In The News
Researchers have known that an individuals’ perception of their own health can be influenced by factors such as income, marital status, gender, and the presence of chronic illnesses.
A new University of Michigan study discovers that how much a particular factor impacts perception of health is not universal.
“In most countries, the poor, those who are single, and women feel less healthy than others. However, the reason may or may not be because they are more ill, depending on the country,” said researcher Dr. Shervin Assari.
“Although by intuition we think those who feel less healthy should be always more sick and chronic diseases are why poor people feel less healthy, this is only true in some but not all countries.”
Assari and colleague Maryam Moghani Lankarani, M.D., of the UM Department of Psychiatry used data of more than 44,000 individuals selected from 15 countries in North America, South America, Asia, and Africa to study whether countries differ in the complex links between demographics, socioeconomic status, medical disease, and self-rated health.
In addition to the U.S. and Puerto Rico, countries include China, India, Russia, Costa Rica, Mexico, Argentina, Barbados, Brazil, Chile, Cuba, Uruguay, Ghana, and South Africa.
The researchers used two models to determine the impact of various factors on perceptions of health.
The first measured the effects of demographic and socioeconomic factors. The second tested if chronic medical conditions would explain the effects of demographic and socioeconomic factors on self-rated health.
The topic is important because an individual’s perception of their health can influence quality of life as well as mortality.
In the U.S., there is a relationship between socioeconomic status, or wealth, and a person’s health. Researchers discovered the reason poor individuals in the U.S. feel less healthy than others was because they were more medically ill.
Interestingly, this is an association the researchers did not find with any other country.
In Costa Rica, Argentina, Barbados, Cuba, and Uruguay, chronic medical conditions explained gender disparities in subjective health. In Puerto Rico, these conditions explained the effect of marital status on subjective health.
Past research in individual countries has shown that socioeconomic status impacts both health and a self-reported sense of well-being. Gender also has been associated with chronic health conditions, because women live longer and, therefore, develop more illness.
Women typically have fewer material resources, and are simply more likely to express concerns about their health. Age and level of education also influence self-rated health.
“In countries such as China, Mexico, Brazil, Russia, Chile, India, Ghana, and South Africa, chronic medical conditions do not explain why the poor, women, or single individuals feel less healthy,” Assari said.
“In those countries, we do not know why the poor feel less healthy if they are not more medically ill.”
Source: University of Michigan
A panel of experts in aging recommends that everyone 70 and older should have their memory and reasoning ability evaluated annually.
This is the first time routine brain health screenings have been recommended for patients starting at age 70, according to members of the panel, which met at Saint Louis University.
Patients found to have cognitive problems also should be screened for physical frailty, and vice versa, the panel added.
“This is an important step toward enhancing brain health for aging populations throughout the world,” said John Morley, M.D., director of geriatric medicine at Saint Louis University and lead author of the consensus paper. “The ability to learn, solve problems, and remember is a key to successful health and aging.”
Published in the Journal of America Medical Directors Association, the recommendation for screenings was spurred by numerous studies that suggest 30 percent of those older than 70 have memory problems. Approximately 16 percent of people in this age group have mild cognitive impairment, while 14 percent have dementia, including Alzheimer’s disease, the panel noted.
Some causes of early cognitive disorders can be reversed and treated when caught early, according to the experts, including depression, hypothyroidism, sleep apnea, problems with sight and hearing, and treatments of multiple health conditions with medications.
“You can actually fix some of these issues, which is one reason why it’s critical to identify a problem and try to find a root cause,” said Morley.
The progression of cognitive impairment can sometimes be slowed through a series of lifestyle changes, according to the panel.
They endorsed changes suggested in FINGER, a Finnish geriatric study published in The Lancet, which found that people who ate a healthy diet, exercised, trained their memories, and managed cardiovascular risks were less likely to develop cognitive decline and memory problems.
“There are things you can do to slow down the progression of not thinking well,” Morley said.
The panel endorsed a Mediterranean-style diet — packed with fruits and vegetables, fish twice a week, olive oil, nuts, legumes, and whole grains — for patients who have early cognitive problems.
And because past research shows brain health, as well as physical well-being, is connected to exercise, they encourage physical exercise, including resistance training and tai chi.
The aging experts also noted that previous studies show that people who dance, engage in intellectual activity, and play a musical instrument have less mental decline than those who not pursue these hobbies. They add that video games can improve reasoning, memory, reaction time, and attention in older adults.
According to the aging experts, it’s important for physicians to know if their patients are not remembering or thinking clearly because they might not be able to follow doctors’ orders for medical problems, such as diabetes or heart disease.
“If you have diabetes and are not thinking as well as the general population, you might forget how to do the required daily finger prick to determine your blood sugar levels, which would compromise your health,” Morley said.
“However, if your doctor knows you have difficulty remembering, someone in his or her office can make sure you understand exactly how to check your glucose levels and give you written instructions as a ready reference. It’s a simple common sense thing that can make a huge difference in your health.”
Finally, for those people whose memory problems likely will worsen, knowing in advance can help them plan for the future, he said. They can begin considering tough questions, such as when to stop driving or remove dangerous tools from their homes, and set up advanced directives for health, financial, and legal matters. They also have time to identify sources of support like family members or friends and organizations such as the Alzheimer’s Association.
“Information is power,” Morley said.
“Our recommendations are going to shape clinical practice in a big way,” Morley said. “Physicians are hungry for this information to help their patients, and as the message gets out, patients will request screenings.”
Source: Saint Louis University
Photo Credit: Saint Louis University
In a new review, researchers analyzed a variety of therapies currently being used to treat premenstrual dysphoric disorder in order to identify which are the most effective. Their findings are published in the Journal of Psychiatric Practice.
Premenstrual dysphoric disorder (PMDD) is a severe form of premenstrual syndrome, featuring a combination of emotional and physical symptoms that may lead to significant impairment in the sufferer’s home, work, and social life.
About three to eight percent of premenopausal women suffer from PMDD. Severe PMDD symptoms may also lead to suicidal thoughts; one study found that 15 percent of women with PMDD reported at least one suicide attempt.
“Given the debilitating symptoms and impact associated with PMDD, health care professionals need to be able to identify and effectively treat patients with PMDD,” write Shalini Maharaj, M.P.A.S., and Kenneth Trevino, Ph.D., of the University of Texas Southwestern Medical Center.
As an aid to clinical decision making, they conducted an in-depth review of the safety and efficacy of proposed treatments for PMDD.
In their review, the researchers identify a wide range of proposed PMDD treatments, classified as psychiatric, anovulatory, supplements, herbal, and non-pharmacologic.
While the cause of PMDD is not entirely understood, one contributing factor seems to be negative effects of changing hormone levels on certain neurotransmitters, including serotonin.
This has been supported by studies showing a rapid response to selective serotonin reuptake inhibitors (SSRIs), a widely used class of antidepressant drugs. Based on the findings of 31 randomized trials including nearly 4,400 women, SSRIs are considered the “first-line” treatment for PMDD.
