Chronic Pain Linked to Increased Risk of Dementia in Older Adults

https://goo.gl/9JaNGi

The study, published in JAMA Internal Medicine, appears to be the first to make this association.

The researchers analyzed data from 10,000 participants aged 60 and up over a 12-year period. Those participants who said they were persistently troubled by moderate or severe pain in both 1998 and 2000 declined 9.2 percent faster in tests of memory function over the next 10 years than those who said they were not troubled by pain. The patients who complained about persistent pain also had a small but significantly increased likelihood of developing dementia overall.

Researchers found that the additional amount of memory decline in those who reported persistent pain suggested that these patients would likely have had a harder time with tasks of daily living, such as independently managing their medications and finances.

“Elderly people need to maintain their cognition to stay independent,” she said.

“Up to one in three older people suffer from chronic pain, so understanding the relationship between pain and cognitive decline is an important first step toward finding ways to help this population.”

The research, conducted in collaboration with members of UCSF’s Division of Geriatrics, suggests three potentially overlapping reasons for the association between chronic pain and dementia. An increased dementia risk could be caused by painkillers, such as opioids, which people are taking in greater numbers. It could also be that the experience of pain somehow compromises the brain’s ability to encode memories and other cognitive functions. Finally, it could be due to some other factor that was not measured in the study, and therefore could not be analyzed.


How Gaps In Mental Health Care Play Out In Emergency Rooms

https://goo.gl/O13CGi

Nearly 1 in 5 children each year suffers a psychiatric illness, according to research estimates. But a national shortage of medical specialists and inpatient facilities means that many still go untreated — despite national efforts to improve mental health care.

New research is driving home the consequences. Scientific abstracts presented Monday in Las Vegas, at the annual meeting of the American College of Emergency Physicians, offer insights into how frequently patients with mental health issues land in the emergency room — often because opportunities to intervene earlier are missed. Pediatricians and child psychiatrists say children are among the hardest hit.

Compared with physically ill patients, people with mental health conditions rely more on the emergency department for treatment and are more often admitted to the hospital from the ER, the scientists found. Also, they tended to be stuck in the ER longer than people who show up in the ER with physical symptoms.

Specifically, the researchers found that about 6 percent of all the emergency department patients — of all ages — had a psychiatric condition. More than 20 percent of these psychiatric patients were admitted to the hospital, compared with just over 13 percent of the medical patients. About 11 percent of these patients with mental health problems required transfer to another facility, compared with 1.4 percent of the patients with physical ailments.

About 23 percent of mental health patients stayed in emergency care for longer than six hours, and about 1.3 percent for more than 24 hours. Only 10 percent of medical patients were under treatment in the ER for more than six hours, and just half a percent were there for more than 24 hours.

The researchers have not yet determined the distribution of ages among the patients in their study who came to the ER because of mental health symptoms. Anecdotally, though, ER patients with psychiatric problems tend to include more children and elderly patients than you'd expect to see based on the age range of the general population, says Suzanne Lippert, a clinical assistant professor in emergency medicine at Stanford University and lead author on the study.

The findings highlight what can happen when patients can't find good outpatient treatment for mental health problems, Lippert says. The evidence also underscores, she says, that when psychiatric patients arrive at the ER in a crisis, there is often no good place where they can continue treatment, once the immediate issue has been addressed.


Five ways to cope with PTSD

https://goo.gl/BucAqw

According to the Anxiety and Depression Association of America (ADAA), 7.7 million adults in the United States live with PTSD, though women are twice as likely as men to develop this condition.

PTSD can last for years, and its symptoms can severely impact overall quality of life. That being the case, it can sometimes be tempting to apply negative coping strategies to deal with symptoms of PTSD.

Negative coping strategies may seem helpful on the spur of the moment, yet they can easily turn self-destructive in the long-term. These can include resorting to alcohol or recreational drugs to numb your feelings, decrease stress, or quieten your thoughts.

So what are some things you can do, in addition to CBT and any other treatments recommended by your doctor, in order to keep your PTSD symptoms under control? Here are a few approaches you may want to consider.

1. Mindfulness meditation

2. Regain focus through physical activity

3. Aromatherapy

4. Art therapy

5. Pets for PTSD


Association of Antidepressant Medications With Incident Type 2 Diabetes Among Medicaid-Insured Youths

https://goo.gl/6kqcpB

Question  Does antidepressant use increase the risk of incident type 2 diabetes among youths?

