Some Mental Health Experts Advocate More Treatment Of Personality Disorders
One expert said personality disorders may be overdiagnosed. But others said the results were not surprising since previous, less rigorous evidence has suggested mental problems are common on college campuses and elsewhere.
Experts praised the studys scope - face-to-face interviews about numerous disorders with more than 5,000 young people ages 19 to 25 - and said it spotlights a problem college administrators need to address.
Study co-author Dr. Mark Olfson of Columbia University and New York State Psychiatric Institute called the widespread lack of treatment particularly worrisome. He said it should alert not only “students and parents, but also deans and people who run college mental health services about the need to extend access to treatment.”
Counting substance abuse, the study found that nearly half of young people surveyed have some sort of psychiatric condition, including students and non-students.
Personality disorders were the second most common problem behind drug or alcohol abuse as a single category. The disorders include obsessive, anti-social and paranoid behaviors that are not mere quirks but actually interfere with ordinary functioning.
The study authors noted that recent tragedies such as fatal shootings at Northern Illinois University and Virginia Tech have raised awareness about the prevalence of mental illness on college campuses.
They also suggest that this age group might be particularly vulnerable.
“For many, young adulthood is characterized by the pursuit of greater educational opportunities and employment prospects, development of personal relationships, and for some, parenthood,” the authors said. These circumstances, they said, can result in stress that triggers the start or recurrence of psychiatric problems.
The study was released Monday in Archives of General Psychiatry. It was based on interviews with 5,092 young adults in 2001 and 2002.
Olfson said it took time to analzye the data, including weighting the results to extrapolate national numbers. But the authors said the results would probably hold true today.
The study was funded with grants from the National Institutes of Health, the American Foundation for Suicide Prevention and the New York Psychiatric Institute.
Imagine if more than 75 percent of diabetic college students didnt get treatment, Hirsch said. “Just think about what would be happening on our college campuses.”
The results highlight the need for mental health services to be housed with other medical services on college campuses, to erase the stigma and make it more likely that people will seek help, she said.
In the study, trained interviewers, but not psychiatrists, questioned participants about symptoms. They used an assessment tool similar to criteria doctors use to diagnose mental illness.
Dr. Jerald Kay, a psychiatry professor at Wright State University and chairman of the American Psychiatric Associations college mental health committee, said the assessment tool is considered valid and more rigorous than self-reports of mental illness. He was not involved in the study.
Personality disorders showed up in similar numbers among both students and non-students, including the most common one, obsessive compulsive personality disorder. About 8 percent of young adults in both groups had this illness, which can include an extreme preoccupation with details, rules, orderliness and perfectionism.
Source: sccha
Asthma Inhalers Are No Longer Using Ozone Destroying CFCs
The down side: The new inhalers cost more, $30 to $60 compared to as little as $5 or $10 for the disappearing generic CFC inhalers.
And patients face a learning curve. HFA inhalers must be used differently than the old-fashioned kind. The medicine feels and tastes different, sometimes alarming new users despite doctors assurances that it works just as well.
“Theres still significant confusion,” says Dr. Harvey Leo of the University of Michigans C.S. Mott Childrens Hospital. “Patients will tell you, I dont feel the puff anymore.”
Calls from parents unsure how to use the new inhalers, or even what they are, have increased in the past two months as more drugstores run out of CFC-powered inhalers and automatically switch people whod been expecting a mere refill, he adds.
The change shouldnt be a surprise. The Food and Drug Administration has long warned it was coming, and lung specialists have spent the past year easing many of the nations 20 million asthma patients - as well as millions of emphysema sufferers who also use albuterol to ease breathing - into it.
But industry figures show that in mid-November, 20 percent of all albuterol prescriptions still were being filled with CFC versions.
Some patients may purposefully be buying up cheaper CFC inhalers before the sales ban. But many patients dont see a lung specialist, or their prescription may not expire until next year so they havent been seen recently enough to be told.
Reaching the last fraction “is, as you can imagine, a very difficult task,” says Dr. Bidrul Chowdhury, FDAs pulmonary drugs chief. “How to get to somebody who is not tuned in?”