Treatment with SSRIs may be continuous, semi-intermittent, or administered at the start of symptoms, but further research is needed to determine which of these treatment schedules provides the best balance between effectiveness and side effects.
For women who do not respond well to SSRIs, other treatment options should be considered. Different types of antidepressants are useful in treating PMDD, while some anti-anxiety drugs are helpful for managing specific PMDD-related symptoms.
They also found that oral contraceptives containing drosperinone/ethinyl estradiol are an effective and recommended treatment option for women with PMDD who are also seeking contraception.
When these options fail, however, various anovulatory treatments — which decrease ovarian hormone production resulting in a state of medical menopause — are effective. However, because of potential side effects and high cost, these are considered “third-line” alternatives.
A variety of potential supplements and herbal-related treatments have been proposed as well, with some warranting further research. However, so far, only calcium supplementation has shown a consistent therapeutic benefit.
The researchers say that larger, placebo-controlled studies are still needed to confirm the best treatments for PMDD. Such studies should use a consistent definition for PMDD and a placebo screening period to confirm the diagnosis.
Source: Wolters Kluwer Health
Certain people are far more vulnerable to nicotine addiction than others, and this is most likely due to genetic and metabolic differences, say scientists at Johns Hopkins University.
Their study, which traced the earliest steps of nicotine “reinforcement” in a sample of 18 adults who had never smoked, found that some people are clear nicotine “choosers” while others are nicotine “avoiders.”
“From an addiction point of view, nicotine is a very unusual drug,” said addiction researcher Roland R. Griffiths, Ph.D., professor of psychiatry and behavioral sciences at the Johns Hopkins University School of Medicine.
“When you give people nicotine for the first time, most people don’t like it. It’s different from many other addictive drugs, for which most people say they enjoy the first experience and would try it again.”
“Our results suggest there are definitely some people who are nicotine avoiders and others who are nicotine choosers,” he said, “and there are probably genetic or metabolic vulnerabilities that make people fall into one group or the other.”
The researchers, whose findings are published in the journal Psychopharmacology, say that they have, for the first time, characterized the body’s reaction to the first, tiniest “hits” of nicotine.
The discovery may lay the groundwork for future research focusing on genetic or other biological factors that make people vulnerable to nicotine addiction.
“Scientists have struggled for decades to understand why, in the face of initial dislike, so many people become addicted to cigarettes,” said Griffiths.
Prior research, for example, has found that a majority of never-smokers who are given a cigarette or dose of nicotine not only report disliking the effects, but later, when offered a nicotine-containing pill, gum, or candy, or a placebo (a classic test of the “reinforcement” abilities of an addictive drug), still choose the placebo.
Similarly, even in laboratory mice and rats, nicotine usually fails the reinforcement test, with animals choosing a placebo over nicotine.
To find an answer to this puzzling question, the researchers set out to explore the conditions under which nicotine’s reinforcement properties first take hold in never-smokers.
Instead of offering a dose of nicotine similar to that in a cigarette or in a nicotine patch or gum — doses that can overwhelm first-time users — his team used doses about 10 times lower, barely above what is needed for someone to notice nicotine’s effects, such as relaxation, jitters, better focus, energy, or changes in mood.
Then the researchers designed a double-blind study in which volunteers wouldn’t know whether they were getting nicotine or a placebo.
“We attempted to develop conditions in which people could learn to become familiar with the subtle mood-altering effects of very low doses of nicotine, with the goal of uncovering the reinforcing effects of nicotine,” Griffiths says.
They recruited 18 healthy men and women who had never smoked — or only ever smoked a handful of cigarettes — and gave each of them two identical-looking pills labeled A and B each day for several weeks. The subjects were told the pills might contain any of a number of substances, ranging from caffeine or sugar, to ginseng, chamomile, theobromine, kava, or nicotine.
The order of the pills was changed across days. Volunteers were asked to report their symptoms — relaxation, changes in energy levels, concentration, light-headedness, drowsiness, and jitters — after each pill.
Finally, the participants were given a choice of taking either pill and asked to explain their decision. Some participants thought the placebo contained a drug — one that made them drowsy, for instance — so they weren’t necessarily choosing one they thought didn’t cause symptoms.
Exactly half of the participants reliably chose the nicotine pill, citing improved concentration, alertness, stimulation, energy, and better mood. The other half, however, chose the placebo, often explaining that the nicotine pill, although they didn’t know it contained nicotine, made them feel light-headed, dizzy, or sick.
Griffiths believes this is the first study to conclusively show that nicotine can pass the reinforcement test in never-users, and he expects it will inform future studies of “avoiders” and “choosers.”
Source: Johns Hopkins Medicine
A nationwide clinical trial has found that high doses of resveratrol stabilizes a biomarker that declines as Alzheimer’s disease progresses.
Resveratrol is a naturally occurring compound found in foods such as red grapes, raspberries, dark chocolate, and some red wines.
The results are “very interesting,” according to the study’s principal investigator, R. Scott Turner, M.D., Ph.D., director of the Memory Disorders Program at Georgetown University Medical Center.
But Turner cautions that the findings cannot be used to recommend resveratrol — at least not yet.
“This is a single, small study with findings that call for further research to interpret properly,” he noted.
The clinical trial was a randomized, placebo-controlled, double blind study with 119 patients with mild to moderate dementia due to Alzheimer’s disease.
An “investigational new drug” application was required by the U.S. Food and Drug Administration to test the pure synthetic pharmaceutical-grade resveratrol in the study. It is not available commercially in this form, the researchers noted.
The highest dose of resveratrol tested was one gram by mouth twice daily, which is equivalent to the amount found in about 1,000 bottles of red wine.
One of the participants in the study was John Bozza, 80. Five years ago, his wife, Diana, began noticing “something wasn’t quite right.” He was diagnosed with mild cognitive impairment, but only a year later, his condition progressed to mild Alzheimer’s.
Diana, whose twin sister died from the same disease, says there are multiple reasons she and John decided to participate in the resveratrol study, and they now know he was assigned to take the active drug.
“I definitely want the medical community to find a cure,” she said. “And of course I thought there’s always a chance that John could have been helped, and who knows, maybe he was.”
Patients, like John, who were treated with increasing doses of resveratrol over 12 months showed little or no change in amyloid-beta40 (Abeta40) levels in their blood and cerebrospinal fluid, according to the study’s findings.
In contrast, those taking a placebo had a decrease in the levels of Abeta40 compared with their levels at the beginning of the study.
“A decrease in Abeta40 is seen as dementia worsens and Alzheimer’s disease progresses,” Turner said. “Still, we can’t conclude from this study that the effects of resveratrol treatment are beneficial. It does appear that resveratrol was able to penetrate the blood brain barrier, which is an important observation. Resveratrol was measured in both blood and cerebrospinal fluid.”
