Опиаты более страшны для людей с психическими проблемами

С праздничками, коллеги!
Вот вам свежая новость от капитана Очевидность.

Оказывается, люди с психическими расстройствами (биполярный психоз, депрессия и т.д.) более подвержены зависимости от опиатов. Полный текст на http://www.biologynews.net/archives/2011/12/13/opioid_abuse_linked_to_mood_and_anxiety_disorders_.html
Да вы что!1111111111111 Оо

1 из 5 американцев сидит на психоактивных лекарствах

Оптимистичненько так. Называется, сделай сам - настроение? - а зачем, ведь есть таблетки, которые создадут любое настроение.
Вот такой интересный материал на http://blisstree.com/feel/1-in-5-americans-on-mental-health-drugs-overmedicating-817/ советую вам почитать для размышлений:

Almost half of all Americans take at least one prescription drug, and now a new report tells us that more than 20% of us take at least one medication to treat a mental health problem–a number that is up 22% since 2001. It’s an alarming trend for sure, and has us wondering: Are all of these drugs really necessary, or are Americans over-medicated?
Granted, mental health disorders are a serious illness which require serious treatment. According to the statistics released by Medco Health Solutions, more than a quarter of us suffer from mental health problems which have us taking antidepressants, antipsychotics, attention deficit hyperactivity disorder drugs or anti‐anxiety treatments every year. And women are far more likely to take a drug to treat a mental health condition than men with those over 45 showing the highest use.
And yet, the World Health Organization says this doesn’t necessarily mean that we are over-medicated.
So what does it mean? Are more Americans just getting diagnosed with depression, anxiety or other mental health disorders? Are these conditions becoming more prevalent? Or, are doctors simply taking the easy way out and prescribing more drugs than necessary without exploring other alternate treatments first for less severe cases?
In Charles Barber’s Comfortably Numb: How Psychiatry Is Medicating a Nation, the New York Times stated that he makes a case for Americans being “vastly overmedicated for often relatively minor mental health concerns”. There is also the theory to the sharp rise in mental health medications: We are asking for them. TheNY Times also suggested that we are a self-drugging society in many respects. We are often too quick to pop pills when something doesn’t feel quite right. Many of us use alcohol to numb feelings of stress, anxiety and depression. It was even suggested that some Americans are taking mental health medications for “ficticious concerns”. For that, we can point a finger to all of the marketing and advertising that the drug companies are doing (over $5 billion a year) that suggest we may have a problem (even though we thought we were fine until we saw their commercial telling us how depressed we are).
In a recent Blisstree post, I talked about the fact that some doctors think depression could actually be good for usbecause it forces us to face our issues and dissect exactly what is happening in our lives and in our head. Because of this, some doctors still think that other mental health treatments like talk therapy should be explored first because putting a pharmaceutical bandage over our depression or anxiety can often preclude us from uncovering our source of true happiness. Other experts have also suggested that a healthy diet, stress-reduction and even yoga can help bring us back to a positive mental state.
Tell us what you think. Are Americans too quick to take mental health medications?

The Clock Is Off: Bipolar Disorder and Circadian Rhythm | ScienceBlog.com

Здоровская статья про маниакально-депрессивное расстройство и циркадные ритмы: The Clock Is Off: Bipolar Disorder and Circadian Rhythm | ScienceBlog.com

У двух психов вероятность родить третьего повышается

Мда... Читаем на http://www.eurekalert.org/pub_releases/2010-03/jaaj-oot022510.php:
Offspring of 2 psychiatric patients have increased risk of developing mental disorders


Offspring of two parents with schizophrenia or bipolar disorder appear more likely to develop the same illness or another psychiatric condition than those with only one parent with psychiatric illness, according to a report in the March issue of Archives of General Psychiatry, one of the JAMA/Archives journals.

The offspring of two parents with psychiatric illness represent an extremely high-risk group, according to background information in the article. Studying these children permits researchers to assess the risk associated with two sources of genetic predisposition to mental disorders. "Such risks will be of use to genetic counselors to inform personal decisions with regard to marriage, family formation, adoption and health insurance planning," the authors write.

Irving I. Gottesman, Ph.D., Hon.F.R.C.Psych., of the University of Minnesota Medical School, Minneapolis, and colleagues studied a population-based cohort of 2.7 million individuals born in Denmark. The researchers matched records in a general registry of the population with a database of psychiatric admissions. They identified individuals whose parents had both been admitted to psychiatric facilities for schizophrenia and bipolar disorder, and compared the rate of psychiatric admissions for these individuals to those of offspring with one or no parents admitted to psychiatric facilities.

