Heart Patients Should Be Screened for Depression

A new scientific advisory asserts that heart patients are particularly vulnerable to depression and should be screened, and if necessary treated, to improve their recovery and overall health.

“Depression and heart disease seem to be very much intertwined,” said Judith H. Lichtman, co-chair of the statement and associate professor of epidemiology at the Yale School of Public Health.

“You can’t treat the heart in isolation from the patient’s mental health.”

The American Psychiatric Association has endorsed the statement — the first of its kind on the link between heart disease and clinical depression. Some of its recommendations include:

• Routine and frequent screening for depression in patients with chronic heart disease in a variety of settings, including the hospital, physician’s office and cardiac rehabilitation center.
• Help for patients with positive screening results by a professional qualified to diagnose and manage treatment for depression.
• Careful monitoring of patients to ensure adherence to their treatment plan.
• Coordination between health care professionals treating patients with combined medical and mental health diagnoses.

While there is no evidence that screening for depression leads to improved outcomes for people with cardiovascular complications, the advisory does state that depression is linked with increased morbidity and mortality, lower rates of cardiac rehabilitation and poorer quality of life.

“By understanding the prevalence of depression and learning more about the subgroups of heart patients at particular risk of depression, we can begin to understand the best ways to recognize and treat it,” said Lichtman.

Depression is approximately three times more common in people with heart complications than in the general population and as many as 20 percent of heart patients meet the criteria for major depression. Studies suggest that younger women in particular may be at high risk.

The advisory recommends that heart patients initially be evaluated with a simple two-item assessment. If even one of the questions generates a “yes” response, it is recommended that a more in-depth screening be done with a total of nine questions.

Heart patients found to be suffering from depression can benefit from a number of treatment options, including behavioral therapy, physical activity, cardiac rehabilitation, antidepressant drugs, or combinations of these treatments.

Source: Yale University

Cardiac Patients Need Mental Health Care

A new scientific advisory asserts that heart patients are particularly vulnerable to depression and should be screened, and if necessary treated, to improve their recovery and overall health.

“Depression and heart disease seem to be very much intertwined,” said Judith H. Lichtman, co-chair of the statement and associate professor of epidemiology at the Yale School of Public Health.

“You can’t treat the heart in isolation from the patient’s mental health.”

The American Psychiatric Association has endorsed the statement—the first of its kind on the link between heart disease and depression. Some of its recommendations include:

• Routine and frequent screening for depression in patients with chronic heart disease in a variety of settings, including the hospital, physician’s office and cardiac rehabilitation center.
• Help for patients with positive screening results by a professional qualified to diagnose and manage treatment for depression.
• Careful monitoring of patients to ensure adherence to their treatment plan.
• Coordination between health care professionals treating patients with combined medical and mental health diagnoses.

While there is no evidence that screening for depression leads to improved outcomes for people with cardiovascular complications, the advisory does state that depression is linked with increased morbidity and mortality, lower rates of cardiac rehabilitation and poorer quality of life.

“By understanding the prevalence of depression and learning more about the subgroups of heart patients at particular risk of depression, we can begin to understand the best ways to recognize and treat it,” said Lichtman.

Depression is approximately three times more common in people with heart complications than in the general population and as many as 20 percent of heart patients meet the criteria for major depression. Studies suggest that younger women in particular may be at high risk.

The advisory recommends that heart patients initially be evaluated with a simple two-item assessment. If even one of the questions generates a “yes” response, it is recommended that a more in-depth screening be done with a total of nine questions.

Heart patients found to be suffering from depression can benefit from a number of treatment options, including behavioral therapy, physical activity, cardiac rehabilitation, antidepressant drugs, or combinations of these treatments.

Source: Yale University

Bpchick fall membership drive

Mr T was all I could get on short notice. Why the rush?  Winter is just around the corner, so fall registration begins…last Monday. Cost to join the club? What’s in it for you us? Money from candy sales. Sign up in the comments section so we can get those BPChick fundraiser sales catalogs out to you ASAP. I’m sure you [...] (Source: bipolar chicks blogging)

Lithium Orotate on Bipolar Beat

Several visitors to both the Bipolar Blog and Bipolar Beat have shown interest in lithium orotate – an over-the-counter form of lithium that’s touted to deliver lithium more efficiently to the brain (than lithium carbonate or lithium citrate), essentially requiring less lithium to get the job done.

Although you’ll find plenty of people denouncing it and others praising it, you’re likely to find very few reliable sources that offer a balanced view. Fortunately, Dr. Fink has decided to review the research and weigh in on this important topic. Check out what she has to say in “Bipolar Disorder Medication Spotlight: Lithium Orotate.”

