Endogenous opioids may protect against minor TBI symptoms

Posted on August 29, 2012 by Maurice Preter MD

This is an interesting finding. We have shown that people (even “normal” people) with early separation events (early parental divorce, parental loss) have a totally different endogenous opioid reactivity in a challenge test. It would make sense if they therefore were predisposed to more severe TBI and mTBI symptomatology.

Morphine protects for head trauma induced cogn… [Neurosci Lett. 2006] – PubMed – NCBI.

Abstract:

Victims of minor traumatic brain injury (mTBI) can show long lasting cognitive, emotional and concentration difficulties, amnesia, depression, apathy and anxiety. The symptoms are generally known as a post-concussive syndrome without clear morphological brain defects. Endogenous opiates are released after impact to the brain, suggesting they may play a role in TBI pathophysiology. Furthermore, the administration of opiates to the brain of injured animals has been shown to affect the injury, induce cellular changes and also have protective qualities for neurological impairments. Here, we examined the protective properties of the opiate morphine on cognitive performances following minimal brain injury in mice. For this purpose, we have used our non-invasive closed-head weight drop model in mice, which closely mimics real life mTBI and examined mice performance in the Morris water maze. Our procedure did not cause visible structural or neurological damage to the mice. A single morphine injection administrated immediately after the induction of minimal TBI protected the injured mice from cognitive impairment, checked 30, 60 and 90 days post injury. However, mice injected with morphine that were examined 7 days after the injury did not show better performance than the saline injected mice. Our results indicate that morphine has long but not short-term effects on the cognitive ability of brain-injured mice. Although the exact nature of opioid neuroprotection is still unknown, its elucidation may lead to the much-needed treatment for traumatic brain injury.

 

 

Posted in Affective Neuroscience, Forensic Neuropsychiatry, Psychiatry/Neurology | Tagged , , , , , |

Short Sleep May Increase Stroke Risk

Posted on August 24, 2012 by Maurice Preter MD

This was posted on www.neurologyreviews.com here.

SLEEP 2012 MEETING
Short Sleep May Increase Stroke Risk
2012;20(7):1,17.
BOSTON—Regularly sleeping for less than six hours quadruples the rate of stroke symptoms among middle-aged and older persons with a normal BMI and a low risk of sleep-disordered breathing, according to a study that was presented at the 26th Annual Meeting of the Associated Professional Sleep Societies.

Researchers found no association between a six-hour sleep duration and stroke symptoms among overweight and obese persons.

Unadjusted results indicated that a sleep duration of less than six hours as well as a sleep duration of nine hours or more were strong predictors of stroke symptoms, but the predictive strength of these factors decreased when the data were adjusted, said Megan Ruiter, PhD, a postdoctoral fellow in preventive medicine at the University of Alabama at Birmingham. She and her colleagues noted a significant interaction between sleep duration and BMI, however.

Sleep duration of less than six hours was strongly associated with a greater incidence of stroke symptoms in the fully adjusted data model for participants with normal BMI. Sleep loss is associated with endothelial dysfunction, and it could increase stroke risk by this mechanism. “Perhaps this short sleep duration in these relatively healthy individuals might be a precursor to more traditional stroke risk factors down the road,” said Dr. Ruiter.
Analysis of Data From the REGARDS Study
Dr. Ruiter and her colleagues analyzed data from the Reasons for Geographic and Racial Differences in Stroke (REGARDS) study to determine whether sleep duration predicted self-reported stroke symptoms among individuals at low risk for sleep-disordered breathing. The longitudinal, nationwide cohort study encompassed 30,239 participants age 45 and older. The investigators collected self-reports of each person’s average sleep duration. At six-month intervals, the researchers obtained subjects’ self-reported stroke symptoms.

A total of 5,666 participants had no history of stroke, transient ischemic attack, or stroke symptoms and were not at high risk for sleep-disordered breathing. Participants’ mean age was 61, and about a third were African American. Most of the individuals in the study were employed. Average follow-up time was two years, and 244 participants reported at least one stroke symptom.

Dr. Ruiter’s team estimated the hazard ratios predicting time from measurement of sleep duration to first stroke symptom. Models were adjusted for demographic information, Framingham stroke risk factors, depressive symptoms, anxiety, and various health behaviors such as physical activity and diet quality.

