Depression program founded – Chinadaily.com.cn

Posted on September 26, 2012 by Maurice Preter MD

Depression program founded|Cover Story|chinadaily.com.cn.

Depression program founded

Updated: 2012-09-12 07:51

By Shan Juan (China Daily)

An onsite training program for physicians has been launched in major Chinese cities jointly by the Lundbeck Institute and the World Psychiatric Association to improve clinical knowledge of depression.

The Ministry of Health estimates that 5 to 10 percent of the population suffers from depression. However, only 5 percent of sufferers have access to proper, timely treatment.

“Apart from people’s reluctance to seek professional therapy, a lack of knowledge about mental illnesses among physicians, particularly at grassroots level health institutions, is a factor,” said Yu Xin, who heads the Institute of Mental Health at Peking University.

According to Yu, some sufferers develop symptoms such as difficulty in sleeping and physical pain, which often obscure the problem and can lead to the patient being examined by doctors in unrelated departments.

“A lack of awareness among these doctors might lead to an incorrect diagnosis and delay proper treatment,” he said, adding that compared with most developed countries, China has a higher rate of misdiagnosis.

Without timely intervention, about 15 percent of those with serious depression worldwide may even be driven to commit suicide, according to the World Psychiatric Association.

To help address the problem, the joint program will train medical staff, including community clinic doctors and nurses in cities such as Beijing, Shanghai, Chengdu, and Guangzhou, in psychiatry with a strong focus on depression.

“That will benefit patients in terms of more timely and quality treatment,” Yu noted. Currently, China has only 20,000 suitably qualified doctors and few physicians in other areas of medicine received any training in psychiatry at medical school, experts said.

shanjuan@chinadaily.com.cn

(China Daily 09/12/2012 page4)

 

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Memory disorders associated with commonly used medications

Posted on September 26, 2012 by Maurice Preter MD
Br J Clin Pharmacol. 2011 Dec;72(6):898-904. doi: 10.1111/j.1365-2125.2011.04009.x.

Memory disorders associated with consumption of drugs: updating through a case/noncase study in the French PharmacoVigilance Database.

Chavant F, Favrelière S, Lafay-Chebassier C, Plazanet C, Pérault-Pochat MC.

Source

CHU de Poitiers, Service de Pharmacologie clinique et Vigilances, Centre Régional de PharmacoVigilance et de Renseignement sur les Médicaments, Poitiers, France. francois.chavant@chu-poitiers.fr

Abstract

AIMS:

To investigate putative associations of reports of memory disorders and suspected drugs.

METHODS:

We used the case/noncase method in the French PharmacoVigilance Database (FPVD). Cases were reports of memory loss in the FPVD between January 2000 and December 2009. Noncases were all other reports during the same period. To assess the association between memory impairment and drug intake, we calculated an odds ratio with its 95% confidence interval.

RESULTS:

Among the 188,284 adverse drug reactions recorded, we identified 519 cases of memory loss. The sex ratio was 0.6 and the median age was 54 years (range 4-93). The maximal number of cases occurred between 40-49 and 50-59 years. Evolution was favourable in 63% of the cases. We found significant odds ratios for benzodiazepines (alprazolam, bromazepam, prazepam, clonazepam etc.), benzodiazepine-like hypnotics (zolpidem and zopiclone), antidepressants (fluoxetine, paroxetine and venlafaxine), analgesics (morphine, nefopam and tramadol), anticonvulsants (topiramate, pregabalin, levetiracetam etc.), antipsychotics (aripiprazole and lithium) and other drugs, such as trihexyphenidyl, ciclosporin and isotretinoin.

CONCLUSIONS:

Our study confirmed an association between memory disorders and some drugs, such as benzodiazepines and anticonvulsants. However, other drugs, such as benzodiazepine-like hypnotics, newer anticonvulsants, serotonin reuptake inhibitor antidepressants, isotretinoin and ciclosporin were significantly associated with memory disorders, although this was not described or poorly described in the literature. Taking account of the limits of this study in the FPVD (under-reporting, notoriety bias etc.), the case/noncase method allows assessment and detection of associations between exposure to drugs and a specific adverse drug reaction, such as memory disorders, and could thus generate signals and orientate us to further prospective studies to confirm such associations.

© 2011 The Authors. British Journal of Clinical Pharmacology © 2011 The British Pharmacological Society.

Comment in

PMID:
21557759
[PubMed – indexed for MEDLINE]
PMCID:
PMC3244635
[Available on 2012/12/1]

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via Memory disorders associated with consump… [Br J Clin Pharmacol. 2011] – PubMed – NCBI.