The CFC-free options: GlaxoSmithKlines Ventolin HFA, Schering Ploughs Proventil HFA and Teva Specialty Pharmaceuticals ProAir HFA all contain albuterol. Also, Sepracors Xopenex HFA contains the similar medication levalbuterol.
Albuterol inhalers are for emergencies, for quick relief of wheezing. Patients also need daily medication to control their asthma and prevent flare-ups. Someone whos using the albuterol inhaler more than a few times a month isnt well-controlled, and his or her doctor needs to determine why, stresses Dr. Paul Greenberger of Northwestern University, president-elect of the American Academy of Allergy, Asthma & Immunology.
Heres the rub: Recent research suggests only one in five children has their asthma under good control; no one knows how many adults do.
Albuterol manufacturers are providing free samples and posting coupons on their Web sites.
Still, specialists worry that some patients will try to save money with a decades-old nonprescription inhaler that contains a different drug, epinephrine, best known by the brand name Primatene Mist - inhalers that also contain ozone-harming CFCs. National asthma guidelines argue against such self-treatment as too risky and less effective than albuterol. The government will allow sale of those over-the-counter inhalers until December 2011 as manufacturers reformulate.
Leo has another concern: Only one of the new inhalers counts doses used. Hes monitoring emergency-room statistics to see if cost-conscious patients trying to squeeze out last drops wind up using empty inhalers.
What do patients need to know as they switch?
-Expect a softer puff instead of the CFC versions cold blast of air in the back of the throat.
Source: sccha
Gout Drug Uloric Manufactured By Takeda
In healthy people, uric acid is dissolved in the blood and excreted from the body in urine. But high levels lead to the formation of needle-like crystals that become deposited in the joints, causing intense pain and swelling. Many patients experience their first attack of gout in the big toe. The disease can progress, causing deformities.
Food and Drug Administration medical reviewers were concerned because early trials of Uloric found a higher risk of death and heart problems from the drug. But Takeda Inc., which makes Uloric, commissioned a much larger clinical study that found no difference in heart risks when compared with the currently available drug, allopurinol.
Takeda said its medication works better for patients with kidney problems. “A lot of gout patients suffer from kidney disease,” said Dr. Nancy Joseph-Ridge, head of research and development for the company. “This is something of real need. Patients who could not take the other drug will now have treatment.”
The FDA arthritis advisory committee voted 12-0 to recommend approval of Uloric for chronic gout. One member abstained. The FDA usually follows the recommendations of its advisers.
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On the Net:
Food and Drug Administration: http://www.fda.gov
Source: ctnhr
Some Psychiatric Patients See Life As A Television Show
“The question is really: Is this just a new twist on an old paranoid or grandiose delusion … or is there sort of a perfect storm of the culture were in, in which fame holds such high value?” said Dr. Joel Gold, a psychiatrist affiliated with New Yorks Bellevue Hospital.
Within a two-year period, Gold said he encountered five patients with delusions related to reality TV. Several of them specifically mentioned “The Truman Show.”
Gold and his brother, a psychologist, started presenting their observations at medical schools in 2006. After word spread beyond medical circles this summer, they learned of about 50 more people with similar symptoms. The brothers are now working on a scholarly paper.
Meanwhile, researchers in London described a “Truman syndrome” patient in the British Journal of Psychiatry in August. The 26-year-old postman “had a sense the world was slightly unreal, as if he was the eponymous hero in the film,” the researchers wrote.
The Oscar-nominated movie stars Jim Carrey as Truman Burbank. He leads a merrily uneventful life until he realizes his friends and family are actors, his seaside town is a TV soundstage and every moment of his life has been broadcast.
His struggle to sort out reality and illusion is heartwarming, but researchers say its often horrifying for “Truman syndrome” patients.
A few take pride in their imagined celebrity, but many are deeply upset at what feels like an Orwellian invasion of privacy. The man profiled in the British journal was diagnosed with schizophrenia and is unable to work. One of Golds patients planned to commit suicide if he couldnt leave his supposed reality show.