Human Damage After The Storm

For many Americans it is the damage after the storm that people often don’t talk about–mental disorders such as depression, anxiety and post-traumatic stress disorder–that strike in the wake of a catastrophic experience.

Post-trauma mental conditions are one of many mental disorders that affect some 57.7 million Americans in any given year, according to the National Alliance on Mental Illness, which is observing Mental Illness Awareness Week, Oct. 5-11, 2008.

Organizations, including Allsup, which represents people nationwide for Social Security Disability Insurance benefits, are helping to raise awareness about mental illnesses and the help available to people and their families.

Anxiety disorders, including post-traumatic stress disorder (PTSD), panic disorder and phobias, affect about 40 million people, NAMI reports. One in five veterans of Iraq and Afghanistan (almost 300,000 troops) will experience major depression or PTSD when they return home.

Other types of mental disorders also affect millions of people, including 5.7 million with bipolar disorder and 2.4 million who have schizophrenia.

“People living with mental illnesses often are among the most vulnerable in our society. Unfortunately, they also are often overlooked during disasters,” said NAMI executive director Michael J. Fitzpatrick, who recently announced the creation of a NAMI Hurricane Relief Fund to help individuals and families affected by hurricanes Gustav and Ike.

One of the most significant facts about mental illness is that two-thirds of people living with a condition do not receive treatment. During Mental Illness Awareness Week, the association is emphasizing the theme, “Building Community. Taking Action.”

Mental illness can affect anyone at any time, and the benefit for individuals and their families comes from realizing that mental health is a part of everyone’s well-being and healthcare.

Source: National Alliance on Mental Illness

Brain Activity Regulates Emotions

New brain imaging studies have improved the understanding of how the human brain regulates emotions, report scientists from Columbia University.

The research, published by Cell Press in the journal Neuron, identifies brain pathways that underlie reinterpretation of aversive images in ways that reduce or enhance their negative emotional intensity.

“If our emotions are a duet played between the self and the environment, then our ability to regulate them keeps us in harmony with the outside world,” says senior study author Dr. Tor D. Wager.

“Although the failure to successfully regulate emotions is thought to contribute to several psychiatric disorders, we do not fully understand how the brain regions involved interact with one another to orchestrate an emotional response and what makes attempts at regulation less successful in some individuals.”

Recently developed brain-based models of emotion regulation identify the prefrontal cortex (PFC) as a key player in the cognitive regulation of emotion.

Specifically, brain imaging studies have demonstrated increased activity in the ventrolateral, dorsolateral, and dorsomedial prefrontal cortices (vlPFC, dlPFC, and dmPFC) when individuals are asked to make use of cognitive strategies, such as reappraisal, to alter the emotional impact of a stimulus.

Scientists think that these brain regions are involved in bringing feelings into line with what the situation demands—for example, avoiding feeling or expressing anger during a conflict with a boss. However, there is relatively scant evidence on how the PFC interacts with nuclei deep in the brain that are critical for generating the visceral emotional responses that sometimes cause us to get carried away.

To examine this potential interaction, Dr. Wager and colleagues developed a novel mechanism that enabled them to identify multiple brain regions that serve as mediators of successful reappraisal and to examine how they are organized into functional networks.

“We looked for evidence on how PFC activity leads to successful reappraisal, and whether it does so by affecting evolutionarily older subcortical systems critical for emotional experience and emotional learning,” explains Dr. Wager.

The researchers correlated activity in the right vlPFC with reduced negative emotional experience during cognitive reappraisal of aversive images. They went on to use their new mapping strategy to identify two separate pathways that linked activity of the vlPFC with regulation of negative emotion during reappraisal.

One pathway, which involved the nucleus accumbens, predicted greater reductions in negative emotion during reappraisal while the other pathway, linked with the amygdala, predicted reduced reappraisal success and, therefore, an increase in negative emotion.

“These results provide evidence that vlPFC is involved in both the generation and regulation of emotion through different subcortical pathways and indicate that the prefrontal cortex is involved in both creating and mitigating negative emotion, depending on the contents of thought,” concludes Dr. Wager.

“Our findings also suggest that the existence of multiple prefrontal-subcortical pathways should be considered when examining how emotion is dysregulated in psychiatric disorders.”

Source: Cell Press

Prepare For College Mental Health Crisis

According to experts, an estimated 15 percent of students experience some form of mental illness — such as major depression –while in college.

Many often struggle with where to get support.