According to Turner, the researchers studied resveratrol because it activates proteins called sirtuins, the same proteins activated by caloric restriction.
The biggest risk factor for developing Alzheimer’s is aging, and studies with animals found that most age-related diseases — including Alzheimer’s — can be prevented or delayed by long-term caloric restriction. That means consuming two-thirds the normal caloric intake, the researchers explained.
According to Turner, the study also found that resveratrol was safe and well-tolerated. The most common side effects experienced were gastrointestinal-related, including nausea and diarrhea. Patients taking resveratrol also experienced weight loss while those on the placebo gained weight, he reported.
However, there was one outcome that was particularly confounding, according to Turner. The researchers obtained brain MRI scans on participants before and after the study, and found that resveratrol-treated patients lost more brain volume than the placebo-treated group.
“We’re not sure how to interpret this finding,” he said. “A similar decrease in brain volume was found with some anti-amyloid immunotherapy trials.”
A working hypothesis is that the treatments may reduce inflammation (or brain swelling) found with Alzheimer’s, he said.
Further studies, including analysis of frozen blood and cerebrospinal fluid taken from patients, are underway to test possible drug mechanisms.
“Given safety and positive trends toward effectiveness in this phase two study, a larger phase three study is warranted to test whether resveratrol is effective for individuals with Alzheimer’s or at risk for Alzheimer’s,” Turner said.
The study, supported by a grant from the National Institute on Aging, was published in Neurology.
The pressure to be constantly available and respond 24/7 on social media can cause depression, anxiety, and reduce sleep quality for teenagers, according to a new study.
For the study, presented at a British Psychological Society conference, researchers Dr. Heather Cleland Woods and Holly Scott of the University of Glasgow provided questionnaires to 467 teenagers regarding their social media use overall, as well as at night time.
A further set of tests measured sleep quality, self-esteem, anxiety, and depression.
The researchers also measured the teens’ emotional investment in social media, which relates to the pressure felt to be available 24/7 and the anxiety around, for example, not responding immediately to texts or posts, they explained.
“Adolescence can be a period of increased vulnerability for the onset of depression and anxiety, and poor sleep quality may contribute to this,” Cleland Woods said. “It is important that we understand how social media use relates to these. Evidence is increasingly supporting a link between social media use and wellbeing, particularly during adolescence, but the causes of this are unclear.”
An analysis of the collected data showed that overall and night-time specific social media use, along with emotional investment, were related to poorer sleep quality and lower self-esteem, coupled with higher anxiety and depression levels.
“While overall social media use impacts on sleep quality, those who log on at night appear to be particularly affected,” Cleland Woods said.
“This may be mostly true of individuals who are highly emotionally invested. This means we have to think about how our kids use social media, in relation to time for switching off.”
A new study indicates a strong need for postnatal support that goes beyond postpartum depression to encompass other types of mental health issues that may plague new moms as well, such as anxiety, loneliness, panic, and overthinking. The findings are published in the Journal of Psychosomatic Obstetrics & Gynecology.
Furthermore, the researchers found that many distressed new mothers failed to “qualify” for postpartum depression after completing the commonly used questionnaire, and therefore received no help.
The authors go on to question whether this measure alone is truly a sufficient method to identify all types of distress. They believe that alternative methods of assessment would be more conducive to identifying and supporting women with a number of different postnatal mental health issues.
For the study, the researchers examined the postnatal symptoms of distress experienced by women, and the support options they were offered.
“Current classification and assessment of postnatal mental health problems may not adequately address the range or combination of emotional distress experienced by mothers,” said researcher Rose Coates and team.
To understand women’s own experiences, the researchers interviewed 17 women, all of whom had a child under one and had experienced a postnatal mental health issue.
Throughout the interviews, the new moms reported a number of different postnatal mental health symptoms, with tearfulness and anxiousness cited as the most common. Furthermore, a number of women each reported feeling the following symptoms: stressed, isolated, lonely, angry, low, panicky, frustrated, worried, scared, and overthinking.
Despite these symptoms of postnatal distress, the women found that they didn’t quite identify with postnatal depression, and many of them were left “bereft of information, advice, and support” about other types of distress. The researchers added that “there was a perception that health professionals were focused on postnatal depression and once it had been ruled out there was no further investigation.”
Upon expression of their symptoms, many of the new moms had been assessed for postnatal depression by health care professionals through answering a questionnaire.
The authors question whether this type of measure alone is really sufficient to identify distress, and suggests that alternative methods of assessment would be helpful in the process of identifying and supporting women with a number of different postnatal mental health issues.
The authors conclude that “Identification and recognition of symptoms and disorders beyond postnatal depression needs to be improved, through evaluating different approaches to assessment and their acceptability to women.”
Source: Taylor & Francis
The pressure to be cool, look good, and own the “right stuff” is detrimental to many children and teenagers, according to a new study.
Researchers at the University of Sussex found that while many young people buy into the consumer culture, believing it will make them feel better about themselves and help them to make friends, often the reverse happens. The result is a negative downward spiral.
In a three-year study of 1,000 children in the UK between the ages of eight and 14, being disruptive, having “cool stuff” and looking good was often seen as the best way to become more popular.
The results, however, show that valuing these behaviors actually had the opposite effect, with peer relations worsening over time for those kids turning to consumer-culture values.
“Our results suggest that children who have low levels of well-being are particularly likely to become orientated towards consumer culture, and thus enter into a negative downward spiral,” said Dr. Matthew Easterbrook, a lecturer in psychology. “Consumer culture may be perceived as a coping mechanism by vulnerable children, but it is one that is detrimental to their well-being.”
“Although friendly and helpful children were ultimately more popular over time, young people mistakenly predicted that the route to being liked was in having a reputation for disruptive behavior, having ‘cool’ stuff and looking good,” added Robin Banerjee, a professor of developmental psychology.
“What we found was another example of a downward spiral — those rejected by peers then turned to consumer culture, which actually worsened, rather than improved, those relationships.”
The study also found some differences between boys and girls.
Depressive symptoms in boys tends to predict increases in their materialism, while depressive symptoms in girls tends to predict the internalization of appearance concerns, the researchers reported in the study, which was presented at the British Psychological Society’s Developmental and Social Psychology Section annual conference.
Source: University of Sussex
Elementary and middle school students whose lunch breaks are at least 25 minutes long are more likely to choose fruits and consume more of their entrees, milk, and vegetables, according to a new study published in the Journal of the Academy of Nutrition and Dietetics.
For children from low-income households, school lunches can account for almost half of their daily caloric intake, so it is extremely important for schools to find ways to improve student selections and consumption and limit food waste.
The researchers found that when children have less than 20 minutes of seated time in the cafeteria to eat lunch, they were significantly less likely to select a fruit when compared to peers who had at least 25 minutes to eat lunch (44 percent vs 57 percent, respectively).
