Sunday, January 15, 2017

Patients with panic disorder report more antidepressant side effects

Researchers at the University of Illinois at Chicago (UIC) looked at 808 patients with diagnosed chronic depression who were taking antidepressant medication.  Within this group, there was a subgroup of 85 people who also had a diagnosis of panic disorder. It is common for patients to have more than one clinical diagnosis. It goes by the ominous term, comorbidity.
In this study, the researchers found that if a patient had both depression and panic disorder, they reported more medication side effects, such as:
• gastrointestinal (47 percent vs. 32 percent)
• cardiovascular (26 percent vs. 14 percent)
• neurological (59 percent vs. 33 percent)
• genital/urinary (24 percent vs. 8 percent) 

In the press release lead author, Stewart Shankman, professor of psychology and psychiatry at UIC stated:

People with panic disorder are especially sensitive to changes in their bodies. It’s called ‘interoceptive awareness.’

Because these patients experience panic attacks — which are sudden, out-of-nowhere symptoms that include heart racing, shortness of breath, and feeling like you’re going to die — they are acutely attuned to changes in their bodies that may signal another panic attack coming on. So it does make sense that these tuned-in patients report more physiological side effects with antidepressant treatment.

Often patients with hyperawareness of their bodies tend to report many more symptoms and worries than the non-hyperaware patient. Dr. Shankman points out:
Physicians and therapists should be aware that their patients with panic disorder may report more side effects, and they should do a thorough assessment of these side effects to try to tease out what might be the result of hypersensitivity, or what might be a side effect worth switching doses or medications for.

Please let me know what you think by clicking the “comments” below.

Tuesday, January 10, 2017

Can antibiotics effect mental status?

An interesting report crossed my desk today. It was published in MedScape Psychiatry.
Antibiotics and Mental Status Changes
All medication can potentially change your mental status, the way you think, feel, or react. In this article, pharmacists from Albany Medical Hospital, Albany NY review this question.
They point out:
Any change in mental status should always prompt a review of medications as a potential contributing factor. Antimicrobials, a drug class that is an often-overlooked etiology, have been associated with a wide range of neurologic symptoms, including sedation, sleep disturbance, confusion, delirium, seizures, mood changes, psychosis, and hallucinations.

A chart of drugs and risk factors is included.

Monday, November 21, 2016

FYI: eye injury quiz

Let’s start off with a little FYI quiz:
What group is most likely to be seen by hospital emergency departments in the United States for chemical eye injuries?
  1. Men working in janitorial and building maintenance.
  2. Woman working in janitorial and building maintenance.
  3. Children under age 2
  4. College students

The answers is: children under the age of 2
Researchers published in the August 2016, JAMA Ophthalmology, reported that children under the age of 2 are at highest risk for ocular (eye) chemical injuries. Most injuries occur in the home.
Spray cleaning bottles, detergents, and cleansers are curiosities for inquisitive toddlers. Nail polish remover, alcohol based hand sanitizes, and vinegar can be damaging to the eye. 
Out in the garage, common items like gasoline, tire rim cleaner, laundry detergent, and plant fertilizers are potentially dangerous as well.
Keeping such items up and away from children is advised. 
The American Academy of Ophthalmology offers advice for preventing eye injury.

Please let me know what you think by clicking the “comments” below.

Monday, November 14, 2016

Sports are good for kids, but early specialization is problematic

I see kids in my office that are focused or pushed by their parents to be superstar athletes, academic savants, musical prodigies, or all three. One mom recently told me that without a football scholarship, her son, age 9, wouldn’t be able to pay for college. 
I advise parents to let sports be fun, good exercise, and a social activity. Every now and then this gets me growled at by a parent who reminds me that Tiger Woods started at age 4. 
AAP warns against sports specialization
Sports specialization is becoming more common, with kids being focused in one sport by well meaning parents or coaches. 
The report by the American Academy of Pediatrics notes:
The norm has become for children and adolescents to participate in organized sports driven by coaches and parents, often with different goals for the game than its young participants. It is also less common now to have a multisport athlete in middle or high school, because the norm has become for young athletes to specialize in a single sport at younger ages. There is increased pressure to participate at a high level, to specialize in 1 sport early, and to play year-round, often on multiple teams. 