Delusions can be a symptom of various psychiatric illnesses, as well as neurological conditions such as Parkinsons and Alzheimers diseases. Some drugs also can make people delusional.
Its not unusual for psychiatrists to see delusional patients who believe their relatives have been replaced by impostors or who think figures in their lives are taking on multiple disguises.
But “Truman” delusions are more sweeping, involving not just some associates but society at large, Gold said.
Delusions tend to be classified by broad categories, such as the belief that one is being persecuted, but research has shown culture and technology can also affect them. Several recent studies have chronicled delusions entwined with the Internet such as a patient in Austria who believed she had become a walking webcam.
Ian Gold, a philosophy and psychology professor at McGill University in Montreal who has researched the matter with his brother, suggests reality TV and the Web, with their ability to make strangers into intimates, may compound psychological pressure on people who have underlying problems dealing with others.
Thats not to say reality shows make healthy people delusional, “but, at the very least, it seems possible to me that people who would become ill are becoming ill quicker or in a different way,” Ian Gold said.
Other researchers arent convinced, but still find the “Truman syndrome” an interesting example of the connection between culture and mental health.
Vaughan Bell, a psychologist who has researched Internet-related delusions, said one of his own former patients believed he was in the virtual-reality universe portrayed in the 1999 blockbuster “The Matrix.”
“I dont think that popular culture causes delusions,” said Bell, who is affiliated with Kings College London and the Universidad de Antioquia in Medellin, Colombia. “But I do think that it is only possible to fully understand delusions and psychosis in light of our wider culture.”
Source: ctnhr
Swiss Legal Heroin Program Aimed At Helping Victims
The nearly 1,300 selected addicts, who have been unhelped by other therapies, visit one of the centers twice a day to receive the carefully measured dose of heroin produced by a government-approved laboratory.
They keep their paraphernalia in cups labeled with their names and use the equipment and clean needles to inject themselves - four at a time - under the supervision of a nurse, and also receive counseling from psychiatrists and social workers.
The aim is to help the addicts learn how to function in society.
The United States and the U.N. narcotics board have criticized the program as potentially fueling drug abuse, but it has attracted attention from governments as far away as Australia and Canada, which in recent years have started or are considering their own programs modeled on the system.
The Netherlands started a smaller program in 2006, and it serves nearly 600 patients. Britain has allowed individual doctors to prescribe heroin since the 1920s, but it has been running trials similar to the Swiss approach in recent years. Belgium, Germany, Spain and Canada have been running trial programs too.
Sixty-eight percent of the 2.26 million Swiss voters casting ballots approved making the heroin program permanent.
By contrast, around 63.2 percent of voters voted against the marijuana proposal, which was based on a separate citizens initiative to decriminalize the consumption of marijuana and growing the plant for personal use.
Olivier Borer, 35, a musician from the northern town of Solothurn, said he welcomed the outcome in part because state action was required to help heroin addicts, but he said legalizing marijuana was a bad idea.
“I think its very important to help these people, but not to facilitate the using of drugs,” Borer said. “You can just see in the Netherlands how its going. People just go there to smoke.”
Sabina Geissbuehler-Strupler of the right-wing Swiss Peoples Party, which led the campaign against the heroin program, said she was disappointed in the vote.
“That is only damage limitation,” she said. “Ninety-five percent of the addicts are not healed from the addiction.”
Parliament approved the heroin measure in a revision of Switzerlands narcotics law in March, but conservatives challenged the decision and forced a national referendum under Switzerlands system of direct democracy.
Jo Lang, a Green Party member of parliament from the central city of Zug, said he was disappointed in the failure of the marijuana measure because it means 600,000 people in Switzerland will be treated as criminals because they use cannabis.
“People have died from alcohol and heroin, but not from cannabis,” Lang said.
The government, which opposed the marijuana proposal, said it feared that liberalizing cannabis could cause problems with neighboring countries.
On a separate issue, 52 percent of voters approved an initiative to eliminate the statute of limitations on pornographic crimes against children before the age of puberty.