Rates of schizophrenia were highest among offspring of two parents with schizophrenia. Of the 196 couples who both had schizophrenia, 27.3 percent of their 270 children were admitted to a psychiatric facility, increasing to 39.2 percent when schizophrenia-related disorders were included. This compared with a rate of 7 percent among 13,878 offspring of 8,006 couples in which one parent had schizophrenia and 0.86 percent in 2.2 million offspring of 1 million couples in which neither parent was admitted for schizophrenia.

Similarly, the risk of bipolar disorder was 24.9 percent in 146 offspring of 83 parent couples who were both admitted for bipolar disorder (increasing to 36 percent when unipolar depressive disorder was also included). This compared to a risk of 4.4 percent among 23,152 offspring of 11,995 couples with only one parent ever admitted for bipolar disorder and 0.48 percent in 2.2 million children of 1 million couples with neither parent ever admitted.

When one parent had bipolar disorder and the other had schizophrenia, offspring had a 15.6 percent risk of schizophrenia and an 11.7 percent risk of bipolar disorder.

The risks in this population "are of such a magnitude that they command clinical and national public health attention in countries with health care roughly similar to Denmark's," the authors write.

"It is important to keep in mind that the yields from genetic epidemiology and the strategies implemented are applicable to groups of people, not to the individuals themselves," they conclude. "However, by joining advances in molecular genetics that are adapted for use in epidemiological genetic screening, our kinds of data with the risk groups described might lead to a large and rapid step forward in the understanding of the etiologies of major mental disorders."

Суицидальная нетрадиционность...

Оказывается, самоидентификация геев, лесбиянок и бисексуалов увеличивает риск суицида. Читаем на http://www.eurekalert.org/pub_releases/2010-02/jgh-yws020510.php
Mental health professionals have long-known that gay, lesbian and bisexual (GLB) teens face significantly elevated risks of mental health problems, including suicidal thoughts and suicidal attempts. However, a group of McGill University researchers in Montreal has now come to the conclusion that self-identity is the crucial risk-factor, rather than actual sexual behaviours. Their results were published in February in the Journal of the American Academy of Child & Adolescent Psychiatry.
The researchers administered a detailed, anonymous questionnaire to nearly 1,900 students in 14 Montreal-area high schools, and found that those teens who self-identified as gay, lesbian or bisexual, or who were unsure of their sexual identity, were indeed at higher risk for suicidal ideation and attempts. However, teens who had same-sex attractions or sexual experiences – but thought of themselves as heterosexual – were at no greater risk than the population at large. Perhaps surprisingly, but consistent with previous studies, the majority of teens with same-sex sexual attraction or experience considered themselves to be heterosexual.
"This is the first study that has separated sexual identity from sexual attractions and behaviours in looking at risk for poor mental health outcomes," said corresponding author Dr. Brett Thombs, of the Lady Davis Institute for Medical Research (LDI) at the Jewish General Hospital.
"It's important to realize that a large proportion of people who have sex with or are attracted to people of the same sex do not identify themselves as gay, lesbian or bisexual. They consider themselves heterosexual." added co-author Dr. Richard Montoro of the McGill University Health Centre (MUHC). "Those students were not at all at risk of worse mental health outcomes."
"The main message is that it's the interface between individuals and society that causes students who identify as gay, lesbian, or bisexual the most distress," said study first author Yue Zhao, a McGill University graduate student working with Dr. Thombs.. "Sexual orientation has three different components. The first is identity, which is dependent on the society in which one lives; the second is attraction or fantasy; and the third is behaviour. Previous studies have not addressed which of those components may explain why GLB youth are at risk."
"What this all means is that clinicians need to look not just at individuals and their sexuality, they really need to assess the environment they are coming from and how they see themselves within it," said study co-author Dr. Karine Igartua. Igartua and Montoro are co-directors of the McGill University Sexual Identity Centre (MUSIC), the first gay and lesbian mental health centre in Canada.
"Our findings also clearly suggest that further study of the link between anti-gay sentiment and suicidality need to be undertaken," added Thombs.

Ген, ответственный за биполярное расстройство

О своём, о маниакально-депрессивном... На http://www.scientificblogging.com/news_articles/faulty_rorb_genes_may_explain_bipolar_disorder_children
A team of researchers said this week that they may have identified the genes responsible for bipolar disorder in children. Their study, published in BMC Psychiatry, implicates malfunctioning circadian clock genes, four alterations of the RORB gene to be specific, in the development of the disorder.