Sleep Fragmentation’s Effect on Stroke Symptom Risk Is Unclear
In the fully adjusted model, participants of normal BMI who slept for less than six hours had a fourfold greater risk for stroke symptoms, compared with normal-weight participants who slept for seven to eight hours. The analysis of the results suggests that improving sleep might lower stroke risk in persons with normal BMI, said Dr. Ruiter. “It might be important to increase physician awareness” of sleep problems, she added.

One of the study’s limitations is that most of the sample population was employed. “People who were not employed, or [who were] retired or homemakers, likely didn’t answer the sleep duration question, because it was asking about how much sleep they would get on their work and nonwork days,” noted Dr. Ruiter.

Because the study asked for participants’ perception of their sleep, it is unclear whether participants reported their total amount of sleep, or their total amount of time in bed, attempting to sleep. The researchers need to analyze the data further to determine whether the increased stroke risk is associated with short sleep or sleep fragmentation, according to Dr. Ruiter.

More evidence is required to validate the results, and Dr. Ruiter and her colleagues will continue to follow the participants in the REGARDS study and look at actual stroke events.

—Erik Greb
Suggested Reading
Eguchi K, Hoshide S, Ishikawa S, et al. Short sleep duration is an independent predictor of stroke events in elderly hypertensive patients. J Am Soc Hypertens. 2010 Sep-Oct;4(5):255-262.
Matthews KA, Strollo PJ Jr, Hall M, et al. Associations of Framingham risk score profile and coronary artery calcification with sleep characteristics in middle-aged men and women: Pittsburgh SleepSCORE study. Sleep. 2011;34(6):711-716.

Posted in Aging, Health | Tagged , , |

Inappropriateness of Medication Prescriptions to Elderly Patients in the Primary Care Setting: A Systematic Review

Posted on August 24, 2012 by Maurice Preter MD

This interesting meta-analysis was just published (notably, in a very reputable open-access, advertisement-free journal). 20% seems a very conservative estimate…
The PDF is here:

Here is the abstract:

RESEARCH ARTICLE
Inappropriateness of Medication Prescriptions to Elderly Patients in the Primary Care Setting: A Systematic Review

Dedan Opondo1*, Saied Eslami1, Stefan Visscher2, Sophia E. de Rooij3, Robert Verheij2, Joke C. Korevaar2, Ameen Abu-Hanna1
1 Department of Medical Informatics, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands, 2 Netherlands Institute for Health Services Research (NIVEL), Utrecht, The Netherlands, 3 Department of Geriatrics, Academic Medical Center, University of Amsterdam, The Netherlands
Abstract Top
Background
Inappropriate medication prescription is a common cause of preventable adverse drug events among elderly persons in the primary care setting.

Objective
The aim of this systematic review is to quantify the extent of inappropriate prescription to elderly persons in the primary care setting.

Methods
We systematically searched Ovid-Medline and Ovid-EMBASE from 1950 and 1980 respectively to March 2012. Two independent reviewers screened and selected primary studies published in English that measured (in)appropriate medication prescription among elderly persons (>65 years) in the primary care setting. We extracted data sources, instruments for assessing medication prescription appropriateness, and the rate of inappropriate medication prescriptions. We grouped the reported individual medications according to the Anatomical Therapeutic and Chemical (ATC) classification and compared the median rate of inappropriate medication prescription and its range within each therapeutic class.

Results
We included 19 studies, 14 of which used the Beers criteria as the instrument for assessing appropriateness of prescriptions. The median rate of inappropriate medication prescriptions (IMP) was 20.5% [IQR 18.1 to 25.6%.]. Medications with largest median rate of inappropriate medication prescriptions were propoxyphene 4.52(0.10–23.30)%, doxazosin 3.96 (0.32 15.70)%, diphenhydramine 3.30(0.02–4.40)% and amitriptiline 3.20 (0.05–20.5)% in a decreasing order of IMP rate. Available studies described unequal sets of medications and different measurement tools to estimate the overall prevalence of inappropriate prescription.

Conclusions
Approximately one in five prescriptions to elderly persons in primary care is inappropropriate despite the attention that has been directed to quality of prescription. Diphenhydramine and amitriptiline are the most common inappropriately prescribed medications with high risk adverse events while propoxyphene and doxazoxin are the most commonly prescribed medications with low risk adverse events. These medications are good candidates for being targeted for improvement e.g. by computerized clinical decision support.