Source: vtben
Exercise No Magic Cure For Heart Failure Patients, So Few Stuck With The Program Making It Difficult To Show A Positive Result
Although there were some encouraging trends and clear benefits for certain people, exercise failed to deliver on the main goal - keeping people out of the hospital and improving their survival rates.
“Its a shame,” said Dr. Harlan Krumholz, a quality-of-care researcher at Yale University who had no role in the study. “Exercise is not that magic elixir that we had hoped,” at least for these patients.
About 5 million Americans have heart failure. It kills more than 300,000 of them and accounts for a million hospitalizations each year. Those numbers are expected to grow as the nations population gets older.
The condition occurs when the heart muscle weakens over time and can no longer pump effectively. Fluid can back up into the lungs, leaving people gurgling and gasping for breath as they struggle to climb stairs or walk around the block.
Exercise has long been known to help prevent the clogged arteries that develop in heart disease and to help heart attack patients recover. But smaller, previous studies have made conflicting findings about whether it helps heart failure patients or even is safe for them.
Doctors had hoped that exercise would prove as effective as drugs for these patients, sparing them the cost and potential side effects.
The study involved 2,231 people with moderate heart failure in the United States, Canada and Europe. It was led by Dr. Christopher OConnor at Duke University.
All of the patients were getting optimal medical care, with more than 90 percent on an ideal mix of medicines. Those who needed them also had implanted heart devices to maintain good rhythm.
They were randomly placed in two groups - one given usual care and the other usual care plus an exercise training program. Exercisers were given 36 supervised training sessions lasting half an hour three times a week. After 18 such sessions, they were given a treadmill or an exercise bike to use at home, for five 40-minute sessions each week.
Three months into the study, only half were exercising at least three times a week for 40 minutes. After one year, only one-fourth were exercising five times a week.
The fact so few stuck with the exercise program made it difficult to show a positive result, OConnor said.
However, after doctors adjusted for factors like how long people were able to tolerate exercise, how badly damaged their hearts were and rates of depression, they did find a modest but significant benefit for exercise.
“Its disappointing,” said Dr. Robert Eckel, a former heart association president and an exercise specialist at the University of Colorado at Denver. “You cannot make strong conclusions about subgroups.”
Insurers now do not pay for exercise training for people with heart failure, and “this study is not going to help” convince them to start, Eckel said.
“We all would have liked to see a huge benefit to exercise,” said Dr. Lawton Cooper, medical officer at the National Heart, Lung and Blood Institute, which paid for the study.
Still, for most people, “it is worth your while,” Cooper said. “We know there are all kinds of benefits of exercise.”
Source: sccha
United States Infant Formula Found To Contain Melamine By FDA
Melamine is the chemical found in Chinese infant formula - in far larger concentrations - that has been blamed for killing at least three babies and making at least 50,000 others ill.
Previously undisclosed tests, obtained by The Associated Press under the Freedom of Information Act, show that the FDA has detected melamine in a sample of one popular formula and the presence of cyanuric acid, a chemical relative of melamine, in the formula of a second manufacturer.
Separately, a third major formula maker told AP that in-house tests had detected trace levels of melamine in its infant formula.
The three firms - Abbott Laboratories, Nestle and Mead Johnson - manufacture more than 90 percent of all infant formula produced in the United States.
The FDA and other experts said the melamine contamination in U.S.-made formula had occurred during the manufacturing process, rather than intentionally.
The U.S. government quietly began testing domestically produced infant formula in September, soon after problems with melamine-spiked formula surfaced in China.
Sundlof said there have been no reports of human illness in the United States from melamine, which can bind with other chemicals in urine, potentially causing damaging stones in the kidney or bladder and, in extreme cases, kidney failure.
Melamine is used in some U.S. plastic food packaging and can rub off onto what we eat; its also contained in a cleaning solution used on some food processing equipment and can leach into the products being prepared.
Sundlof told the AP the positive test results “so far are in the trace range, and from a public health or infant health perspective, we consider those to be perfectly fine.”
Thats different from the impression of zero tolerance the agency left on Oct. 3, when it stated: “FDA is currently unable to establish any level of melamine and melamine-related compounds in infant formula that does not raise public health concerns.”