But a new study at the University of North Carolina at Chapel Hill could close this gap by encouraging students to consider their needs and treatment options well in advance.

The research project, which began this year, explores whether students with mental illnesses will document their mental health issues, outline the care they prefer and provide copies of this information to people and agencies that students agree could assist if a crisis occurred.

Known as “advanced directives for mental health,” these legal documents enable someone to communicate their wishes while they are capable of making decisions on their own. The study is being funded by the UNC School of Social Work’s Armfield-Reeves Innovations Fund, which was established by Billy and Janie Armfield and Sam and Betsy Reeves.

The project is believed to be the first of its kind involving college students and could help ensure that young people get the help they need sooner, said Anna Scheyett, the project’s lead investigator and associate dean for academic affairs at the School of Social Work.

“It’s almost like a living will,” Scheyett said. “It gives you a chance up front when you’re healthy to speak for yourself and your needs – to keep your autonomy when the illness might be trying to take that away from you.”

Scheyett said because of confidentiality laws, administrators often struggle with the legal and ethical dilemmas of how to respond when a student shows symptoms of a mental illness. An advanced directive could help the University to act more responsively for students.

The document can include as much information as a student is comfortable sharing. For example, it may explain “how a student looks” during a crisis or what signs to watch for, what medicines he or she prefers to take, the name of a therapist and hospital instructions.

“It could even include things like, ‘Call my brother and tell him to pay my rent so I don’t lose my place,’” Scheyett noted.

Information on the study is being distributed through UNC’s Disability Services, the Office of the Dean of Students and Counseling and Wellness Services.

Students must be 18 to participate. Staff members have been trained to assist students with creating the advanced directives documents and selecting what agencies should receive copies, such as campus police, an emergency room or a local police social work unit. Students can also choose to give copies to resident advisers, faculty or any other friends, relatives or people they trust.

“I think the preparation just says a lot,” said Jim Kessler, director of Disability Services. “I think many students do have ownership of their mental health issues and are compliant with their medication, but sometimes that doesn’t work.”

For families, just preparing for college can be stressful. When it involves a child with a mental illness, there are additional anxieties.
Knowing that the University has an advanced directive on file may help alleviate family fears, Scheyett said.

It also ensures that the University has up-to-date information in case of an emergency, said Melinda Manning, assistant dean of students. “Our ultimate goal is we want to retain all of our students,” she said. “And anything we can do to accomplish that goal is worth it to us.”

Source: University of North Carolina

Author discusses “the bipolar puzzle”

Jennifer Egan, who wrote the problematic "The Bipolar Puzzle" concerning the bipolar child paradigm in the New York Times Sunday Magazine two weeks ago, was a guest on KQED-FM's "Forum" program yesterday. KQED is the main NPR station in the San Francisco Bay Area and, full disclosure, once upon a time I interned at the station before deciding I was a print guy and not a radio guy. Anyway, I think Egan did a much better job of getting at the complexities of things with allegedly bipolar kids than she did in her article, which I previously hashed apart here. You can hear the program here on streaming audio. Still, I was disappointed with Egan on a few points she made. She called it a "pretty hard fact" that 10 percent to 15 percent of kids with alleged bipolar disorder commit suicide and that's simply not true. What she and the host were doing was conflating adult statistics--which I've argued before are deeply overstated--for child stats. That's dumb. She also admitted that she had interviewed several parents who were going it without meds but had kept them out of the article because she was more compelled by little boys beating up their little sisters. Seriously, she said that shit. That's a very odd motivation and some weird journalism there. (Source: Furious Seasons)

Are American Kids Overmedicated

According to a new study, American children are approximately three times more likely to be prescribed psychotropic medication than children in Europe.

The study, published in BioMed Central’s open access journal Child and Adolescent Psychiatry and Mental Health, claims that the differences may be accounted for by regulatory practices and cultural beliefs about the role of medication in emotional and behavioral problems.

Julie Zito led a team of researchers from the USA, Germany and the Netherlands who investigated prescription levels in the three countries. She said, “Antidepressant and stimulant prevalence were three or more times greater in the US than in the Netherlands and Germany, while antipsychotic prevalence was 1.5 to 2.2 times greater”.

The use of antidepressants, like Prozac, and stimulants, like Ritalin, in children has been the subject of a great deal of controversy and this study quantifies the differences in practice between the US and Western Europe.

The authors claim that the differences may be partly due to different diagnostic classification systems, “The US trend of increasing bipolar diagnosis in children and adolescents does not reflect European practice”.

