Psychotic Symptoms Linked to Adolescent Suicide Risk

From Psychiatric News Alert (8/12/13): According to a recent study, psychotic symptoms alone (as distinguished from diagnosed psychotic disorders) are a striking marker of suicide danger in adolescents, especially in those adolescents who demonstrate other types of psychiatric pathology.

“This is a very interesting study,” said child and adolescent psychiatrist Kayla Pope, M.D., of Boys Town National Research Hospital in Nebraska. “We need better markers for assessing suicide risk, and the finding in this study is an important step in that direction.”

The finding, from a team of European researchers in JAMA Psychiatry, came as a surprise to the lead researcher, Ian Kelleher, M.D., Ph.D.

“While we knew that people with psychotic disorders are at high risk of suicidal behavior, we did not know that there was such a strong relationship between psychotic experiences (which are much more common than psychotic disorders) and suicidal behavior in the population.”

More information about suicide risks can be found in Psychiatric News herehere, andhere. Information about suicide is also available in The American Psychiatric Publishing Textbook of Suicide Assessment and Management, Second Edition.

Psychotic Symptoms, Rather than Antipsychotic Meds, Linked to Alzheimer Patient Death & Institutionalization

It is the presence of psychiatric symptoms, including psychosis and agitation, not the use of antipsychotic medications that appears to raise the risk for institutionalization or death among patients with Alzheimer’s disease (AD), according to a new study published in AJP in Advance.

Researchers at several institutions, led by Oscar Lopez, M.D., of the University of Pittsburgh, examined time to nursing home admission and time to death in nearly 1,000 patients with a diagnosis of probable AD, taking into account a range of variables, including dementia severity, physical illnesses, extrapyramidal signs, depression, psychosis, aggression, agitation, and dementia medication use. A total of 241 patients (25 percent) were exposed to antipsychotics at some time during follow-up. A higher proportion of patients exposed to antipsychotic medications, especially conventional antipsychotics, were admitted to a nursing home or died compared with those who never took these medications, but the association was no longer significant after adjustment for psychiatric symptoms. Psychosis was strongly associated with nursing home admission and time to death, but neither conventional nor atypical antipsychotics were associated with time to death.

“This observational study does not support the association between mortality and antipsychotic use that has been reported in institutionalized elderly patients,” the researchers stated.

Geriatric psychiatrist and immediate past APA President Dilip Jeste, M.D., who reviewed the study, called it “an important contribution to the literature on mortality related to psychosis and antipsychotics in persons with Alzheimer’s disease.”

“The results from various published studies have often been at variance with one another. The present study’s finding that psychosis itself is associated with increased mortality is consistent with several other reports, suggesting the need to treat these symptoms. Although there are no FDA-approved safe and effective treatments for psychosis in dementia, a number of pharmacological and psychosocial approaches are available. The treating clinician needs to take into account the risk-benefit ratios for various treatments as well as no specific treatment.”

For more information about AD, see American Psychiatric Publishing’s Clinical Manual of Alzheimer Disease and Other Dementias here and Psychiatric News here.

Making Our Minds Last a Lifetime

While it may not be possible to completely age-proof our brains, a brave new world of anti-aging research shows that our gray matter may be far more flexible than we thought.

The brain has often been called the three-pound universe. It’s our most powerful and mysterious organ, the seat of the self, laced with as many billions of neurons as the galaxy has stars. No wonder the mere notion of aging, the failing brain and the prospect of memory loss, confusion, and the unraveling of our personality  is so terrifying. About a third of all people age 60 and over have recall problems that are noticeable to them and are measurable with testing. At least a quarter of people age 85 and up suffer from dementia – loss of memory and cognitive function and an inability to understand words, carry out motor activities, and recognize or identify objects.

Yet the degeneration of the brain is far from inevitable. “Its design features are such that it should continue to function for a lifetime,” says Zaven Khachaturian, Ph.D., director of the Alzheimer’s Association’s Ronald and Nancy Reagan Research Institute. “There is no reason to expect it to deteriorate with age, even though many of us are living longer lives.” In fact, scientists’ view of the brain’s potential is rapidly changing according to Sanford University neuroscientist Robert Sapolsky, Ph.D. Thirty-five years ago we thought Alzheimer’s disease was a dramatic version of normal aging. Now we realize it’s a disease with a distinct pathology. In fact, some people simply don’t experience any mental decline, so we have begun to study them.”

So what’s the secret to keeping our brains agile and fit? Activity and exercise, lung function, and feelings of self-sufficiency and being surrounded by family and friends. See Psychology Today and related links about the foundation and cornerstones of Successful Aging.



