterol and other cardiovascular risk factors than other
lipid-lowering drugs."
"The association could also be related to increased health
consciousness and compliance among patients taking statins, the authors
suggest."
"Without controlled clinical trials, it cannot be concluded
that statins exert a direct antidepressive effect."
Arch Internal Med
2003;163:1926-1932.
September 8, 2003
Q
"My wife and I are both on antidepressants, but she seems to be
responding differently. I told her that I read that women get better
quicker. Can you send me a reference on that?"
A You
might want to review; "Differentiation
according to sex is not important in treatment with common
antidepressants. Although women with major and predominantly
melancholic depression appeared to have higher plasma concentrations
of tricyclic antidepressants than did men, the consequences of this
difference for clinical effects are unclear.
Men and women had similar rates of remission,
defined as Hamilton depression scale score less than 8, when treated
with clomipramine, and they had significantly higher remission rates
with clomipramine than with the comparison treatments. Plasma
concentrations of clomipramine, which were measured weekly in a
subgroup of 110 patients, were significantly higher for women than for
men.
There were no sex differences in posttreatment Hamilton
depression scale scores, therapeutic effects of treatment, dropout rates, or
adverse events, nor was any relationship documented between plasma
concentrations, sex, and therapeutic outcome."
Am J Psychiatry.
2003;160:1643-1650
September 1, 2003
Q
"My husband just underwent bypass surgery [CABG]. He has been
very depressed. We were told that this is of no concern and is
normal. Are you aware of any articles on this topic?"
A I
hope you find the following helpful:
"Patients with moderate to severe
depression have higher rates of death after coronary artery bypass
graft (CABG) surgery than those who are not depressed. Despite
advances in the medical management of patients after CABG, the
prognostic importance of clinical depression provides a further
opportunity to reduce adverse outcomes associated with the procedure
by treating depressed patients after surgery...depression is an
established risk factor for coronary relapse after CABG...Many
patients who undergo CABG are at increased risk of death because
they are clinically depressed; this risk could be reduced by
treatment of depression after surgery.
Lancet. 2003;362:604-609
August 27, 2003
Q
"My neighbor has twin sons. One committed suicide. The family
is devastated, and a psychologist told them that their surviving
twin would likely also make a suicidal attempt. Is that true?"
A She
may want to read in the area beginning with this recent article.
"Findings from a Danish study
spanning several decades indicates that twins have a substantially
lower risk of suicide compared with the general population.
The researchers' findings are published in the
August 16, 2003, issue of the British Medical Journal. Although 211
suicides occurred in the twin cohort, 293 cases would have been
expected based on rates in the general population. Males twins were
26% less likely to commit suicide than their non-twin counterparts,
while female twins were 31% less likely to commit suicide than their
non-twin peers.
The decreased suicide risk in twins, coupled with the fact
that suicide rates were similar for monozygotic and dizygotic twins, "supports
the hypothesis that strong family ties reduce the risk for suicidal behavior,"
the investigators note.
Although mental illness--the strongest risk factor for
suicide-is more common among twins, this risk may be offset by strong family
ties, they add."
BMJ 2003;327:373-374.
August 18, 2003
Q
"Does my sleep apnea have anything to do with my being tired all the
time?"
A
You should check with your
internist, and you may also wish to read this article when you have
an opportunity: "Rhinosinusitis symptoms are significantly
prevalent in patients with chronic fatigue or bodily pain,. These
findings are in agreement with the otolaryngological literature
suggesting that endoscopic sinus surgery can resolve the fatigue and
pain in these patients.
Among 297 patients in Dr. Chester's private internal medicine
practice, 65 patients (22%) had unexplained chronic fatigue, 33
(11%) had unexplained chronic pain, and 26 patients (9%) had both
symptoms.
Compared with 232 patients without unexplained chronic fatigue (UCF),
patients with UCF more frequently had rhinosinusitis symptoms
including facial pressure, heavy-headedness, nasal
obstruction, frontal headache, postnasal drip, sore throat, and
tender cervical lymph nodes.
Patients with bodily pain and those with chronic fatigue syndrome
also had a similar predominance of rhinosinusitis symptoms.
Rhinosinusitis symptoms were at least as common in UCF as
gastrointestinal complaints, sleep disturbance, and psychiatric
problems, and they were more common in UCF than in fatigue explained
by a physical or mental illness."
Arch Intern Med. 2003;163:1832-1836
August 11, 2003
Q
"We live in a gang infected neighborhood, and my son and
daughter are terrified of getting to and from school. They have
nightmares. Do they have posttraumatic stress disorder?"
A This summary may prove helpful: "A
brief, standardized cognitive-behavioral group intervention
delivered to middle-school students exposed to violence
substantially reduces their symptoms of post-traumatic stress
disorder (PTSD) and depression.
"Substantial exposure to violence" was defined as
"being the victim or witness of violence involving a knife or gun or
having a Life Events Scale summed score greater than 6" out of a
potential of 34.
The intervention consisted of a 10-session
"Cognitive-Behavioral Intervention for Trauma in Schools" (CBITS). At
3-month follow-up, scores on the Child PTSD Symptom Scale had declined
from a baseline average of 24.5 to 8.9. In the delayed intervention
group, corresponding scores were 23.5 and 15.5. Dr. Stein pointed out
the value of conducting a group intervention with such children.
"Children who suffer anxiety and depression after experiencing
violence often think they're going crazy or that no one else has had
similar experiences," he said. They benefit from hearing from their
peers about their experiences, and "can help each other gain coping
skills in confronting their fear and anxiety."