Findings  In a cohort study of youths insured by Medicaid that included 119 608 youths who initiated antidepressant treatment, the current use of selective serotonin reuptake inhibitors or serotonin-norepinephrine reuptake inhibitors—the most commonly used antidepressant subclass—was associated with an increased risk of incident type 2 diabetes that intensified with increasing duration of use, cumulative dose, and average daily dose.

Meaning  The study findings provide an impetus to improve monitoring for benefits vs risks of antidepressant use in pediatric care models and to shed light on the underlying biological mechanism of antidepressant treatment–emergent type 2 diabetes.


Anxiety and Depression Linked to Migraines

https://goo.gl/s2RNdr

In a study of 588 patients who attended an outpatient headache clinic, more frequent migraines were experienced by participants with symptoms of anxiety and depression. In the Headache study, poor sleep quality was also found to be an independent predictor of more severe depression and anxiety symptoms.

The study’s investigators noted that factors such as emotional distress and frequency of headache may influence each other through a common pathophysiological mechanism. For example, emotional responses have the potential to alter pain perception and modulation through certain signaling pathways.

“These findings potentially suggest that adequate medical treatment to decrease headache frequency may reduce the risk of depression and anxiety in migraine patients,” said Dr. Fu-Chi Yang, corresponding author of the study and an investigator in the Department of Neurology, Tri-Service General Hospital, National Defense Medical Center, Taiwan.


Forecasting the onset and course of mental illness with Twitter data

https://goo.gl/sHNxra

We developed computational models to predict the emergence of depression and Post-Traumatic Stress Disorder in Twitter users. 

Twitter data and details of depression history were collected from 204 individuals (105 depressed, 99 healthy). We extracted predictive features measuring affect, linguistic style, and context from participant tweets (N = 279,951) and built models using these features with supervised learning algorithms. 

Resulting models successfully discriminated between depressed and healthy content, and compared favorably to general practitioners’ average success rates in diagnosing depression, albeit in a separate population. Results held even when the analysis was restricted to content posted before first depression diagnosis. 


Hollywood’s Other ‘Open Secret’ Besides Harvey Weinstein: Preying on Young Boys

https://goo.gl/K6ycbQ

Last week, former child actor Corey Feldman (Stand by Me, The Goonies) tweeted that he’d been asked for a statement about Harvey Weinstein’s sexual-harassment and rape allegations. It makes sense, since he has spent years speaking out about sexual abuse in Hollywood—not of women, but of young men. He has long alleged that pedophilia is the worst problem in Hollywood and that it’s in part responsible for his best friend Corey Haim’s eventual death by drug overdose.

Speaking to The Hollywood Reporter in 2016, Feldman said: “[Haim] had more direct abuse than I did. With me, there were some molestations, and it did come from several hands, so to speak, but with Corey, his was direct rape, whereas mine was not actual rape. And his also occurred when he was 11. My son is 11 now, and I can’t even begin to fathom the idea of something like that happening to him. It would destroy his whole being. As I look at my son, a sweet, innocent, 11-year-old boy and then try to put him in Corey Haim’s shoes, I go, ‘Oh my God—well of course he was erratic and not well-behaved on sets and things like that.’ What more could we expect of him really?”

He continued, “Everybody deals with things differently. I’m not able to name names. People are frustrated, people are angry, they want to know how is this happening, and they want answers—and they turn to me and they say, ‘Why don’t you be a man and stand up and name names and stop hiding and being a coward?’ I have to deal with that, which is not pleasant, especially given the fact that I would love to name names. I’d love to be the first to do it. But unfortunately California conveniently enough has a statute of limitations that prevents that from happening. Because if I were to go and mention anybody’s name, I would be the one that would be in legal problems and I’m the one that would be sued. We should be talking to the district attorneys and the lawmakers in California, especially because this is where the entertainment industry is and this is a place where adults have more direct and inappropriate connection with children than probably anywhere else in the world.”