Furthermore, children with less than 20 minutes to eat lunch consumed 13 percent less of their entrees, 10 percent less of their milk, and 12 percent less of their veggies when compared to students who had at least 25 minutes to eat their lunch. These findings indicate that kids who were given less time at lunch may be missing out on key components of a healthy diet such as fiber-rich whole grains and calcium.
“Policies that improve the school food environment can have important public health implications in addressing the growing socioeconomic disparities in the prevalence of obesity and in improving the overall nutrient quality of children’s diets,” said lead investigator Juliana F. W. Cohen, Sc.D., Sc.M., of the Department of Health Sciences at Merrimack College in Massachusetts.
“This research suggests that enabling students to have sufficient time to eat their meals can help address this important issue.”
According to the study, another challenge children face is the minutes they must use during their school lunch period for activities besides eating or sitting. Many students spend a considerable amount of time traveling to the cafeteria and then waiting in line to get their lunch.
After taking this into account, some children had as little as 10 minutes to eat their lunch.
“Although not all schools will be able to accommodate longer lunch periods, several other factors have been cited as areas where schools can improve the amount of time students have to eat,” said Cohen. “Increasing the number of serving lines, more efficient cashiers, and/or an automated point of sale system can all lead to enhanced efficiency for students going through lunch lines.”
The findings demonstrate a definite link between the amount of time a student is given to eat and how much food they are likely to consume. A shorter lunch period means that children are in danger of missing out on important calories they rely on during the school day.
Furthermore, previous research has shown that consuming food too quickly is associated with a decrease in satiety, which can lead to overeating and contribute to obesity. Because of this, having insufficient time for lunch is especially risky as children are learning the eating habits they will take with them into adulthood.
“Policies that enable students to have at least 25 minutes of seated time might lead to improvements in students’ diets and decrease plate waste in school cafeterias,” concluded Cohen.
“These findings provide evidence that policies at the district, state, or national level may be warranted to ensure all children have sufficient time to eat their meals in schools.”
Emerging research suggest that in both blacks and whites, everyday feelings of discrimination can influence levels of the primary stress hormone, cortisol.
In African-Americans, however, the negative effects of perceived discrimination on cortisol are stronger than in whites, according to the new study.
The review is one of the first to look at the biological response to the cumulative impact of prejudicial treatment.
Interesting, the teenage years were found to be a particularly sensitive period to be experiencing discrimination — in terms of the future impact on adult cortisol levels.
“We found cumulative experiences matter and that discrimination mattered more for blacks,” said study lead author Emma Adam, a developmental psychologist at Northwestern’s School of Education and Social Policy.
“We saw a flattening of cortisol levels for both blacks and whites, but blacks also had an overall drop in levels. The surprise was that this was particularly true for discrimination that happened during adolescence.”
The study is currently available online in the journal Psychoneuroendocrinology and will follow in hard copy.
In times of stress, the body releases several hormones, including cortisol. Ideally, cortisol levels are high in the morning to help energize us for the day. At night, cortisol levels wane as the body prepares for sleep.
Previous research indicates that discrimination can affect the natural rhythm of this process. Work by Adam and others suggests that young adults from racial/ethnic minority groups who perceive more discrimination have higher levels of cortisol in the evening and less decline in cortisol levels across the day than those with lower discrimination.
The variation in cortisol levels influence a variety of mental and physical functions.
Having flatter or dysfunctional cortisol levels across the day is linked with higher fatigue, worse mental health, cardiovascular disease, and mortality, as well as cognitive problems, such as impaired memory.
The latest study suggests for the first time that the impact of discrimination on cortisol adds up over time.
A review of data collected over a 20-year period identified that the more discrimination people experience throughout adolescence and early adulthood, the more dysfunctional their cortisol rhythms are by age 32.
“We’ve been trying to solve the mystery behind why African-Americans have flatter diurnal cortisol rhythms than whites,” said Adam, a faculty fellow at Northwestern’s Institute for Policy Research.
“There’s a fair amount of research on how discrimination affects people in the moment. But we haven’t been sufficiently considering the wear and tear and accumulation of discrimination over lifetimes.
“Our study offers the first empirical demonstration that everyday discrimination affects biology in ways that have small but cumulative negative effects over time.”
Even after controlling for income, education, depression, times of waking, and other health behaviors, they still couldn’t explain or remove the effects of discrimination, “making it unlikely that those other factors play a role,” Adam said.
The researchers measured discrimination from ages 12 to 32, prospectively. They also assessed adult cortisol levels over a seven-day period. Using modeling, they determined the age range during which discrimination most dramatically affected cortisol.
“Adolescence might be an important time period because there are a lot of changes in the brain and body,” Adam said.
“When you experience perceived discrimination during this period of change, it’s more likely that those effects are built into the system and have a bigger impact.”
The most effective treatment for Parkinson’s disease is the long-term use of a medication called L-DOPA or levodopa. Unfortunately, a common side effect of the drug is a movement problem called dyskinesia. Often, this side-effect is as debilitating as Parkinson’s disease itself.
In a new study, researchers have now discovered why long-term use of L-DOPA (levodopa), leads to dyskinesia.
Using a new method for manipulating neurons in a mouse model of Parkinson’s, a Columbia University Medical Center (CUMC) research team found that dyskinesia arises when particular nerve cells (striatonigral) become less responsive to GABA, an inhibitory neurotransmitter.
Experts believe this finding suggests that it may be possible to modulate the activity of these neurons to prevent or delay this disabling side effect.
A paper explaining the finding was published recently in the online edition of the journal Neuron.
Parkinson’s disease is a progressive neurodegenerative disorder. Brain cells die in various parts of the brain, especially in a region called the substantia nigra.
It is in the substantia nigra that a neurotransmitter called dopamine is formed — a substance that helps nerve cells work normally. When dopamine is insufficient or lacking, neurons fire abnormally, impairing one’s ability to control movement.
“While Parkinson’s is not curable, it is treatable with L-DOPA, which is converted into dopamine in the brain,” said study leader David L. Sulzer, Ph.D.
“However, while taking L-DOPA helps patients move normally, in many individuals it eventually triggers uncontrolled excessive movements.” Parkinson’s is estimated to affect about one million people in the U.S. and up to 10 million worldwide.
Most studies into the cause of dyskinesia in Parkinson’s have focused on the dopamine receptors that remain in the brain, which over time become over-reactive to L-DOPA therapy. However, the CUMC team decided to look at how neurons of the basal ganglia regulates movement in the absence of dopamine.
“Dopamine neurons modulate the basal ganglia,” explained lead author Anders Borgkvist, Ph.D., a postdoctoral fellow in Dr. Sulzer’s laboratory. “And because that circuit is still running in patients with Parkinson’s, it’s long been suspected that other parts of the circuit behave abnormally in this disease.”
However, scientists lacked a way to stimulate selective parts of the basal ganglia to evaluate what was happening when dopamine is no longer available. The CUMC team employed a novel form of optogenetics, a technique that uses light to control neurons that have been genetically sensitized to light, and found that after long-term dopamine loss, striatonigral neurons lose their ability to respond to the neurotransmitter GABA (gamma-aminobutyric acid). This effect was not found with short-term dopamine loss.