Scientists studied the RORA and RORB genes of 152 children with Bipolar and 140 control children. They found four alterations to the RORB gene that were positively associated with being bipolar. "Our findings suggest that clock genes in general and RORB in particular may be important candidates for further investigation in the search for the molecular basis of bipolar disorder," explained co-author Alexander Niculescu.

RORB is mainly expressed in the eye, pineal gland and brain. Its expression is known to change as a function of circadian rhythm in some tissues, and mice without the gene exhibit circadian rhythm abnormalities.

According to Niculescu, "Bipolar disorder is often characterized by circadian rhythm abnormalities, and this is particularly true among pediatric bipolar patients. Decreased sleep has even been noted as one of the earliest symptoms discriminating children with bipolar disorder from those with attention deficit hyperactivity disorder (ADHD). It will be necessary to verify our association results in other independent samples, and to continue to study the relationship between RORB, other clock genes, and bipolar disorder".

Pediatric bipolar disorder is a controversial diagnosis characterized by alternating bouts of depression and mania in children, although it does not affect all young people in the same way and the duration and severity of the disorder can vary enormously.

Citation: Casey L McGrath, Stephen J Glatt, Pamela Sklar, Helen Le-Niculescu, Ronald Kuczenski, Alysa E Doyle, Joseph Biederman, Eric Mick, Stephen V Faraone, Alexander B Niculescu, Ming T Tsuang, 'Evidence for Genetic Association of RORB with Bipolar Disorder',
BMC Psychiatry 2009, doi:10.1186/1471-244X-9-70

Безумие и гениальность

Читаем на http://www.eurekalert.org/pub_releases/2009-09/afps-mgs092809.php

Vincent van Gogh cut off his ear. Sylvia Plath stuck her head in the oven. History teems with examples of great artists acting in very peculiar ways. Were these artists simply mad or brilliant? According to new research reported in Psychological Science, a journal of the Association for Psychological Science, maybe both.

In order to examine the link between psychosis and creativity, psychiatrist Szabolcs Kéri of Semmelweis University in Hungary focused his research on neuregulin 1, a gene that normally plays a role in a variety of brain processes, including development and strengthening communication between neurons. However, a variant of this gene (or genotype) is associated with a greater risk of developing mental disorders, such as schizophrenia and bipolar disorder.

In this study, the researchers recruited volunteers who considered themselves to be very creative and accomplished. They underwent a battery of tests, including assessments for intelligence and creativity. To measure creativity, the volunteers were asked to respond to a series of unusual questions (for example, "Just suppose clouds had strings attached to them which hang down to earth. What would happen?") and were scored based on the originality and flexibility of their answers. They also completed a questionnaire regarding their lifetime creative achievements before the researchers took blood samples.

The results show a clear link between neuregulin 1 and creativity: Volunteers with the specific variant of this gene were more likely to have higher scores on the creativity assessment and also greater lifetime creative achievements than volunteers with a different form of the gene. Kéri notes that this is the first study to show that a genetic variant associated with psychosis may have some beneficial functions. He observes that "molecular factors that are loosely associated with severe mental disorders but are present in many healthy people may have an advantage enabling us to think more creatively." In addition, these findings suggest that certain genetic variations, even though associated with adverse health problems, may survive evolutionary selection and remain in a population's gene pool if they also have beneficial effects.

###

For more information about this study, please contact: Szabolcs Kéri (szkeri@phys.szote.u-szeged.hu)

Psychological Science is ranked among the top 10 general psychology journals for impact by the Institute for Scientific Information. For a copy of the article "Genes for Psychosis and Creativity" and access to other Psychological Science research findings, please contact Barbara Isanski at 202-293-9300 or bisanski@psychologicalscience.org

И снова о депрессии

Об очень интересном исследовании мне довелось прочитать на http://www.scienceblog.com/cms/depressed-people-have-trouble-learning-good-things-life-19595.html, оказывается, восприятие позитивной и негативной информации отличается у людей в депрессии и нормальных...

COLUMBUS, Ohio - While depression is often linked to negative thoughts and emotions, a new study suggests the real problem may be a failure to appreciate positive experiences.

Researchers at Ohio State University found that depressed and non-depressed people were about equal in their ability to learn negative information that was presented to them.

But depressed people weren't nearly as successful at learning positive information as were their non-depressed counterparts.

"Since depression is characterized by negative thinking, it is easy to assume that depressed people learn the negative lessons of life better than non-depressed people - but that's not true," said Laren Conklin, co-author of the study and a graduate student in psychology at Ohio State.

The study appears in the March issue of the Journal of Behavior Therapy and Experimental Psychiatry.