Ten Steps the Federal Government Should Take Now to Reverse the Opioid Addiction Epidemic

https://goo.gl/e679wB

The United States is in the midst of the worst drug addiction epidemic in its history. Prescriptions for and deaths from opioids both quadrupled between 1995 and 2010. By 2015, an estimated 92 million individuals in the United States were prescribed an opioid and there were more than 33 000 deaths from an opioid-involved overdose.1

There are no simple solutions to ending this epidemic. Effective programs need to address 2 separate priorities: (1) prevention of addiction among people not currently addicted, and (2) treatment and risk reduction to prevent overdose and death among the millions of individuals in the United States now addicted. In this Viewpoint, we suggest 10 steps that could accelerate progress; national declarations, state-specific emergency declarations, or both could potentially facilitate implementation of these steps.2

1. Improve surveillance of possible opioid addiction
2. Improve reporting of and response to opioid-related overdoses and fatalities
3. Promote more cautious prescribing for acute pain
4. Change labeling for chronic pain and greatly restrict or eliminate marketing of opioids for this indication
5. Increase insurance coverage of and access to nonopioid and nonpharmacological management of pain
6. Interrupt the supply of heroin and illicitly produced synthetic opioids and improve coordination between legal and public health authorities (not going to happen)
7. Identify possible opioid addiction early and link individuals to treatment
8. Expand low-threshold access to opioid agonist treatment, particularly with methadone and buprenorphine
9. Implement harm reduction measures for current users, including access to clean syringes and naloxone
10. Consider removing ultra-high-dosage-unit opioid analgesics from the market


Underlying Factors in Drug Overdose Deaths

https://goo.gl/WuVnRM

Although increased heroin use and risk taking likely contribute, available data suggest contamination of the heroin supply with illicitly manufactured fentanyl as the overwhelming driver of the recent increases in opioid-related overdose deaths. Illicitly manufactured fentanyl is usually added to or sold as heroin. For every individual using heroin during recent years in the United States, it is likely that the risk of overdose death has increased considerably.

Fentanyl is approximately 50 times as potent as heroin. This provides strong economic incentives for drug dealers to mix fentanyl with heroin and other drugs because smaller volumes can provide equally powerful effects with lower costs and easier transport. Many people who use heroin are not seeking fentanyl and try to avoid it.3 It can be difficult to identify fentanyl, particularly in the white powder heroin typically sold in states east of the Mississippi River.4 The black tar and brown powder heroin typically sold in Western states might be limiting the penetration of fentanyl into this market for now. Among jurisdictions reporting provisional 2016 data, increases in drug overdose deaths since 2015 were much greater east of the Mississippi River.2

There are limited data about the effectiveness of interventions to prevent overdoses related to illicitly manufactured fentanyl. However, interventions that reduce opioid use disorder and opioid overdoses are likely to reduce overdoses related to illicitly manufactured fentanyl. Unnecessary exposure to prescription opioids must be reduced to prevent development of opioid use disorder in the first place. Despite recent progress, 3 times the amount of opioids were prescribed in 2015 compared with 1999 (Figure). Among people ultimately entering treatment for opioid use disorder, the proportion starting with prescription opioids rather than heroin has decreased in 1 study5 from more than 90% in 2005 to 67% in 2015. However, prescription opioid exposure remains a path to heroin use.


Your brain is particularly vulnerable to trauma at two distinct ages

https://goo.gl/O343IJ

Our brain’s ability to process information and adapt effectively is dependent on a number of factors, including genes, nutrition, and life experiences. These life experiences wield particular influence over the brain during a few sensitive periods when our most important muscle is most likely to undergo physical, chemical, and functional remodeling.

According to Tara Swart, a neuroscientist and senior lecturer at MIT, your “terrible twos” and those turbulent teen years are when the brain’s wiring is most malleable. As a result, traumatic experiences that occur during these time periods can alter brain activity and ultimately change gene expressions—sometimes for good.

The “terrible twos”

Even though you won’t have any memories of the interruptions (most people can’t remember much before age five), any kind of traumatic event—whether it’s abuse, neglect, ill health, or separation from your loved ones—can lead to lasting behavioral and cognitive deficits later in life, warns Swart.

To make her point, Swart points to numerous studies on orphans in Romania during the 1980s and 1990s. After the nation’s communist regime collapsed, an economic decline swept throughout the region and 100,000 children found themselves in harsh, overcrowded government institutions.

The teenage years

During this period, the brain’s frontal lobes, especially the prefrontal cortex, experience increased activity and, for the first time, the brain is capable of comparing and analyzing several complex concepts at once. Similar to a baby learning how to speak, this period in an adolescent’s life is marked by a need for increasingly advanced communication skills and emotional maturity.

“At that age, they’re starting to become more understanding of social relationships and politics. It’s really sophisticated,” Swart noted. All of this brain activity is also a major reason why teenagers need so much sleep.