FDA scientists said then that they couldnt set an acceptable level of melamine exposure in infant formula because science hadnt had enough time to understand the chemicals effects on infants underdeveloped kidneys. Plus, there is the complicating factor that infant formula often constitutes a newborns entire diet.
Still, the announcement was widely interpreted by manufacturers, the news media and Congress to mean that infant formula that tested positive at any level could not be sold in the United States.
The Grocery Manufacturers Association, for example, told its members: “FDA could not identify a safe level for melamine and related compounds in infant formula; thus it can be concluded they will not accept any detectable melamine in infant formula.”
It was not until the AP inquired about tests on domestic formula that the FDA articulated that while it couldnt set a safe exposure for infants, it would accept some melamine in formula - raising the question of whether the decision to accept very low concentrations was made only after traces were detected.
On Sunday, Sundlof said the agency had never said, nor implied, that domestic infant formula was going to be entirely free of melamine. He said he didnt know if the agencys statements on infant formula had been misinterpreted.
In China, melamine was intentionally dumped into watered-down milk to trick food quality tests into showing higher protein levels than actually existed. Byproducts of the milk ended up in infant formula, coffee creamers, even biscuits.
Source: midtn
Army Bases Prepare For Influx Of Over-Toured Soldiers: PTSD And Schizophrenia
The three 101st Airborne combat brigades, which have begun arriving home, have gone through at least three tours in Iraq. The 3rd Brigade also served seven months in Afghanistan, early in the war. Next spring, the 4th Brigade will return from a 15-month tour in Afghanistan. So far, roughly 10,000 soldiers have come back; the remainder are expected by the end of January.
Army leaders say they will closely watch Fort Campbell to determine the proper medical staffing levels needed to aid soldiers who have endured repeated rotations in the two war zones.
“I dont know what to expect. I dont think anybody knows,” said Gen. Peter Chiarelli, vice chief of staff of the Army, as he flew back to Washington from a recent tour of the bases medical facilities. “Thats why I want to see numbers from the 101sts third deployment.”
What happens with the 101st Airborne, he said, will let the Army help other bases ready for similar homecomings in the next year or two, when multiple brigades from the 4th Infantry Division and the 1st Cavalry Division return.
Noting that some soldiers in the 101st Airborne units have been to war four or five times, Chiarelli said he is most worried the military will not be able to find enough health care providers to deal effectively with the troops needing assistance.
Many of the military bases are near small or remote communities that do not have access to the number of health professionals who might be needed as a great many soldiers return home.
More than 63,600 active duty Army soldiers have done three or more tours in Iraq or Afghanistan. That is a nearly 12 percent of the total number of soldiers who have deployed at least once. Roughly four in 10 soldiers who have gone to war have served more than one deployment - and that number is growing steadily.
One solution under discussion is the formation of mobile medical and psychological teams that can go to Army bases when they are expecting a surge in activity from returning units.
At Fort Campbell, the director of health services, Col. Richard Thomas, has roughly doubled his authorized staff of psychologists and behavioral specialists to 55 and is trying to hire a few more.
“I think we have enough staff to meet the demands of the soldiers here, but I could use more, and Ill hire more if I can,” said Thomas. “Ill hire them until they tell me to stop.”
He said he expects the increased staffing levels to last at least through next year.
The second one is generally the time when indications of stress surface, after the initial euphoria of the homecoming wears off and sleeplessness, nightmares, and other symptoms show up.
“Were seeing a lot of soldiers with stress related issues,” he said. “Theyre not bipolar or schizophrenic. But theyre deploying three and four times and the stress is tremendous. Theyre having relationship issues, financial issues, marital problems - all stress related.”
According to Dr. Bret Logan, deputy commander for managed care at the base, extended war zone stints that have lasted as long as 38 months over the course of the wars in Afghanistan and Iraq have taken a severe toll.
More than 3,000 of the 15,000 troops returning home, Logan estimated, probably will experience headaches, sleep disorders, irritability, memory loss, relationship strains or other symptoms linked to stress disorder.