Researchers tested 34 college students, 17 of whom met criteria for clinical depression and 17 of whom were not depressed.

This study is one of the first to be able to link clinical levels of depression to how people form attitudes when they encounter new events or information, said Daniel Strunk, co-author of the study and assistant professor of psychology at Ohio State.

Strunk said the key to conducting this study was the use of a computer game paradigm co-developed at Ohio State in 2004 by Russell Fazio, a professor of psychology and co-author of this new study. Fazio and his collaborators, Natalie Shook, a PhD graduate of Ohio State now at Virginia Commonwealth University and J. Richard Eiser of the University of Sheffield (England) have used the game in many studies examining differences in the development of positive and negative attitudes.

The developers affectionately call the game "BeanFest." It involves people encountering images of beans on the computer screen. The beans could be good or bad, depending on their shape and the number of speckles they had.

Good beans earned the players points, while bad beans took points away. The goal was to earn as many points as possible.

While the game may seem trivial to a naive audience, Strunk said it offers a unique and powerful way to measure how people learn new attitudes.

"Before, if researchers wanted to investigate how people formed new attitudes, it was very difficult to do," Strunk said. If researchers asked about real-life issues, the problem is that prior learning and attitudes may impact how people respond to new information. But in this game, participants don't have any prior knowledge or attitudes about the beans so researchers could learn how they formed their attitudes in a novel situation, without interference from past experiences.

In the game phase of this study, participants had to choose whether they would accept a bean when it appeared on the screen. If they accepted the bean, the points were added or deducted from their total. If they rejected the bean, they were still told how many points they would have earned or lost if they had accepted it.

Each of the 34 beans was shown three times during the game phase, giving the participants a good opportunity to learn which beans were good and which were bad.

Then, in the test phase, participants had to indicate whether beans they learned about in the game phase were "good" (choosing it would increase points) or "bad" (choosing it would decrease points). The researchers tallied how well participants did in correctly identifying positive and negative beans.

The non-depressed students correctly identified 61 percent of the negative beans, which was about the same as the depressed students, who correctly identified 66 percent of the "bad" beans.

But while the non-depressed students correctly identified 60 percent of the positive beans, depressed students correctly classified only 49 percent of these good beans. Non-depressed students identified the good beans better than the depressed students, who failed to identify good beans better than chance.

"The depressed people showed a bias against learning positive information although they had no trouble learning the negative," Strunk said.

One of measures researchers used in the study classified whether the depressed participants were currently undergoing a mild, moderate or severe episode of depression. In the study, those undergoing a severe depressive episode did more poorly on correctly choosing positive beans than those with mild depression, further strengthening the results.

While more research is needed, Conklin and Strunk said this study suggests possible ways to improve treatment of depressed people.

"Depressed people may have a tendency to remember the negative experiences in a situation, but not remember the good things that happened," Conklin said. "Therapists need to be aware of that."

For example, a depressed person who is trying out a new exercise program may mention how it makes him feel sore and tired - but not consider the weight he has lost as a result of the exercise.

"Therapists might focus more on helping their depressed clients recognize and remember the positive aspects of their new experiences," Strunk said.

О новом фармсредстве. Антидепрессант и лекарство от фибромиалгии

Не стоит на месте доблестная Фармацевтическая Промышленность!!! Вот, очередной препарат - http://scienceblogs.com/corpuscallosum/2009/01/milnacipran_savella_approved_f.php
Milnacipran (Savella™) Approved for Fibromyalgia

Category: Neuroscience • Science News
Posted on: January 26, 2009 8:25 AM, by Joseph j7uy5
Milnacipran (Savella™)On 14 January, 2008, the US FDA approved milnacipran for use in treatment of fibromyalgia. It is ( or soon will be) available in tablets of 12.5, 25, 50, and 100mg. It has been marketed as an antidepressant in Europe for years, but has not been available in the USA until now.

Milnacipran is a drug that inhibits reuptake of serotonin and norepinephrine. The effect on norepinephrine is stronger than the effect on serotonin. It can be thought of as an SNRI, is the same family as venlafaxine (Effexor), duloxetine (Cymbalta) and desvenlafaxine (Pristiq).

From the Savella package insert (PDF), I've copied the dosing guidelines below. Note that the initial dosing guidelines often are not quite right; it takes experience in a larger population to figure out the best dosing. The titration schedule, as proposed, has the potential to be troublesome. It is likely that they will distribute dose-packs to make the titration easier to follow.