Another important component of the program, is that
the participants were given homework to be completed with their
parents. "Hopefully, by working together and confronting their past
experiences, the whole family will be more resilient when confronting
other violence in the future." The intervention may also modify the
participants' future risk of substance abuse, he predicted, which is
elevated among teenagers who have been exposed to violence.
In the second report, the authors designed the
Screening Tool for Early Predictors of PTSD (STEPP) from surveys
administered to 269 children ages 8 to 17 who had been hospitalized
following traffic-related injuries. The screen was also administered
to one parent.
Results of the short screening tool could be used to
identify families that would benefit from a more complete mental
health evaluation, she added, and possible involvement of the
hospital's social services department or psychological services.
JAMA
2003;290:603-611,643-649.
August 4, 2003
Q
"My wife quit smoking for her pregnancy but now is back smoking
more than a pack per day. Our daughter is only six weeks old. What
does my wife need to know?"
A
Have her read this article:
"Prohibiting smoking in the home produces a small but
significant drop in infants' exposure to tobacco smoke. In a survey
of 314 parents living in smoking households with infants, nearly all
respondents thought tobacco smoke was harmful, yet only a small
minority banned smoking in the home. Eighty-six percent of parents
considered tobacco smoke harmful and 90% believed that infants could
be protected from exposure in the home. Although 65% of parents used
protective measures, only 18% actually prohibited smoking in the
home.
Of various measures taken, including airing rooms
after smoking and not smoking in the same room as the infant, the only
one that had any effect on infant urinary cotinine levels was
completely banning smoking in the home. Even then, the drop in levels,
though significant, was slight.
Moreover, it is unclear if the reduction in cotinine levels
translates into a meaningful reduction in the risk of sudden infant death.
The new findings suggest that anything short of a total
smoking ban is unlikely to help infants, but this needs to be verified in a
larger subject group.
BMJ 2003;327:257-260."
July 28, 2003
Q
"I had been told by a
friend that eating tuna will lessen my risk for Alzheimer's Disease.
This seemed far fetched."
A
You may wish to look further into this:
"Weekly consumption of fish
and the dietary intake of n-3 fatty acids reduced risk of incident
Alzheimer's disease in a large prospective study.
One hundred thirty-one subjects developed
Alzheimer's disease during follow-up (annual incidence rate, 2.6%).
Subjects who consumed fish at least once a week had a 60% lower risk
of developing the disease than those who rarely or never consumed fish
(relative risk, 0.4).
Total intake of n-3 polyunsaturated fatty acids was associated
with a reduced risk of incident Alzheimer's disease. After adjusting for age,
subjects in the top fifth of intake had a 70% reduction in risk compared with
those in the lowest fifth of intake.
Intake of docosahexaenoic acid was also associated with a
reduced risk of Alzheimer's disease.
The current findings, taken in combination with previous
results, "suggest that consumption of fish (at least weekly), oil-based salad
dressings, and nuts may reduce the risk of Alzheimer's disease."
Arch Neurol 2003;60:940-946.
July 21, 2003
Q
"I read that taking Motrin can keep me from getting Alzheimer's
Disease."
A You
may want to note: "A
new review of several observational studies provides further
evidence that use of non-steroidal antiinflammatory drugs protects
against the development of Alzheimer's disease...Overall, NSAID
users were 28% less likely to develop Alzheimer's disease than
nonusers, the investigators note. When the analysis was limited to
aspirin use, the risk reduction was 13%. The risk of Alzheimer's was
inversely related to the duration of NSAID use. The risk fell by
only 5% when these drugs were used for less than 1 month, while
NSAID use for 2 or more years produced a 73% drop in the risk. Once
the disease has already set in, NSAIDs do not appear to be
particularly beneficial. In a study released last month, NSAID use
by patients with mild to moderate Alzheimer's did nothing to slow
their cognitive decline. BMJ
2003;327:128-131.
July 14, 2003
Q
"My father is in assisted living. He seems very depressed. I
have been told that this is normal and that nothing can/should be
done. Is this accurate?"
A You
might want to review this: "Sertraline
safely reduces symptoms of major depression in patients 60 years of
age or older, according to the results of a large placebo-controlled
trial of antidepressant treatment in the elderly.
The three primary efficacy variables--the Hamilton
depression scale score, Clinical Global Impression (CGI) severity
score and CGI improvement score--were all significantly more improved
in the active treatment group at the end of the 8-week trial.
Response rates as assessed by CGI improvements scores
indicating "very much improved" or "much improved" were significantly higher
after treatment with sertraline.
Am J Psychiatry
2003;160:1277-1285.
July 7, 2003
Q
"I am in the midst of a very messy divorce, and the children
are suffering. Should I have them seen or tested or something?."
A
"One in 4 children and
teenagers has a psychosocial problem that affects their functioning
at home or school...This incidence is believed to be underestimated
due, in large part, to inadequate screening by primary care
providers. Despite the high incidence, only a small percentage of
parents or children report talking to their physician or nurse
practitioner about psychosocial concerns. The top five mental health
worries identified by children/teens and their parents included:
- How to cope with stressful
things in their lives.
- Depression.
- Anxiety.
- Self-esteem.
- Parent-child relationships.
In fact, about 25% of kids worried about how to
cope with stressful things often to nearly always. Another important finding
from the study is that despite the fact that so many children and parents have
these worries, only a very small percentage talked to their nurse practitioner
or physician about them."
If you feel that your children need someone
outside the family with whom to discuss their concerns, you should consider
contacting local mental health associations for a list of doctors.
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