Schizophrenia Tied to Teen Brain Changes By PSYCH CENTRAL NEWS EDITOR Reviewed by John M. Grohol, Psy.D.

on January 2, 2012 http://www.news-medical.net/news/20100504/Mood-and-anxiety-disorders-associated-with-poorhealth-outcomes.aspx Teenagers who have been diagnosed with schizophrenia or similar psychotic disorders sometimes show a greater decrease in gray matter volume compared to healthy teens, according to new research. The new study also found that adolescents with schizophrenia showed an increase in cerebrospinal fluid in the frontal lobe of their brain. Progressive loss of brain gray matter has been reported in childhood-onset schizophrenia, the authors note in the new study. However, it is uncertain whether these changes are shared by pediatric patients with different psychoses. The study was conducted by Celso Arango, M.D., Ph.D., of the Hospital General Universitario Gregorio Maran, Madrid, Spain, and colleagues, and was designed to examine the progression of brain changes in first-episode early-onset psychosis in teens. The research also wanted to look at the relationship to diagnosis and prognosis after two years. The patients in the study were drawn from six child and adolescent psychiatric units in Spain. The authors performed magnetic resonance imaging (MRI) of the brain for 61 patients (25 diagnosed with schizophrenia, 16 with bipolar disorder and 20 with other psychoses) and 70 healthy control participants. MRI scans were conducted at the onset of the study, and then again after two years. Compared with control patients, those diagnosed with schizophrenia showed greater gray matter volume loss in the frontal lobe during the two-year follow-up. Patients with schizophrenia also showed cerebrospinal fluid increase in the left frontal lobe. Additionally, changes for total brain gray matter and left parietal gray matter were significantly different in patients with schizophrenia compared with patients in the control group. Among patients with schizophrenia, progressive brain volume changes in certain areas were related to markers of poorer prognosis, such as more weeks of hospitalization during follow-up and less improvement in negative symptoms. Greater left frontal gray matter volume loss was related to more weeks of hospitalization whereas severity of negative symptoms correlated with cerebrospinal fluid increase in patients with schizophrenia.

The study could not determine whether the brain changes were a result of the schizophrenia, or whether schizophrenia was the result of the brain changes. The authors did not find any significant changes in patients with bipolar disorder compared to control patients, and longitudinal brain changes in the control group were consistent with the expected pattern described for healthy adolescents. In conclusion, we found progression of gray matter volume loss after a two-year follow-up in patients who ended up with a diagnosis of schizophrenia but not bipolar disease compared with healthy controls, the authors write. Some of these pathophysiologic processes seem to be markers of poorer prognosis. To develop therapeutic strategies to counteract these pathologic progressive brain changes, future studies should focus on their neurobiological underpinnings. The new study appears in the January 2012 issue of the journalArchives of General Psychiatry. Source: JAMA APA Reference News Editor, P. (2012). Schizophrenia Tied to Teen Brain Changes. Psych Central. Retrieved on January 8, 2012, from http://psychcentral.com/news/2012/01/02/schizophrenia-linked-toteen-brain-changes/33178.html

Ketamine reduces depression in treatment-resistant bipolar disorder: Study

Published on August 3, 2010 at 2:02 AM No Comments http://www.news-medical.net/news/20100504/Mood-and-anxiety-disorders-associated-with-poorhealth-outcomes.aspx

A single intravenous dose of the anesthetic agent ketamine appears to reduce symptoms of depression within 40 minutes among those with bipolar disorder who have not responded to other treatments, according to a report in the August issue ofArchives of General Psychiatry, one of the JAMA/Archives journals. "Bipolar disorder is one of the most severe psychiatric disorders and ranks in the top 10 causes of medical disability worldwide," the authors write as background information in the article. About 4 percent of Americans will develop bipolar disorder in their lifetimes, and depressive symptoms dominate for most of the course of the illness. Several treatments for bipolar depression are currently approved, but some patients do not respond to these therapies despite adequate trials. In addition, existing treatments are associated with a lag of onset; most patients do not respond within the first week of therapy, resulting in considerable illness and increased suicide risk.

One reason for the lack of better therapies is a limited understanding of the neurobiological basis of bipolar disorder, the authors note. However, recent research suggest dysfunction in the brain's glutamatergic system which plays a role in information processing and memory formation may contribute. Nancy Diazgranados, M.D., M.S., and colleagues at the National Institute of Mental Health, Bethesda, Md., assessed the effectiveness of one modulator of this system ketamine hydrochloride, commonly used as an anesthetic for bipolar depression.