“When striatonigral neurons are working normally, they act as a brake on the basal ganglia, in effect shutting down unwanted movement,” said Dr. Sulzer.
“But when there is dopamine loss, as in Parkinson’s, striatonigral neurons try to compensate, and eventually lose their responsiveness to GABA. Our hypothesis is that when L-DOPA is added into the system, you lose the ability to filter, or turn off, unwanted movement.”
“Our findings suggest that GABA and GABA receptors are still present in the striatonigral neurons,” said Dr. Borgkvist.
“So then the question becomes, why they aren’t functional? I think that we, or another lab, will eventually find the answer. In any case, the implication is that this defect is correctable, and that would mean that we could prevent or at least delay dyskinesia, so that patients could continue to use L-DOPA.”
“Patients do not develop dyskinesias in the early stages of Parkinson’s, but only after several years of the disease,” said Stanley Fahn, MD.
“A major reason why these patients want to delay the initiation of L-DOPA therapy is to avoid these dyskinesias for as long as possible. These new findings open up possible ways to treat or prevent the dyskinesias. If such treatments were found, patients would probably seek to be treated early and improve their quality of life sooner.”
Researchers also believe that other mechanisms, in addition to striatonigral neurons, will be discovered that contribute to Parkinson’s-related dyskinesia.
Negative symptoms in patients with schizophrenia are associated with an increased likelihood of hospital admission, longer duration of admission, and an increased likelihood of re-admission following discharge, according to a new study by researchers at King’s College London.
Negative symptoms include poor motivation, poor eye contact, and a reduction in speech and activity. As a result, people with schizophrenia often appear emotionless, flat, and apathetic. These contrast with the positive symptoms of hallucinations or delusions, which are typically the first targets of treatment.
The study is the largest ever to investigate a relationship between negative symptoms and clinical outcomes, pulling from a sample of more than 7,500 patients.
“Hospital admissions are the main drivers of cost in the care of patients with schizophrenia — yet they have traditionally been linked to the severity of positive psychotic symptoms,” said Dr. Rashmi Patel from the Department of Psychosis Studies.
“Our data indicate that negative symptoms are an equally important factor, and suggest that a greater emphasis on assessing and treating these features of schizophrenia may have significant health economic benefits.”
“However, as our findings are drawn from observational data, interventional clinical studies are required to determine whether an effective treatment for negative symptoms would lead to better clinical outcomes.”
For the study, researchers used the Clinical Record Interactive Search (CRIS) application, a text-mining tool, to analyze anonymous patient data on negative symptoms. Natural Language Processing (NLP) was used to detect statements within the clinical records that determined references to specified negative symptoms.
Ten negative symptoms were identified, including poor motivation, blunted or flattened mood, poor eye contact, emotional withdrawal, poor rapport, social withdrawal, poverty of speech (excessively short speech with minimal elaborations), inability to speak, apathy, and concrete thinking (the inability to think in abstract terms).
The researchers found that 41 percent of patients exhibited two or more negative symptoms. Negative symptoms across the sample were associated with an increased likelihood of hospital admission, longer duration of admission, and an increased likelihood of re-admission following discharge from hospital.
In fact, patients with two or more negative symptoms were 24 percent more likely to have been admitted to the hospital. In addition, each of their admissions were, on average, an extra 21 days in duration and, when discharged, these individuals had a 58 percent higher risk of re-admission within 12 months.
The most frequently recorded negative symptoms were poor motivation (31 percent), blunted or flattened mood (27 percent), poor eye contact (26 percent), and emotional withdrawal (24 percent).
The findings are published in the journal BMJ Open.
Source: King’s College London
A long-term study of U.S. Marines has found that reduced heart rate variability may be a contributing risk factor for post-traumatic stress disorder (PTSD).
Reduced heart rate variability refers to the changing time between heartbeats. Experts explain that even at rest, the normal rhythm of the heart fluctuates, reflecting influences and changes in other parts of the body.
Generally speaking, the greater the heart rate variability or HRV, the better. Conversely, reduced HRV suggests poorer functioning of regulatory systems in the body and has been cited as an indicator or predictor for a number of conditions. These disorders include fetal distress, heart disease, depression, asthma, diabetic neuropathy, and disorders of the autonomic nervous system.
Experts have also found an association between HRV and PTSD — a mental health condition linked to a number of maladies, including anger, insomnia, substance consciously directed, such as heartbeat, breathing, and digestion — are often associated with abuse and chronic depression.
PTSD is particularly associated with persons deployed to war. For example, the lifetime prevalence in Vietnam-era combat veterans is 19 percent. For veterans of Iraq and Afghanistan, it is 13 to 15 percent. In the general U.S. population, the PTSD prevalence rate is eight percent.
In the study, researchers investigated whether reduced HRV before combat deployment conferred increased risk of a PTSD diagnosis after deployment. From July 2008 to October 2013, they assessed two large cohorts of active-duty Marines one to two months before combat deployment and again four to six months after their return.
After accounting for deployment-related combat exposure, the researchers found that U.S. Marines with reduced HRV prior to deployment displayed increased vulnerability to PTSD upon return.
“The evidence is initial and modest,” said Arpi Minassian, Ph.D., clinical professor of psychiatry at University of California, San Diego School of Medicine and first author of the study.
“It suggests that an altered state of the autonomic nervous system may contribute to vulnerability and resilience to PTSD, along with known risk factors, such as combat exposure and preexisting stress and trauma symptoms.”
The researchers said that if the findings are buttressed by future studies, it may suggest new opportunities for preventing PTSD by addressing the biology of the autonomic nervous system.
Study findings appear in the online issue of JAMA Psychiatry.
The results from an informative new study suggest the “power” of touch is promulgated through a series of illusions coordinated by the brain. The sensory illusions, in turn, help to create a “social glue” that bonds people together.
Researchers give the example that the incredibly soft feeling we experience when we touch someone else’s skin may actually not represent reality.
In a series of studies led by Aikaterini Fotopoulou of the University College London, participants consistently rated the skin of another person as being softer than their own, whether or not it really was softer.
The researchers suggest that this phenomenon may exist to ensure that humans are motivated to build social bonds through touch.
“What is intriguing about the illusion is its specificity,” says Antje Gentsch, also of the University College London.
“We found the illusion to be strongest when the stroking was applied intentionally and according to the optimal properties of the specialized system in the skin for receiving affective touch.”
The skin system typically responds to slow, gentle stroking found in intimate relationships and encodes the pleasure of touch. In other words, this “social softness illusion” in the mind of the touch-giver is selective to the body parts and the stroking speeds that are most likely to elicit pleasure in the receiver.
“The illusion reveals a largely automatic and unconscious mechanism by which ‘giving pleasure is receiving pleasure’ in the touch domain,” Fotopoulou says.