Posted in Forensic Neuropsychiatry, Health, Psychiatry/Neurology | Tagged , , , |

Stress may disturb the blood-brain barrier

Posted on September 24, 2012 by Maurice Preter MD

 

Stress may disturb the blood-brain barrier

BMJ 1996; 313 doi: 10.1136/bmj.313.7071.1505a (Published 14 December 1996) Cite this as: BMJ 1996;313:1505.2
Severe stress can disturb the blood-brain barrier that protects the brain from drugs and other chemicals that enter the circulatory system, say Israeli researchers. Their discovery may help to explain why soldiers given the drug pyridostigmine to protect against nerve gas poisoning during the Gulf war reacted differently from soldiers given the drug in peace time.
Professor Hermona Soreq, a neurobiologist at Jerusalem’s Hebrew University, and Dr Alon Friedman, a neurosurgeon at Beersheba’s Soroka Hospital who was a doctor in Israel’s defence forces during the Gulf war, reported their research in Nature Medicine (1996:2:1382- 5). They caused severe stress in a group of mice by forcing them to swim for eight minutes and then injected them with pyridostigmine. The drug was found in the brain cells in the mice in the experimental group but not in those in a comparable control group. After this surprising finding, the researchers tested other substances, including dyes, and these too entered the brain in stressed animals.
The brain is unique among organs in that, due to an elaborate membrane structure, few chemicals have been known to pass into it from the blood. Pyridostigmine, an inhibitor of the neurotransmitter carbamate acetylcholinesterase, has been regarded as the most effective drug for protecting people exposed to nerve gas and was believed not to cause central nervous system symptoms because it “did not permeate” the blood-brain barrier.
However earlier research had shown that Israeli soldiers given pyridostigmine during the Gulf war showed a greater than threefold increase in the frequency of reported central nervous system symptoms than soldiers given the same regimen during clinical trials. This increase was not due to enhanced absorption or decreased elimination of the drug.
This latest research in mice supports the theory that the stress situation associated with war induces disruption in the blood brain barrier and allows pyridostigmine to penetrate the brain. “These findings suggest that peripherally acting drugs administered under stress may reach the brain and affect centrally controlled functions,” the authors say.
The authors also postulate that changes to the blood-brain barrier may explain the vulnerability of stressed animals to viral infections of the central nervous system. And further understanding of the mechanisms underlying these alterations in the permeability of the blood-brain barrier may have far reaching clinical implications with regard to the delivery of drugs or gene therapy agents to the brain.—JUDY SIEGEL-ITZKOVICH, medical correspondent, Jerusalem Post
© 2011 BMJ Publishing Group Ltd

Posted in epigenetics, Forensic Neuropsychiatry, Health, metabolic, Psychiatry/Neurology | Tagged , , , , , , |

Maternal migraine is associated with increased risk of infant colic.

Posted on September 24, 2012 by Maurice Preter MD

One wonders if an updated view of genetics, i.e. one that includes epigenetics would make more sense. We mentioned the nexus of migraine, panic disorder, separation anxiety and abdominal symptoms in childhood in our 2008 paper [Preter M, Klein DF. Panic, Suffocation False Alarms, Separation Anxiety and Endogenous Opioids. Progress in Neuropsychopharmacology and Biological Psychiatry 32/3 (2008) 603-612. Full version at PubMed Central] and lecture.

 

Before the headache
Infant colic as an early life expression of migraine
Amy A. Gelfand, MD, Katherine C. Thomas, BS and Peter J. Goadsby, MD, PhD
+ Author Affiliations

From the Department of Neurology, Division of Child Neurology (A.A.G.), Headache Center (A.A.G., P.J.G.), and School of Medicine (K.C.T.), University of California, San Francisco.
Correspondence & reprint requests to Dr. Gelfand: gelfanda@neuropeds.ucsf.edu
View Complete Disclosures

ABSTRACT

Objective: Childhood periodic syndromes are thought to be early life expressions of the genetic tendency for migraine. The objective of this study was to determine whether maternal migraine is associated with an increased risk of infant colic, because this may indicate that colic is a childhood periodic syndrome.

Methods: This was a cross-sectional study performed in general pediatric clinics. To minimize recall bias, mothers were surveyed at their infants’ 2-month-old well-child visit, the age when colic is most prevalent. Colic was ascertained via parental report using modified Wessel criteria. Migraine history was obtained by having a physician diagnosis or a positive screen on ID Migraine. The primary outcome measure was difference in colic prevalence in infants with and without a maternal history of migraine.

