Mind / Body Blog

North Shore-Lenox Hill Hospital Neurology Grand Rounds on May 21, 2013 Topic: Panic, Separation Anxiety, Suffocation False Alarms and Endogenous Opioids: How panic research can inform clinical neurology.

I will be giving North Shore-Lenox Hill Hospital Neurology Grand Rounds on May 21, 2013 – all invited!

Topic:    Panic, Separation Anxiety, Suffocation False Alarms and Endogenous Opioids: How panic research can inform clinical neurology. 

Speaker:  Maurice Preter, MD

Date:          5/21/2013

Time:    8:30-9:30 AM                 

Location:  2nd Floor Achelis Conference Room

[PDF is here: North Shore flyer may 21]

Learning Objectives: Upon completion of this session, participants should be able to:

1) Understand research on panic and separation anxiety

2) Be able to apply the research findings on panic and separation anxiety to neurology practice.

Target Audience: Neurologists, Neurosurgeons, Neuropsychiatrists and Neuroradiologists

CME Accreditation:

North Shore-LIJ Health System is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

 Credit Designation

The North-Shore LIJ Health System designates this live activity for a maximum of 1 AMA PRA Category 1 credit ™.  Physicians should only claim credit commensurate with the extent of their participation in the activity.

Disclosure Policy:  North Shore-LIJ Health System adheres to the ACCME’s New Standards for Commercial Support. Any individuals in a position to control the content of a CME activity, including faculty, planners and managers, are required to disclose all financial relationships with commercial interests. All identified potential conflicts of interest are thoroughly vetted by North Shore-LIJ for fair balance and scientific objectivity and to ensure appropriateness of patient care recommendations.

Planner and Speaker’s Disclosures: Dr. Preter has nothing to disclose.

Recognition of Program Support: An announcement of program support will be made to all attendees at the beginning of each Regularly Scheduled Session

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Fetal antiepileptic drug exposure and cognitive outcomes at age 6 years (NEAD study): a prospective observational study : The Lancet Neurology

The Lancet Neurology, Volume 12, Issue 3, Pages 244 – 252, March 2013

Published Online: 23 January 2013

Fetal antiepileptic drug exposure and cognitive outcomes at age 6 years (NEAD study): a prospective observational study

Prof Kimford J Meador MD a Corresponding AuthorEmail Address, Gus A Baker PhD b, Nancy Browning PhD c, Morris J Cohen EdD d, Rebecca L Bromley PhD e, Jill Clayton-Smith MD f, Laura A Kalayjian MD g, Andres Kanner MD h, Joyce D Liporace MD i, Page B Pennell MD j, Michael Privitera MD k, David W Loring PhD a, for the NEAD Study Group†

Summary

Background

Many women of childbearing potential take antiepileptic drugs, but the cognitive effects of fetal exposure are uncertain. We aimed to assess effects of commonly used antiepileptic drugs on cognitive outcomes in children up to 6 years of age.

Methods

In this prospective, observational, assessor-masked, multicentre study, we enrolled pregnant women with epilepsy on antiepileptic drug monotherapy (carbamazepine, lamotrigine, phenytoin, or valproate) between October, 1999, and February, 2004, at 25 epilepsy centres in the UK and the USA. Our primary outcome was intelligence quotient (IQ) at 6 years of age (age-6 IQ) in all children, assessed with linear regression adjusted for maternal IQ, antiepileptic drug type, standardised dose, gestational birth age, and use of periconceptional folate. We also assessed multiple cognitive domains and compared findings with outcomes at younger ages. This study is registered with ClinicalTrials.gov, number NCT00021866.