• Administer Savella in two divided doses per day
• Begin dosing at 12.5 mg on the first day and increase to 100 mg/day over a 1-week period (2.1): Day 1: 12.5 mg once Days 2-3: 25 mg/day (12.5 mg twice daily) Days 4-7: 50 mg/day (25 mg twice daily) After Day 7: 100 mg/day (50 mg twice daily)
• Recommended dose is 100 mg/day
• May be increased to 200 mg/day based on individual patient response

For milnacipran, the kinetics are as follows: oral bioavailability is 85-90%; the extent of absorption is not affected by food; half-life is 6-8 hours; 55% percent is excreted unchanged in the urine. Note that the active enantiomer, d-milnacipran, has a longer elimination half-life (8-10 hours) than the l-enantiomer (4-6 hours). Small percentages of the parent drug are metabolized by desethylation (N-desethyl milnacipran, 8%) and glucuronidation (d- and l-milnacipran carbamoyl-O-glucuronide, 2% and 17%, respectively). Plasma protein binding is 13%. No dosage adjustment is needed for mild renal impairment, or for mild to moderate hepatic impairment. Cmax and area-under-the-curve are 30% higher for persons over 65, and 20% higher for women, but no dosage adjustment is necessary. Milnacipran did not inhibit or induce any of the cytochrome P450 enzymes listed in the PI.

Savella carries a black-box warning about suicidality, based upon its similarity to other SNRI. This is addressed in this Medication Guide (PDF).

What role will milnacipran have in the armamentarium of available treatments? As it happens, a meta-analysis was published in JAMA a couple of weeks ago: Treatment of Fibromyalgia Syndrome With Antidepressants: A Meta-analysis (JAMA. 2009;301(2):198-209) Only the abstract is openly accessible. There's a summary available on Medscape (free registration) that contains more detail than the abstract:

The researchers found that amitriptyline had a large effect on reducing pain, fatigue, and sleep disturbances, a small effect on HRQOL, and no significant effect on mood.

In addition, they found that the SSRIs fluoxetine and paroxetine had a small effect on reducing pain and improving HRQOL but had no effect on fatigue or sleep.

SNRIs duloxetine and milnacipran had a small effect on reducing pain and sleep disturbances, and duloxetine had a small effect on improving mood and HRQOL, but no effect on fatigue.

The MAOIs moclobemide and pirlindole had a small effect on pain reduction. Moclobemide had no effect on sleep or fatigue, and pirlindole did not affect depressed mood.


HRQOL=health-related quality of life.

Only one study of milnacipran was included in the analysis, so there is a lot of information that was not included. Plus, the meta-analysis isn't ideally suited to compare one drug against the others. The bottom line, though, is that amitriptyline appeared to have the biggest effect. Unfortunately, amitriptyline is more likely than the others to have burdensome adverse effects. Amitriptyline is inexpensive, $4/month in some places. I don't know what milnacipran will cost, but it will be a lot more than $4/month.

Some additional perspective can be gained from this interview with a fibromyalgia expert, Daniel J. Clauw, MD:

Q: Do you have a standardized treatment protocol for your FM patients?

Dr. Clauw: I use a combination of low-impact aerobic exercise, symptom-based pharmacologic therapy, and cognitive behavioral therapy. Not all patients need all three.

I usually begin by prescribing medications to target the two or three most prominent symptoms that a patient has. In most cases pain is one, but poor sleep, fatigue, memory problems, or other symptoms sometimes interfere more with function than pain.

I only use one treatment at a time, and see if it works before deciding whether to continue with the treatment, or discard it. One of the biggest problems I see in practice is that doctors and patients try too many things at once, and then they have limited ability to tell if something is working, or whether a new symptom is a side effect of a treatment.

After I find the correct one or two medications to reasonably control many of the symptoms, then I will add aerobic exercise, and sometimes cognitive behavioral therapy (CBT). Both exercise and CBT can either be done simply (with simple instructions for exercise or a workbook or Arthritis Foundation course for CBT) or with more professional guidance (e.g., with a physical therapist, personal trainer, social worker, or psychologist).

These treatments take many months to work (in contrast to medications, which usually work within a month or so if they are going to work at all), but the benefits are more durable than the benefits obtained from medications.


Clauw goes on to discuss specific drugs, but milnacipran is not included, since the interview is from 2007.

The main points from the interview: patients often have to try several different medications or combinations, and the medication is only part of the overall treatment. There is no single treatment that stands out as clearly superior, and there is no single treatment that eliminates the need for multimodal intervention. In such a situation, it is always nice to have another option. In my view, milnacipran is exactly that: another option. Probably it will be a great thing for some people, pretty good for others, so-so for some, and worthless for others.