Citation: Opondo D, Eslami S, Visscher S, de Rooij SE, Verheij R, et al. (2012) Inappropriateness of Medication Prescriptions to Elderly Patients in the Primary Care Setting: A Systematic Review. PLoS ONE 7(8): e43617. doi:10.1371/journal.pone.0043617

Editor: Colin Simpson, The University of Edinburgh, United Kingdom

Received: January 3, 2012; Accepted: July 23, 2012; Published: August 22, 2012

Copyright: © 2012 Opondo et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Funding: These authors have no support or funding to report.

Competing interests: The authors have declared that no competing interests exist.

* E-mail: d.o.opondo@amc.uva.nl

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

SSRIs should be considered in the list of medications that are risk factors for osteoporotic fractures.

Posted on August 21, 2012 by Maurice Preter MD
Not really news but still an important pharmacovigilance paper.
As has been correctly pointed out, relevant to the changing informed consent & decision making landscape.
More on the subject matter at http://www.ncbi.nlm.nih.gov/pubmed/17592097
Bone. 2012 Sep;51(3):606-13. Epub 2012 May 30.

Antidepressant medications and osteoporosis.

Source

Division of Bone Diseases, Department of Medical Specialties, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland.

Abstract

Use of antidepressant medications that act on the serotonin system has been linked to detrimental impacts on bone mineral density (BMD), and to osteoporosis. This article reviews current evidence for such effects, and identifies themes for future research. Serotonin receptors are found in all major types of bone cell (osteoblasts, osteocytes, and osteoclasts), indicating an important role of the neuroendocrine system in bone. Observational studies indicate a complex relationship between depression, antidepressants, and fracture. First, the presence of depression itself increases fracture risk, in relation with decreased BMD and an increase in falls. A range of aspects of depression may operate, including behavioral factors (e.g., smoking and nutrition), biological changes, and confounders (e.g., comorbidities and concomitant medications). A substantial proportion of depressed patients receive antidepressants, mostly selective serotonin reuptake inhibitors (SSRIs). Some of these have been linked to decreased BMD (SSRIs) and increased fracture risk (SSRIs and tricyclic agents). Current use of SSRIs and tricyclics increases fracture risk by as much as twofold versus nonusers, even after adjustment for potential confounders. While there is a dose-response relationship for SSRIs, the effect does not appear to be homogeneous across the whole class of drugs and may be linked to affinity for the serotonin transporter system. The increase in risk is the greatest in the early stages of treatment, with a dramatic increase after initiation, reaching a peak within 1month for tricyclics and 8months for SSRIs. Treatment-associated increased risk diminishes towards baseline in the year following discontinuation. The body of evidence suggests that SSRIs should be considered in the list of medications that are risk factors for osteoporotic fractures.

Copyright © 2012 Elsevier Inc. All rights reserved.

PMID:
22659406
[PubMed – in process]

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

From the Blackburn lab: Socioeconomic status and cell aging in children.

Posted on August 12, 2012 by Maurice Preter MD

I am studying telomerase-environment interactions. Fascinating, as they say. Not news, but –  poverty and lack of education kills (faster), literally. Link http://biochemistry.ucsf.edu/labs/blackburn/index.php?option=com_content&view=article&id=12&Itemid=8

Here is the abstract:

Soc Sci Med. 2012 Jun;74(12):1948-51. Epub 2012 Mar 17.
Socioeconomic status and cell aging in children.
Needham BL, Fernandez JR, Lin J, Epel ES, Blackburn EH.
Source
Department of Sociology, University of Alabama at Birmingham, 1530 3rd Ave. S., HHB 460C, Birmingham, AL 35294, USA. bneedham@uab.edu
Abstract
Theory suggests that chronic stress associated with disadvantaged social status may lead to acceleration in the rate of decline in physiological functioning. The purpose of this study is to examine the association between parental socioeconomic status (SES) and leukocyte telomere length (LTL), a marker of cell aging, in children. We examined SES and LTL in 70 white and black US children aged 7-13 who participated in the community-based AMERICO (Admixture Mapping for Ethnic and Racial Insulin Complex Outcomes) study. LTL was assessed using the polymerase chain reaction (PCR) method. Parental education was positively associated with child LTL, net of controls for sex, age, race/ethnicity, and family income. Compared to children with at least one college-educated parent, children whose parents never attended college had telomeres shorter by 1,178 base pairs, which is roughly equivalent to 6 years of additional aging. Socioeconomic disparities in cell aging are evident in early life, long before the onset of age-related diseases.
Copyright © 2012 Elsevier Ltd. All rights reserved.
PMID: 22472277 [PubMed – in process]
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Posted in Aging, development, epigenetics, Forensic Neuropsychiatry, Health, News | Tagged , , , |