Why not specialize in one sport?
If practice makes perfect, doesn’t it make sense that more practice in one sport gives a child the best chance at stardom, fame, and fortune?
But, there is a real concern that children that focus too early are more likely to have overuse injuries and emotional burnout. Often parents push their gifted athletes to perform so that the parents can get their personal needs met.
The AAP reports, “Young athletes who specialize too soon are at risk of physical, emotional, and social problems.”
The report includes a nine point “Guidance for the Pediatrician”, to help doctors discuss this issue with parents. Even if you are not a pediatrician I advise you to read this section:
Guidance for the Pediatrician, from AAP

When a pediatrician encounters athletes younger than 18 years who are considering specialization or have already specialized, the following guidance for the athlete, parents, and coaches can be helpful.

1. The primary focus of sports for young athletes should be to have fun and learn lifelong physical activity skills.

2. Participating in multiple sports, at least until puberty, decreases the chances of injuries, stress, and burnout in young athletes.

3. For most sports, specializing in a sport later (i.e., late adolescence) may lead to a higher chance of the young athlete accomplishing his or her athletic goals.

4. Early diversification and later specialization provides for a greater chance of lifetime sports involvement, lifetime physical fitness, and possibly elite participation.

5. If a young athlete has decided to specialize in a single sport, discussing his or her goals to determine whether they are appropriate and realistic is important. This discussion may involve helping the young athlete distinguish these goals from those of the parents and/or coaches.

6. It is important for parents to closely monitor the training and coaching environment of “elite” youth sports programs (Malina RM. Children and adolescents in the sport culture: the overwhelming majority to the select few. J Exerc Sci Fit. 2009;7(2 suppl):S1–S10) and be aware of best practices for their children’s sports.

7. Having at least a total of 3 months off throughout the year, in increments of 1 month, from their particular sport of interest will allow for athletes’ physical and psychological recovery. Young athletes can still remain active in other activities to meet physical activity guidelines during the time off.

8. Young athletes having at least 1 to 2 days off per week from their particular sport of interest can decrease the chance for injuries.

9. Closely monitoring young athletes who pursue intensive training for physical and psychological growth and maturation as well as nutritional status is an important parameter for health and well-being.

US Olympic Committee
The US Olympic Committee and others recommend the American Development Model:
The 5 stages they created include the following:
1. Discover, Learn, and Play (ages 0–12 years)
2. Develop and Challenge (ages 10–16 years)
3. Train and Compete (ages 13–19 years)
4. Excel for High Performance or Participate and Succeed (ages ≥15 years)
5. Mentor and Thrive (for Life)

[Team USA. American Development Model. Available at: Accessed December 15, 2015]

Overall I recommend focusing on your child’s needs and not pushing sports, but rather enjoying sports. 

Monday, November 7, 2016

Denial or stigma keep many adults from getting help for depression

A study published in the journal JAMA Internal Medicine (8/2016) notes that:
Despite recent increased use of antidepressants in the United States, concerns persist that many adults with depression do not receive treatment, whereas others receive treatments that do not match their level of illness severity.

The study screened 46,000 Americans for depression finding that about 8 percent showed diagnosable symptoms. On follow-up, only 1 in 3 were getting treatment. 
The reasons for the gap in treatment were complicated. Some respondents avoided care because of stigma or denial. Others had limited access and/or lack of insurance. 
The researchers point out:
…critical treatment gaps persist, especially for racial / ethnic minorities, low income individuals, less educated adults, and uninsured people.

Monday, October 31, 2016

Teens Think e-Cigarettes Are Safe

Philip Copitch, Ph.D. – Author of Life's Laws For New Adults: Mastering Your Social I.Q.

In the October 2016 journal, Pediatrics, researchers evaluated the numbers from the 2012 and 2014 National Youth Tobacco Survey. This cross-sectional survey of 6th to 12th grade students looked at how students perceived the harm and addictiveness of e-cigarettes. 
Inside the e-cigarette
It is documented that electronic cigarettes (e-cigarettes) are now the most commonly used tobacco product by American youth.
E-cigarettes are battery powered devices that heat a liquid containing nicotine and often a flavoring. This warm vapor is inhaled.
Teens are unaware of the dangers of e-cigarettes. 
About 3 of every 4 students believed that e-cigarettes were less dangerous than paper and tobacco cigarettes. Just under half believed that e-cigarettes were less addictive than cigarettes. 
Read the research paper.
More information: E-cigarettes and Lung Health (American Lung Association)