Results: Data from 154 infant-mother pairs were analyzed. Infants with a maternal history of migraine were 2.6 times as likely to have colic as infants without a maternal history of migraine (29% vs 11%, prevalence ratio 2.6 (95% confidence interval 1.2−5.5), p = 0.02). There was no difference in the accuracy with which migraineur mothers perceived their infants’ colic status compared with that of nonmigraineur mothers. Data on paternal history of migraine were available for 93 infants. Infants with a paternal history of migraine may have a higher prevalence of colic (22% vs 10%), although the prevalence ratio 2.3 (0.6−9.4, p = 0.24) had wide confidence intervals.

Conclusions: Maternal migraine is associated with increased risk of infant colic. Because migraine has a strong genetic underpinning, this association suggests that colic may be an early life manifestation of migraine.

Received March 1, 2012.
Accepted May 31, 2012.
Copyright © 2012 by AAN Enterprises, Inc.
Articles citing this article
Infant colic and migraine: Is there a connection?
Neurology September 25, 2012 79:e112-e115
Full TextFull Text (PDF)

Posted in Affective Neuroscience, development, epigenetics | Tagged , , , , , |

Vitamin D, cognition, and dementia

Posted on September 24, 2012 by Maurice Preter MD

Lots of interesting articles this week in Neurology. This is one of them.

Vitamin D, cognition, and dementia
A systematic review and meta-analysis
Cynthia Balion, PhD, Lauren E. Griffith, PhD, Lisa Strifler, BSc, Matthew Henderson, PhD, Christopher Patterson, MD, George Heckman, MD, David J. Llewellyn, PhD and Parminder Raina, PhD
+ Author Affiliations

From the Departments of Pathology and Molecular Medicine (C.B., M.H.), Clinical Epidemiology and Biostatistics (L.E.G., L.S., P.R.), and Medicine (C.P.), and R. Samuel McLaughlin Center on Gerontological Research and Education (P.R.), McMaster University, Hamilton; Department of Health Studies and Gerontology (G.H.), University of Waterloo, Schlegel-UW Research Institute for Aging, Kitchener, Canada; and Peninsula College of Medicine and Dentistry (D.J.L.), University of Exeter, Devon, UK.
Correspondence & reprint requests to Dr. Balion: balion@hhsc.ca
View Complete Disclosures

ABSTRACT

Objective: To examine the association between cognitive function and dementia with vitamin D concentration in adults.

Methods: Five databases were searched for English-language studies up to August 2010, and included all study designs with a comparative group. Cognitive function or impairment was defined by tests of global or domain-specific cognitive performance and dementia was diagnosed according to recognized criteria. A vitamin D measurement was required. Two authors independently extracted data and assessed study quality using predefined criteria. The Q statistic and I2 methods were used to test for heterogeneity. We conducted meta-analyses using random effects models for the weighted mean difference (WMD) and Hedge’s g.

Results: Thirty-seven studies were included; 8 contained data allowing mean Mini-Mental State Examination (MMSE) scores to be compared between participants with vitamin D <50 nmol/L to those with values ≥50 nmol/L. There was significant heterogeneity among the studies that compared the WMD for MMSE but an overall positive effect for the higher vitamin D group (1.2, 95% confidence interval [CI] 0.5 to 1.9; I2 = 0.65; p = 0.002). The small positive effect persisted despite several sensitivity analyses. Six studies presented data comparing Alzheimer disease (AD) to controls but 2 utilized a method withdrawn from commercial use. For the remaining 4 studies the AD group had a lower vitamin D concentration compared to the control group (WMD = −6.2 nmol/L, 95% CI −10.6 to −1.8) with no heterogeneity (I2 < 0.01; p = 0.53).

Conclusion: These results suggest that lower vitamin D concentrations are associated with poorer cognitive function and a higher risk of AD. Further studies are required to determine the significance and potential public health benefit of this association.

FOOTNOTES

Study funding: Ontario Research Coalition of Research Institutes/Centres on Health & Aging, Ontario Ministry of Long-Term Care. Parminder Raina holds a Canada Research Chair in GeroScience and Raymond and Margaret Labarge Chair in Research and Knowledge Application for Optimal Aging.
Supplemental data at www.neurology.org
Received August 11, 2011.
Accepted May 1, 2012.
Copyright © 2012 by AAN Enterprises, Inc.

 

Posted in Aging, dietary, epigenetics, Health, News, Psychiatry/Neurology | Tagged , , |