The authors also mention government cost restrictions in Europe, the larger number of child psychiatrists per capita in the US and the use of two or more different psychotropic drugs in a single year in US children as possible explanations.

Zito concludes that, “Direct to consumer drug advertising, which is common in the US, is also likely to account for some of the differences. The increased use of medication in the US also reflects the individualist and activist therapeutic mentality of US medical culture”.

Source: BioMed Central

“Next Generation” Depression Treatment

In preparation for advanced space travel scientists with the National Space Biomedical Research Institute (NSBRI) are developing a software program can provide self-guided treatment for depression.

Specifically, the interactive, multi-media program will assist astronauts in recognizing and effectively managing depression and other psychosocial problems, which can pose a substantial threat to crew safety and mission operations during long-duration spaceflights.

Even though the depression treatment is under development for NASA, project leader Dr. James Cartreine said it could be spun off for use on Earth.

“This project has great potential as a self-guided treatment for many people,” said Cartreine, a member of NSBRI’s Neurobehavioral and Psychosocial Factors Team. “Depression is the number one cause of disability days in the United States, but it’s not only about days lost.
Depression also results in presenteeism - showing up for work but not really working.”

The depression treatment is part of the Virtual Space Station, a multi-media program that addresses multiple types of potential psychosocial problems and can be used for training before, and for assistance during, missions. Other problems being addressed via the Virtual Space Station include interpersonal conflict, and stress and anxiety.

Cartreine, a Harvard Medical School research psychologist based in the Division of Clinical Informatics at Beth Israel Deaconess Medical Center in Boston, said the Virtual Space Station will make effective therapeutic depression treatment more easily accessible to astronauts aboard the International Space Station and proposed missions to the moon and Mars. Currently, astronauts have audio and video access to psychologists only when communication links are available.

Project co-investigator and former astronaut Dr. Jay Buckey said long-duration spaceflight can be tough on astronauts. “While astronauts are not particularly prone to psychological problems, the environment is very demanding,” Buckey said. “On a mission, they face a lot of challenges that could lead to depression.”

Buckey, a professor and physician at Dartmouth Medical School, said the depression module and other aspects of the Virtual Space Station are based upon proven methods. “These are unique NSBRI products that did not exist before,” Buckey said. “The Virtual Space Station is based on proven treatment programs and is a very helpful way to work on problems in general.”

The system’s multi-media approach for depression includes graphics and video featuring a psychologist who leads the user through a straightforward process called Problem-Solving Treatment. The system provides feedback based upon the information provided when answering a series of questions.

The first step of the process is to make a problem list and select a problem on which to work. The second and third steps are setting goals and brainstorming ways to reach them. The final two steps are assessing the pros and cons of possible solutions and making an action plan to implement them. The program also helps users plan and schedule enjoyable activities, which people who have depression often stop doing. Additionally, the program provides preventative and educational information on depression.

Cartreine and Buckey, who received input from 29 current and former astronauts while designing the Virtual Space Station, said some of the system’s other benefits include its portability and privacy. “It can be delivered to the International Space Station on a flash drive and run directly from that drive, so that the astronaut has complete control over his or her data,” Cartreine said. “The system is private and secure. The user is the only one who can share the information with others.”

An early version of the depression treatment system was beta-tested on research stations in Antarctica, which is used as an analog to long-duration spaceflights due to its isolation from the rest of the world, length of stay and team composition. Cartreine said feedback from that early test run has been positive, and a clinical evaluation of the latest version on 68 Boston-area volunteers is about to begin.
“We plan to study the program’s ability to treat depression,” he said.

“We are looking for people who are similar to astronauts, such as people in the technology industry.”

Eventually, the researchers want to adapt the system for use in many different settings, giving people access to treatment they may not have now. For instance, people with depression often seek treatment by going to their primary care physician, so the researchers hope to adapt it for use at the doctor’s office or in a person’s home.

The system could also be beneficial in rural areas where clinical help is in short supply or nonexistent. Other possible locations for use include schools, social service offices, places of worship, military bases, prisons, commercial ships, oil rigs and underwater research stations.

The self-guided treatment project is part of the NSBRI Neurobehavioral and Psychosocial Factors Team portfolio, which includes studies on and development of countermeasures for stress, anxiety, interpersonal conflict and fatigue.

Content on stress and anxiety management for the Virtual Space Station is being developed by Dr. Raphael Rose at UCLA. Harvard Medical School and Massachusetts General Hospital researcher Dr. Gary Strangman is studying the depression treatment program’s effects on brain activity using infrared imaging.

Source: National Space Biomedical Research Institute (NSBRI)

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