CDC: One in Five Kids Lives with a Mental Health Issue

From NAMI Top Story
by Stephanie Dinkmeyer, NAMI Communications Intern

Millions of American children are living with mental disorders. Reports and studies have shown that it’s nearly one in five. But a newly published six-year study from the Centers for Disease Control and Prevention (CDC) shed some light on the specifics behind the numbers.

Between 2005 and 2011, the CDC collected data from studies performed by theSubstance Abuse and Mental Health Services Administration (SAMHSA), theNational Institute of Mental Health (NIMH),  the Health Resources and Services Administration (HRSA), and others, concerning mental disorder diagnoses in children aged 3 to 17. The report also revealed a decrease in substance use disorders in children aged 12 to 17 from 2002 to 2011.

The study covers a breadth of disorders, including but not limited to ADHD,depressionanxiety, substance use disorders and Tourette’s syndrome. ADHD was the most common disorder to affect the children studied, at 6.8 percent. Tourette’s syndrome was the least common, at less than 0.5 percent. The study also revealed gender disparities. ADHD and conduct disorders such as oppositional defiant disorder (ODD) are more common in boys; over twice as common in the latter case. Autism spectrum disorders (ASD), too, are more prevalent in boys. Mood disorders, however, are shown to be more common in girls. While depression is just as prevalent in both genders, inequalities arise with age. Girls aged 14 to 16 are more likely to have been diagnosed or currently diagnosed with depression. This data is consistent with the fact that adult women are more prone to depression.

The report’s focus on mental health also included surveys about adolescent’s drug, alcohol and tobacco use. Although 1.7 million adolescents (classified as 12 to 17 year olds) are diagnosed with a substance use disorder every year, this number is almost a 2 percent decrease since 2002. The CDC’s source for this data, the National Survey on Drug Use and Health (NSDUH), differentiates between substance dependence and substance use disorder based on criteria such as tolerance, emotional and physical problems associated with the substance, withdrawal symptoms, and legal trouble.

As the first exhaustive report of childhood mental disorders of its kind, the CDC’s report has proven to be a critical first step in understanding the children affected. Although the new and controversial Diagnostic and Statistical Manual of Mental Disorders (DSM-5) may have an impact on the approach to these disorders in the years ahead, the groundwork for providing effective services to children and their families has been laid.

New Analysis Compares 15 Antipsychotics

From APA Psychiatric News Alert: An analysis of 212 clinical trials of 15 antipsychotic medications found that all were significantly more effective than placebo, and the differences between them in efficacy were “small but robust.” The study, which was published online yesterday in Lancet, included data from randomized controlled trials involving more than 43,000 participants. In addition to assessing efficacy, the study also analyzed discontinuation of the medications and their side effects.

The researchers found that clozapine, amisulpride, and olanzapine showed, respectively, the greatest efficacy, while lurasidone and iloperidone showed the least. Assessment of all-cause discontinuation (when compared with placebo) showed that the best drug on this measure was amisulpride, and the worst was haloperidol. For extrapyramidal side effects, clozapine had the best odds ratio, and haloperidol the worst, while for sedation, amisulpride had the highest odds ratio, and clozapine the worst. Weight gain was also evaluated in comparison with placebo, and haloperidol was linked with the least weight gain, and olanzapine with the most. The researchers said as well that their findings “challenge the straightforward classification of antipsychotics into first-generation and second-generation groupings. Rather, hierarchies in the different domains should help clinicians to adapt the choice of antipsychotic drug to the needs of individual patients.”

To read about decision making in choosing a psychoactive medication, see the From the Experts column in Psychiatric News here.

Intra-Family Bullying Bad for Kids’ Mental Health

From Psychiatric News Alert
The Voice of the American Psychiatric Association
and the Psychiatric Community

Bullying by brothers or sisters against their siblings is as bad as that from outsiders and is associated with worse children’s and adolescents’ mental health. A national sample of 3599 youth and caregivers reported greater mental health distress in the prior year if they experienced psychological, property, or mild or severe physical assault by their siblings, wrote Corinna Jenkins Tucker, Ph.D., of the Department of Family Studies, University of New Hampshire in Durham.

Sibling physical aggression was nearly as harmful as that by non-family peers, and combined aggression from within and outside the family caused nearly double the level of distress.

“Sibling aggression is not benign for children and adolescents, regardless of how severe or frequent… An implication of our work is that parents, pediatricians, and the public should treat sibling aggression as potentially harmful and something not to be dismissed as normal, minor, or even beneficial. The mobilization to prevent and stop peer victimization and bullying should expand to encompass sibling aggression as well.”

Tucker et al., in the July issue of the journal Pediatrics.

For more in Psychiatric News about bullying, click here.