Social touch is known to play a powerful role in human life — from infancy to old age — with beneficial effects on physical and mental health. Many studies have focused on the benefits of touch for the person receiving it.
For instance, premature infants benefit greatly from time spent in direct physical contact with their mothers. Yet, Fotopoulou and her colleagues say, remarkably little is known about the psychological benefits of actively touching others.
Earlier studies showed that softness and smoothness stimulate parts of the brain associated with emotion and reward. Therefore, this “illusion” that other people are softer ensures that reaching out and touching another person comes as its own reward.
This rewarding illusion acts as a kind of “social glue,” bonding people to each other. For example, touching a baby in a gentle manner seems to give the mother tactile pleasure, the researchers say. In fact, the feeling gives the mother pleasure over and above any other thoughts the mother may have in the moment.
Fotopoulou says the next step is to examine the neurophysiological mechanisms involved in giving affective touch.
Researchers are also curious to examine any differences that may exist in the experience of this softness illusion among partners, friends, and strangers.
Source: Cell Press/EurekAlert
Obesity is a health epidemic that impacts around 79 million Americans. Obesity is now viewed as a chronic disorder, a classification that acknowledges that once a person becomes obese, they usually remain obese for their entire lifespan.
The situation is dire as obesity often leads to high rates of diabetes, heart disease, and cancer fueling poor health and expensive medical care. Experts believe the number of obese Americans will remain unacceptably high unless there is radical change in both the U.S. health care system and the environment.
As such, public health researchers call for a revolutionary new approach to prevent and treat obesity.
“We propose a new model for the prevention and treatment of obesity, one that integrates health care in the clinic with resources in the community that make it easier for people to prevent unhealthy weight gain or lose weight and keep it off,” said lead author William H. Dietz, M.D., Ph.D., director of the Sumner M. Redstone Global Center for Prevention and Wellness at Milken Institute School of Public Health at the George Washington University.
Dietz and his co-authors, including representatives from leading U.S. managed care organizations such as Kaiser Permanente and HealthPartners, point out that the Affordable Care Act (ACA), with its focus on prevention, provides support for this new model.
At the same time, the authors note that there will be challenges to implement an integrated framework, including the need for incentives so that health care systems go beyond the clinic doors to link up with resources for fighting obesity in the neighborhoods where people actually live.
Community resources include safe places for people to exercise and stores or farmers markets where they can purchase healthy foods.
The new model proposed by Dietz and his colleagues includes:
- A system that is centered on individual patients and family engagement. The authors note that successful models of obesity treatment often require behavioral changes such as preparing nutritious foods or increasing physical activity — and families play a key role in these efforts;
- Restructured clinical services by providers who are sensitive to the stigmatization of people with obesity. Doctors and other health professionals also need to learn behavioral strategies that can motivate patients to change their diet and get started on an exercise routine;
- Better integration between clinical services and community systems that can make it easier for patients to lose or maintain their weight. For example, partnerships between the clinic and the YMCA or other community-based resources can often provide patients with a structured way to get regular exercise or nutrition counseling.
Successful implementation of the model, however, will require significant changes in both clinical care and health care reimbursement models.
For example, Dietz and his colleagues believe that clinical training for health professionals must include behavior change strategies and up to date information about new ways to treat obesity, a complex biological condition.
They also call for better integration of clinical and community services — a relationship that will likely require negotiations and written agreements between groups that are not used to working together.
Other policy changes that must be addressed include an expanded role of hospitals, health plans and individual clinicians in supporting environmental and social norm changes that can help patients lose weight.
Further, researchers call for a standardized set of metrics that can be used to judge the new model and gauge novel approaches to training a diverse group of professionals to collaborate in new and more effective ways. Finally, a payment approach that rewards values and outcomes is necessary.
Although the challenges to implementing the new model for obesity are substantial, study authors believe the obstacles can be overcome with the help of innovative programs, mechanisms, and policies that support the radical new framework.
Source: George Washington University
A new study finds that women are not only at greater risk of developing Alzheimer’s disease (AD) when compared to men, they also bear six times the cost of AD care that men do.
Researchers from Emory University used a lifetime perspective to calculate AD costs to women and men based on three factors: the probability of developing AD, the disease’s duration, and the required formal or informal care for the patients.
Study findings are published in the journal Women’s Health Issues.
Drs. Zhou Yang of Emory University’s Rollins School of Public Health and Allan Levey of the Emory University School of Medicine discovered that the greater cost burden for women stems from the informal care they deliver to family members with Alzheimer’s disease and the lack of Medicaid relief for caregiving.
“As baby boomers age, Alzheimer’s disease and other forms of dementia will place a greater strain on our health care system and on families,” said Chloe E. Bird, Ph.D., editor-in-chief of Women’s Health Issues.
“This study demonstrates the importance of policies to address the needs not only of patients but of caregivers, the majority of whom are women.”
Yang and Levey used 2000-2010 data from the Medicare Current Beneficiary Survey, a nationally representative sample of Medicare beneficiaries that merges survey responses with Medicare and Medicaid claims data.
They calculated costs for clinical care paid by Medicare; long-term-care (LTC) costs paid by Medicaid; out-of-pocket costs for care at home or in assisted living facilities; and the costs of informal, uncompensated care.
When considering aggregate costs for the baby boom generation, care for women with AD costs more than care for men with AD across the lifetime, the authors found, with a women-to-men cost ratio of 1.5 for Medicare costs, 2.2 for Medicaid costs, and 5.8 for out-of-pocket payments for assisted living and home health care.
The results show that by far, the greatest difference is in the informal care. In fact, Yang and Levey report that women provide informal, uncompensated AD care worth 20 times the care from men.
Challenges abound in the American culture. Some female caregivers are still in the workforce and must juggle unpaid care with job and other family responsibilities. Others are older and often struggling with health or economic problems of their own, yet still provide many hours of unpaid care to a spouse or other family members, the authors say.
Alzheimer’s can last up to 10 years, and caregiving can be physically and psychologically demanding as well as exact a financial toll that is often shouldered by women.
Yang and Levey go on to note that advances to cure, prevent, or postpone the onset of AD would ease the disproportionate burden on women. They also urge policy reforms, including reforms to Medicare and Medicaid payments to meet the needs of AD patients and their families.
“Public policy interventions that aim at curing or slowing the progress of AD, as well as those meeting the special home health care or long-term care need of the AD patients, will greatly benefit the welfare and economic status of women,” Yang said.
Source: George Washington University
Two-year-olds with poor motor function are more likely to have a poor understanding of math, according to a new study by researchers in Norway. This knowledge will make it easier for teachers to identify children who may need extra help.
“There were big differences in mathematical skill levels between the children with the strongest and poorest motor skills. Most of the children who had poor motor skills were not very good at mathematics.
“We cannot comment on causality, only that the level of mathematical proficiency can be reflected in motor skills,” said Associate Professor Elin Reikerås of the Norwegian Reading Centre at the University of Stavanger.