Findings

We included 305 mothers and 311 children (six twin pairs) in the primary analysis. 224 children completed 6 years of follow-up (6-year-completer sample). Multivariate analysis of all children showed that age-6 IQ was lower after exposure to valproate (mean 97, 95% CI 94—101) than to carbamazepine (105, 102—108; p=0·0015), lamotrigine (108, 105—110; p=0·0003), or phenytoin (108, 104—112; p=0·0006). Children exposed to valproate did poorly on measures of verbal and memory abilities compared with those exposed to the other antiepileptic drugs and on non-verbal and executive functions compared with lamotrigine (but not carbamazepine or phenytoin). High doses of valproate were negatively associated with IQ (r=—0·56, p<0·0001), verbal ability (r=—0·40, p=0·0045), non-verbal ability (r=—0·42, p=0·0028), memory (r=—0·30, p=0·0434), and executive function (r=—0·42, p=0·0004), but other antiepileptic drugs were not. Age-6 IQ correlated with IQs at younger ages, and IQ improved with age for infants exposed to any antiepileptic drug. Compared with a normative sample (173 [93%] of 187 children), right-handedness was less frequent in children in our study overall (185 [86%] of 215; p=0·0404) and in the lamotrigine (59 [83%] of 71; p=0·0287) and valproate (38 [79%] of 40; p=0·0089) groups. Verbal abilities were worse than non-verbal abilities in children in our study overall and in the lamotrigine and valproate groups. Mean IQs were higher in children exposed to periconceptional folate (108, 95% CI 106—111) than they were in unexposed children (101, 98—104; p=0·0009).

Interpretation

Fetal valproate exposure has dose-dependent associations with reduced cognitive abilities across a range of domains at 6 years of age. Reduced right-handedness and verbal (vs non-verbal) abilities might be attributable to changes in cerebral lateralisation induced by exposure to antiepileptic drugs. The positive association of periconceptional folate with IQ is consistent with other recent studies.

Funding

US National Institutes of Health, UK Epilepsy Research Foundation.

via Fetal antiepileptic drug exposure and cognitive outcomes at age 6 years (NEAD study): a prospective observational study : The Lancet Neurology.

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Job creation (paying jobs, that is) anyone? Suicide Among Adults Aged 35–64 Years — United States, 1999–2010

Job creation (paying jobs, that is) anyone?

From the CDC:
Suicide Among Adults Aged 35–64 Years — United States, 1999–2010
.

Suicide Among Adults Aged 35–64 Years — United States, 1999–2010

Weekly

May 3, 2013 / 62(17);321-325

Suicide is an increasing public health concern. In 2009, the number of deaths from suicide surpassed the number of deaths from motor vehicle crashes in the United States (1). Traditionally, suicide prevention efforts have been focused mostly on youths and older adults, but recent evidence suggests that there have been substantial increases in suicide rates among middle-aged adults in the United States (2). To investigate trends in suicide rates among adults aged 35–64 years over the last decade, CDC analyzed National Vital Statistics System (NVSS) mortality data from 1999–2010. Trends in suicide rates were examined by sex, age group, race/ethnicity, state and region of residence, and mechanism of suicide. The results of this analysis indicated that the annual, age-adjusted suicide rate among persons aged 35–64 years increased 28.4%, from 13.7 per 100,000 population in 1999 to 17.6 in 2010. Among racial/ethnic populations, the greatest increases were observed among American Indian/Alaska Natives (AI/ANs) (65.2%, from 11.2 to 18.5) and whites (40.4%, from 15.9 to 22.3). By mechanism, the greatest increase was observed for use of suffocation (81.3%, from 2.3 to 4.1), followed by poisoning (24.4%, from 3.0 to 3.8) and firearms (14.4%, from 7.2 to 8.3). The findings underscore the need for suicide preventive measures directed toward middle-aged populations.

CDC used the Web-based Injury Statistics Query and Reporting System (3) to compile NVSS data on suicides reported during 1999–2010 among U.S. residents aged >10 years. Age group–specific annual suicide rates, as well as age-adjusted annual suicide rates calculated using the U.S. standard 2000 population, were based on bridged race population estimates from the U.S. Census Bureau. Trends in age-adjusted suicide rates from 1999, when signs of an increase began (4), through 2010, the latest data available, were analyzed for adults aged 35–64 years by sex and mechanism of suicide. The three most common suicide mechanisms were firearms (i.e., penetrating injury or gunshot wound from a weapon using a powder charge to fire a projectile), poisoning (predominantly drug overdose), and suffocation (predominantly hanging). These three mechanisms and an “all other” mechanism category were used for comparisons. Data also were analyzed by age group, race/ethnicity,* and U.S. Census region.