Medical staff at Fort Campbell say they also worry that there will be a new surge of suicides - an escalating problem in recent years, largely related to the stresses of war.
Source: kmov
C. Difficile Infectious Stomach Bug Is Spreading
The latest study estimates that more than 7,100 hospital patients are infected with it on any given day. That number is between 6.5 and 20 times greater than previous estimates, according to the Association for Professionals in Infection Control and Epidemiology. Researchers from that group presented their findings Tuesday at a medical conference in Orlando.
“This study shows that C. difficile infection is an escalating issue in our nations health care facilities,” said Dr. William Jarvis, the studys lead investigator, in a prepared statement. Jarvis, formerly a scientist with the U.S. Centers for Disease Control and Prevention, is a consulting epidemiologist hired by the association.
The study suggests that about 13 per 1,000 hospital patients have the germ.
The bacteria are found in the colon and can cause diarrhea and a more serious intestinal condition known as colitis. It can be deadly, particularly to the elderly, and has been blamed in outbreaks that have killed as many as 100 people at some hospitals.
The most dangerous form is spread by spores in feces, and the spores are difficult to kill with most conventional household cleaners or antibacterial soap.
The new numbers are based on surveys of about 650 U.S. hospitals. Each hospital was asked to pick one day between May and August of this year to review every patients medical records for documentation of the infection. A total of 1,443 infected patients were identified, and about 70 percent were older than 60.
Past studies have tried to measure the germs incidence in different ways, making comparisons with previous estimates difficult. However, the researchers believe their latest estimate indicates the bug is far more common than previously believed.
The infection control group recommends that hospitals and nursing homes beef up cleaning efforts, such as using bleach, and that medical staff quickly isolate patients who have the infection, Jarvis said.
Last year, the same group released a report that found a dangerous, drug-resistant staph germ - methicillin-resistant Staphylococcus aureus (MRSA) - may be infecting as many as 5 percent of hospital and nursing home patients. According to that estimate, MRSA is a more common problem than Clostridium difficile, which infects about 1.3 percent.
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On the Net:
Source: sccha
Women’s Hands Are Dirtier Than Mens
A recent study found that in general men have hands that are less dirty than women. “The sheer number of bacteria species detected on the hands of the study participants was a big surprise, and so was the greater diversity of bacteria we found on the hands of women,” added lead researcher Noah Fierer, an assistant professor in Colorados department of ecology and evolutionary biology.
The researchers arent sure why women harbored a greater variety of bacteria than men, but Fierer suggested it may have to so with the acidity of the skin. Knight said men generally have more acidic skin than women.
Other possibilities are differences in sweat and oil gland production between men and women, the frequency of moisturizer or cosmetics applications, skin thickness or hormone production, he said.
Women also may have more bacteria living under the surface of the skin where they are not accessible to washing, Knight added.
Asked if guys should worry about holding hands with girls, Knight said: “I guess it depends on which girl.”
He stressed that “the vast majority of the bacteria we have on our body are either harmless or beneficial … the pathogens are a small minority.”
The researchers took samples from the palms of 51 college students - thats 102 hands - and tested the samples using a new, highly detailed system for detecting bacteria DNA.
They identified 4,742 species of bacteria overall, only 5 of which were on every hand, they report on Mondays online edition of Proceedings of the National Academy of Sciences.
The average hand harbored 150 species of bacteria.
Not only did individuals have few types of bacteria in common, the left and right hands of the same individual shared only about 17 percent of the same bacteria types, the researchers found.
The differences between dominant and non-dominant hands were probably due to environmental conditions like oil production, salinity, moisture or variable environmental surfaces touched by either hand of an individual, Fierer said.
While the researchers stressed the importance of regular hand washing, they also noted that washing did not eliminate bacteria.
“Either the bacterial colonies rapidly re-establish after hand washing, or washing (as practiced by the students included in this study) does not remove the majority of bacteria taxa found on the skin surface,” the researchers said in their report.
While the tests could determine how many different types of bacteria were present, they could not count the total amount of bacteria on each hand.
The research was funded primarily by the National Institutes of Health and the National Science Foundation.
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Source: mibax