“It is important that teachers of small children are aware of these findings. It will be easier for them to identify children who may be at risk of having difficulties in understanding mathematics.”
Researchers studied data from the Stavanger Project, which monitors the development of more than 1000 children aged two to ten years in kindergartens and schools in Stavanger. The vast majority of Norwegian children start kindergarten at the age of one.
The researchers divided the children into three groups according to their level of motor skills: poor, average, and strong. They observed whether the children had mastered motor skills such as putting on clothes, doing jigsaws, eating with a spoon and fork, using scissors, walking around the room without bumping into things, using playground equipment, and throwing and catching a ball.
Different math skills were examined as well, such as if the two-year-olds were able to use their fingers to show how old they were, if they could use the shape sorter box, sort toys or objects (according to color, size or category, for example), demonstrate the difference between big and small through the use of body language or words, use numerals (“I have a thousand cars!”), and draw a tadpole.
“Children with good motor skills were more mathematically advanced in all of the areas that were studied, and those with average scores in the motor skills group also had average scores for mathematical skills,” said Reikerås.
The researchers note that both motor and math skills are important for play, discovery, and experience.
“Children create experiences when they use their bodies. This is also important within mathematics. When children play, climb, crawl, and hide outdoors, this contributes to the development of spatial awareness,” said Reikerås.
“Shapes and sizes are explored through drawing, painting, and playing with blocks. Putting on clothes in the right order or sorting and tidying toys requires both logical reasoning and motor skills. Dealing with numbers, such as giving a cup to everyone and then pointing and saying the numbers, also involves connections with motor function.”
Further research is needed into the significance of motor skills and the early development of math proficiency. Since this study only looked at two-year-olds, the researchers do not currently know if children continue to develop within these two areas and if the correlation continues to be as strong later on.
“Even though we have found a close correlation between mathematical skills and motor function, this does not mean that if we just focus on one area there will be also an improvement in the other area,” Reikerås said.
“It is important to facilitate play-based activities where children can develop in several areas at the same time. Both motor and mathematical skills are important for children in the here and now, at play and during everyday activities, but these skills are also important with regard to development and learning.”
“The earlier this foundation is in place, the better it is for the child. Our findings mean that children with poor motor skills should be observed more closely for poor mathematical skills,” she said.
The findings are published in the European Journal of Early Childhood Education.
Source: University of Stavenger
New research discovers taking pride in a personal achievement can either solidify self-discipline and self-determination or release indulgence as a reward for a job well-done.
The realization that pride can have such conflicting effects on behavior could help policy makers in fields as divergent as health care and economics.
The study, led by researchers from the University of Cincinnati and published in the Journal of Consumer Research, found that when people took pride in an accomplishment and chalked that up to being disciplined and responsible, they were more likely to continue making disciplined choices through the day.
But when people considered a self-control goal that they had before feeling proud — a goal such as eating healthy, working out, or saving money — they were more likely to think they had made good progress toward their goal, and therefore were more likely to indulge in a reward that veered from making disciplined choices.
The findings could hold possibilities ranging from investigating the nation’s obesity epidemic to examining Americans’ growing credit card debt.
Researchers on the study are Carl H. Lindner College of Business, Juliano Laran, a professor of marketing for the University of Miami, Coral Gables, Florida, and Chris Janiszewski, the Russell Berrie Eminent Scholar Chair and professor of marketing, Warrington College of Business Administration, University of Florida, Gainesville.
The journal article summarizes four studies in which half of the participants thought about a self-control goal and half did not, so those participants were studied in a so-called neutral condition.
In the first study involving 182 undergraduates, participants in the active, self-regulatory goal condition were shown words associated with being regulated, such as “health, willpower, persistence, and virtue.” The second, neutral group was shown words such as “flower, refrigerator, notebook, and picture.”
In a second study involving 312 undergraduates, the neutral participants were asked to write about a typical day. The pride-related participants were told to that the purpose of the writing task was to reveal life events that made them feel proud.
The third exercise, involving 312 undergraduates, involved a self-control dilemma that allowed participants to be either disciplined or indulgent, such as choosing between a granola bar or some cookies, sleeping in, or getting up early.
The fourth study, involving 257 undergraduates, examined how pride influences people’s budgeting habits.
“We found that when people did not have a self-control goal and were made to feel proud, they increased their level of self-control, becoming more likely to choose healthy snacks or to save money,” said co-author Dr. Anthony Salerno, a University of Cincinnati assistant professor of marketing.
“However, when people had a self-control goal and were made to feel proud, they had less self-control, becoming more likely to select the indulgent snacks or to spend their money, because they thought of themselves as having already achieved their goal.”
Said Salerno, “It’s almost like this misattribution. You have this goal, you’re made to feel proud — which is a sense of accomplishment — so they feel it gives them license to indulge. It’s one of those issues that depending on what we’re thinking about, we tend to get different effects.”
Salerno says that when the research is applied to marketing or advertising, the successful sell would involve first focusing on an emotion or goal, which could result in a fast-food run or a trip to the supplement store. He adds that the findings could possibly be applied toward examining the obesity crisis in the United States as well as overspending amid shrinking savings accounts.
“The basic finding is that, for the most part, when people are made to feel proud, they’re more likely to exercise restraint, such as choosing a salad or intending to save more than to spend,” Salerno said.
“But if people first think about a healthy eating or savings goal and are proud of what they’ve accomplished so far, their behavior starts to become more hedonic. So it all depends on what pride focuses us to think about. When pride focuses us on who we are, we seem to become more restrained. When pride focuses us on what we’ve done, there’s more of a license to indulge.”
Source: University of Cincinnati
Taking a break during work is usually a necessity as we struggle with stress reduction, eye strain, or boredom. A new study has some surprising findings on what makes a break “good,” the best time to take a break, and the optimal length of a break.
Work breaks may be in a variety of formats including coffee breaks, lunch breaks, a break to visit with coworkers, or perhaps an exercise break that includes a late afternoon walk around the building. Yet despite the universality of taking work breaks, the benefits gained from a particular type of break or the overall effectiveness of a break have not been formally evaluated.
Researchers scrutinized work breaks and looked for answers to the following questions: Which break does a better job of boosting energy, aiding concentration, and increasing motivation? In short, which type of break is best?
In the empirical study, “Give Me a Better Break: Choosing Workday Break Activities to Maximize Resource Recovery,” Emily Hunter, Ph.D., and Cindy Wu, Ph.D., associate professors of management in Baylor University’s Hankamer School of Business, uncovered several factors that can improve the effectiveness of breaks.
As published in the Journal of Applied Psychology, the authors provide suggestions on when, where, and how to plan the most beneficial daily escapes from the job. The research also debunks some common break-time myths.