Percentage changes in observed suicide rates from 1999 to 2010 were calculated along with corresponding 95% confidence intervals, assuming a Poisson distribution. Tests of significance of trends in annual age-adjusted suicide rates for adults aged 35–64 years across the 12-year period were conducted using joinpoint regression (5), assuming a log-linear model. This report focuses on adults aged 35–64 years because percentage changes from 1999 to 2010 in the annual age-adjusted suicide rates for persons aged 10–34 years and ≥65 years were comparatively small and not statistically significant (a 7.0% increase from 9.2 in 1999 to 9.9 in 2010 [p = 0.06] and a 5.9% decrease from 15.8 in 1999 to 14.9 in 2010 [p = 0.09], respectively). Finally, data were analyzed by state, and percentage changes in age-adjusted suicide rates from 1999 to 2010 were calculated for all 50 states.

From 1999 to 2010, the age-adjusted suicide rate for adults aged 35–64 years in the United States increased significantly by 28.4%, from 13.7 per 100,000 population to 17.6 (p<0.001) (Table 1). The suicide rate for men aged 35–64 years increased 27.3%, from 21.5 to 27.3, and the rate for women increased 31.5%, from 6.2 to 8.1 (Table 2). Among men, the greatest increases were among those aged 50–54 years and 55–59 years, (49.4%, from 20.6 to 30.7, and 47.8%, from 20.3 to 30.0, respectively). Among women, suicide rates increased with age, and the largest percentage increase in suicide rate was observed among women aged 60–64 years (59.7%, from 4.4 to 7.0).

By racial/ethnic population, the greatest increases from 1999 to 2010 among men and women overall were observed among AI/ANs (65.2%, from 11.2 to 18.5) and whites (40.4%, from 15.9 to 22.3). Among AI/ANs, the suicide rate for women increased 81.4%, from 5.7 to 10.3; the rate for men increased 59.5%, from 17.0 to 27.2. Among whites, the rate for women increased 41.9%, from 7.4 to 10.5; the rate for men increased 39.6%, from 24.5 to 34.2.

Suicide rates from 1999 to 2010 increased significantly across all four geographic regions and in 39 states. In 2010, rates for adults aged 35–64 years were highest (19.5 per 100,000 population) in the West U.S. Census Region (Table 1). By suicide mechanism, age-adjusted rates increased for the three primary mechanisms for both men and women (Figure). Firearms and suffocation were the most common mechanisms for men (14.3 and 6.8 in 2010, respectively), whereas poisoning and firearms were the most common mechanisms for women (3.4 and 2.5 in 2010, respectively). By mechanism, the greatest increase was observed for use of suffocation (81.3%, from 2.3 to 4.1), followed by poisoning (24.4%, from 3.0 to 3.8) and firearms (14.4%, from 7.2 to 8.3) (Table 1). By sex, the increase for suffocation was 75.0% for men (from 3.9 to 6.8) and 115.0% for women (from 0.7 to 1.5) (Table 2). From 1999 to 2010, suicides by suffocation increased from 18% to 24% of all suicides for men and from 12% to 18% of all suicides for women.

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JAMA Internal Medicine | Perioperative Use of Selective Serotonin Reuptake Inhibitors and Risks for Adverse Outcomes of SurgeryPerioperative SSRI Use and Adverse Outcome Risk

Original Investigation | ONLINE FIRST

Perioperative Use of Selective Serotonin Reuptake Inhibitors and Risks for Adverse Outcomes of Surgery

Andrew D. Auerbach, MD, MPH; Eric Vittinghoff, PhD; Judith Maselli, MSPH; Penelope S. Pekow, PhD; John Q. Young, MD; Peter K. Lindenauer, MD, MS
JAMA Intern Med. 2013;():1-7. doi:10.1001/jamainternmed.2013.714.
Text Size: A A A
Published online April 29, 2013

Importance  Single-site studies have described an association between use of selective serotonin reuptake inhibitors (SSRIs) and adverse outcomes of surgery. Multicenter studies including a broad range of surgical procedures that explore rare outcomes, such as bleeding and mortality, and that account for indications for administration of SSRIs are needed.