Researchers surveyed 95 employees (ages 22-67) over a five-day workweek. Each person was asked to document each break they took during that time. Breaks were defined as “any period of time, formal or informal, during the workday in which work-relevant tasks are not required or expected, including but not limited to a break for lunch, coffee, personal email, or socializing with coworkers, not including bathroom breaks.”
Hunter and Wu chronicled and analyzed a total of 959 break surveys, an average of two breaks per person per day. They say the results of the study benefit both managers and employees.
“We took some of our layperson hypotheses about what we believed were helpful in a break and tested those empirically in the best way possible,” Hunter said.
“This is a strong study design with strong analyses to test those hypotheses. What we found was that a better workday break was not composed of many of the things we believed. ”
Key findings of the study include:
1. The most beneficial time to take a workday break is mid-morning.
Hunter and Wu found that rather than the typical culture of working hard all morning only to take a lunch-hour or mid-afternoon break, a respite earlier in the workday replenishes more resources — energy, concentration, and motivation.
“We found that when more hours had elapsed since the beginning of the work shift, fewer resources and more symptoms of poor health were reported after a break,” the study says. “Therefore, breaks later in the day seem to be less effective.”
2. “Better breaks” incorporate activities that employees prefer.
A common belief exists that doing things that are non-work-related are more beneficial, Hunter explained. Based on the study, there was no evidence to prove that non-work-related activities were more beneficial. Simply put, preferred break activities are things you choose to do and things you like to do. These could also include work-related tasks.
“Finding something on your break that you prefer to do — something that’s not given to you or assigned to you — are the kinds of activities that are going to make your breaks much more restful, provide better recovery, and help you come back to work stronger,” Hunter said.
3. People who take “better breaks” experience better health and increased job satisfaction.
The employee surveys showed that recovery of resources — energy, concentration, and motivation — following a “better break” (earlier in the day, doing things they preferred) led workers to experience less somatic symptoms, including headache, eyestrain, and lower back pain after the break.
These employees also experienced increased job satisfaction and organizational citizenship behavior as well as a decrease in emotional exhaustion (burnout), the study shows.
4. Longer breaks are good, but it’s beneficial to take frequent short breaks.
While the study was unable to pinpoint an exact length of time for a better workday break (15 minutes, 30 minutes, etc.), the research found that more short breaks were associated with higher resources, suggesting that employees should be encouraged to take more frequent short breaks to facilitate recovery.
Researchers believe breaks are an essential intervention to help a person stay sharp and energized.
“Unlike your cellphone, which popular wisdom tells us should be depleted to zero percent before you charge it fully to 100 percent, people instead need to charge more frequently throughout the day,” Hunter said.
Source: Baylor University/EurekAlert
New findings on a popular smoking cessation drug do not support the risks highlighted in earlier studies. Currently available smoking cessation treatments include nicotine replacement therapies and nicotine-free prescription drugs. But increasingly, tobacco dependence is treated with a drug called varenicline (sold as Chantix).
It works by targeting the “nicotinic acetylcholine receptor” in the brain to dampen down withdrawal symptoms and reduce the positive rewards from smoking. Varenicline has been shown in many studies to be more effective than placebo, the drug bupropion (Wellbutrin) which is used to treat depression and to help people stop smoking, or of nicotine replacement therapy.
However, reports of suicidality, depression, psychoses, and violence have led to warnings being issued by regulatory agencies. Varenicline use has also been restricted or prohibited for pilots, air traffic controllers, truck and bus drivers, and certain military personnel due to reports of traffic accidents.
A team led by Dr. Seena Fazel of Oxford University, UK, investigated the drug’s potential risks using information on 7,917,436 people in Sweden aged 15 and over. Among these, 69,757 took varenicline between 2006 and 2009. National registers were examined for details of criminal convictions, psychiatric conditions, suicidal behavior, transport accidents and traffic offenses, and substance abuse.
The drug “was not associated with significant hazards of suicidal behavior, criminal offending, transport accidents, traffic offences, or psychoses,” report the team in the British Medical Journal. They believe that earlier reports of such links “may not have taken full account of underlying risk factors.”
“However, varenicline was associated with a small increase in the risk of anxiety conditions (23 percent raised risk) and mood conditions (31 percent raised risk), which was only seen in people with pre-existing psychiatric disorders.”
In conclusion, the authors believe that concerns that varenicline is associated with an increased risk of many adverse outcomes, including suicidality and accidents, are not supported. But they call for further research investigating “the small increase in risk of two psychiatric conditions in people with pre-existing psychiatric disorders.”
The authors also point out that they lack information on adherence to the drug, and that their study is limitated to incidents that appear on official registers. “Only outcomes serious enough to warrant emergency visits or hospital admission (for psychiatric conditions, transport accidents, or suicidal behaviors) or detection by the police (for crime outcomes), would end up in the registers,” they write. “On the other hand, register based outcomes are more comparable across countries than self reports and represent important public health concerns.”
Previous fears over an increased risk of suicidal behavior, depression, psychoses and violence led regulatory agencies in the U.S. and Europe to issue warnings over varenicline. For example, on March 9, 2015, the U.S. Food and Drug Administration made a safety announcement stating that the Warnings and Precautions section of the label had been updated “to include information about several studies that investigated the risk of neuropsychiatric side effects on mood, behavior, or thinking occurring with varenicline.”
The studies taken into account included observational studies, and analyses conducted by the drug’s manufacturer, Pfizer, of randomized controlled clinical trial data. “These studies did not show an increased risk of neuropsychiatric side effects with varenicline,” the FDA states, “however, they did not examine all types of neuropsychiatric side effects, and they had limitations that prevented us from drawing reliable conclusions.”
Pfizer currently is carrying out a large safety trial of varenicline to investigate these risks. Results are expected to appear later this year.
Evidence for an interaction with alcohol appears clearer. As the FDA says, varenicline “can change the way people react to alcohol.” Reports of adverse events describe patients who drank alcohol while on varenicline treatment and experienced decreased tolerance to alcohol, including increased drunkenness, unusual or aggressive behavior, or they had no memory of things that happened.
The drug has also been linked with seizures among individuals who either had no history of seizures or had a seizure disorder that had previously been well-controlled. In most of these cases, the seizures occurred within the first month of starting varenicline.
Nevertheless, the FDA adds, “Millions of Americans have serious health problems caused by smoking, which can be reduced by quitting. Varenicline is a prescription medicine that is FDA-approved to help adults quit smoking. In clinical trials, varenicline increased the likelihood of quitting smoking and “staying quit” for as long as one year compared to treatment with a placebo, an inactive treatment.”
Molero, Y. et al. Varenicline and the risk of psychiatric conditions, suicidal behaviour, criminal offending, and transport accidents and offences: population based cohort study. British Medical Journal, 3 June 2015, doi: 10.1136/bmj.h2388
FDA Drug Safety Communication: FDA updates label for stop smoking drug Chantix (varenicline) to include potential alcohol interaction, rare risk of seizures, and studies of side effects on mood, behavior, or thinking.