Objective  To determine whether perioperative use of SSRIs is associated with adverse outcomes of surgery in a national sample of patients.

Design  Retrospective study of patients 18 years or older who underwent major surgery from January 1, 2006, through December 31, 2008, at 375 US hospitals. We used multivariable hierarchical models to estimate associations between SSRI use and our outcomes. Pharmacy data were used to determine whether a patient received an SSRI in the perioperative period.

Setting  Three hundred seventy-five US hospitals.

Participants  Five hundred thirty thousand four hundred sixteen patients 18 years or older.

Exposure  Perioperative use of SSRIs.

Main Outcomes and Measures  In-hospital mortality, length of stay, readmission at 30 days, bleeding events, transfusions, and incidence of ventricular arrhythmias.

Results  Patients receiving SSRIs were more likely to have obesity, chronic pulmonary disease, or hypothyroidism (P < .001 for each) and more likely to have depression (41.0% vs 6.2%, P < .001). After adjustment, patients receiving SSRIs had higher odds of in-hospital mortality (adjusted odds ratio, 1.20 [95% CI, 1.07-1.36]), bleeding (1.09 [1.04-1.15]), and readmission at 30 days (1.22 [1.18-1.26]). Similar results were observed in propensity-matched analyses, although the risk of inpatient mortality was attenuated among patients with depression. Sensitivity analyses suggest that, to invalidate our results, an unmeasured covariate would have to have higher prevalence and be more strongly associated with mortality than any covariate included in our models.

Conclusions and Relevance  Receiving SSRIs in the perioperative period is associated with a higher risk for adverse events. Determining whether patient factors or SSRIs themselves are responsible for elevated risks requires prospective study.

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Vulnerabilities to misinformation in online pharmaceutical marketing

Vulnerabilities to misinformation in online pharmaceutical marketing

 

  1. Julian De Freitas1
  2. Brian A Falls2
  3. Omar S Haque3
  4. Harold J Bursztajn4

  1. 1Department of Psychology, Yale University, New Haven, CT 06520, USA

  2. 2Department of Psychiatry, Harvard Medical School, VA Boston Healthcare System, Boston, MA 02169, USA

  3. 3Program in Psychiatry and the Law, Harvard Medical School, Boston, MA 02138, USA

  4. 4Department of Psychiatry, Program in Psychiatry and the Law at BIDMC Psychiatry of Harvard Medical School, Boston, MA 02138, USA
  1. Correspondence to: Harold J Bursztajn. Email: harold_bursztajn@hms.harvard.edu

 

Abstract

Given the large percentage of Internet users who search for health information online, pharmaceutical companies have invested significantly in online marketing of their products. Although online pharmaceutical marketing can potentially benefit both physicians and patients, it can also harm these groups by misleading them. Indeed, some pharmaceutical companies have been guilty of undue influence, which has threatened public health and trust. We conducted a review of the available literature on online pharmaceutical marketing, undue influence and the psychology of decision-making, in order to identify factors that contribute to Internet users’ vulnerability to online pharmaceutical misinformation. We find five converging factors: Internet dependence, excessive trust in the veracity of online information, unawareness of pharmaceutical company influence, social isolation and detail fixation. As the Internet continues to change, it is important that regulators keep in mind not only misinformation that surrounds new web technologies and their contents, but also the factors that make Internet users vulnerable to misinformation in the first place. Psychological components are a critical, although often neglected, risk factor for Internet users becoming misinformed upon exposure to online pharmaceutical marketing. Awareness of these psychological factors may help Internet users attentively and safely navigate an evolving web terrain.

Full text (free) at http://jrs.sagepub.com/content/106/5/184

 

 

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