From October 2006 through June 2009, 18 participants with bipolar depression that had failed to respond to the medications lithium or valproate received an intravenous infusion of either ketamine or a placebo on two test days two weeks apart. The order of the infusions was randomly assigned. Participants were assessed using a depression rating scale before each injection and then 40, 80, 120 and 230 minutes and one, two, three, seven, 10 and 14 days afterward. Within 40 minutes, those who received ketamine experienced a significant improvement in depressive symptoms compared with those who took placebo, an improvement that was largest at day two and remained significant through day three. At some point during the course of the trial, 71 percent of participants responded to ketamine and 6 percent responded to placebo. "These findings are particularly noteworthy because a substantial proportion of study participants had been prescribed complex polypharmacy regimens in the past with substantial treatment failures," the authors write. "The mean [average] number of past antidepressant trials was seven, and more than 55 percent of participants failed to respond to electroconvulsive therapy. The toll of this protracted and refractory illness on the subjects was evident, in that twothirds of participants were on psychiatric disability and nearly all were unemployed." No serious adverse effects were reported during the study. The results lend support to the hypothesis that the glutamatergic system is implicated in the development of bipolar disorder, and that targeting it may lead to improved therapies. "Future research will need to address whether differences in kinetics associated with intravenous administration which allows for faster absorption and avoids hepatic metabolism are important or necessary for rapid antidepressant effects to occur," the authors write. In addition, "future studies should examine strategies for long-term maintenance of ketamine's rapid antidepressant response." SOURCE Archives of General Psychiatry

Media reporting can reduce impact of infectious disease outbreaks

Published on September 17, 2010 at 4:42 AM http://www.news-medical.net/category/DiseaseInfection-News.aspx At the first sign of a disease pandemic, public health officials should begin strongly communicating about the extent of the outbreak and the steps that can be taken by the public to avoid infection. That's the recommendation of two mathematical biologists who have modified the most widely used infectious disease transmission model to account for the impact of news media coverage. During outbreaks of serious infectious diseases, many individuals closely follow media reports and as a result, take precautions to protect themselves against the disease. These precautions may include staying home, getting vaccinated, avoiding crowds, using disinfectants, canceling travel plans and wearing face masks. Known as "self-isolation," these precautions can significantly reduce the severity of an outbreak, according to mathematical modeling done by researchers at the Georgia Institute of Technology and Marshall University in Huntington, West Virginia. "The more forcefully the media provides information about pandemic infections and deaths, the more the total number of infections is reduced," said Howard Weiss, a professor in the Georgia Tech School of Mathematics. "Media coverage also reduces the maximum number of infections at any particular time, which is important for allocating the resources needed for treating infectious diseases." The benefit of publicly reporting disease outbreaks seems obvious, and public health officials in the United States have a policy of regularly communicating with the news media about such incidents. But according to Weiss, not all world governments choose to communicate so well and nobody had used rigorous mathematical techniques to study the impact of that communication before. Epidemiologists use the S-I-R model to anticipate the effect of disease outbreaks. The basic model places individuals into one of three groups signified by each letter of the acronym:
Susceptible individuals are those that are vulnerable to the disease;
Infected individuals are those who have the disease;
Removed individuals are those who are not in the other groups because they have been vaccinated, have isolated themselves from the population, have already recovered from the disease - or have died. Weiss and collaborator Anna Mummert, an assistant professor of mathematics at Marshall University, modified that model to take into account ways that individuals could move from the "Susceptible" group to the "Removed" group without passing through the "Infected" group. By "self-isolating" as a result of news media warnings, they reasoned, individuals could move directly into the "Removed" class because they are no longer susceptible.

"On a chart showing the number of infected people at any one time, as you increase the intensity of the media coverage, you substantially decrease the number of infections," Weiss noted. "We are assuming that people self-isolate at a rate that is proportional to the amount of media coverage, though we would like to study that in more detail." The sooner the media coverage of a pandemic begins, the fewer individuals will ultimately be infected. But Weiss said the model shows that almost any media coverage is helpful at reducing the extent of a pandemic. "Telling the public always helps, but the longer you wait, the less it helps," he said. "If you wait long enough, the effect of media coverage is essentially negligible." In a paper about the model submitted to a biostatistics journal and posted on the Physics arXiv blog, Mummert and Weiss describe testing their model with a hypothetical outbreak of Ebola Hemorrhagic Fever in Huntington - a college community of about 50,000 residents. They also tested the model on a long-term infection - HIV, the virus that causes AIDS. In the case of pandemics that occur over a long period of time, regular coverage by the news media may be required to maintain a lower infection rate. In their model, Mummert and Weiss did not look at such issues as the quality of news coverage, or what may happen if news reports turn out to be false or overstated. They also didn't study the effect of individuals occasionally leaving their isolation to purchase food or medicine, for instance. The paper cites the case of a false rumor spread across the Internet in 2003 about a restaurant worker in New York's Chinatown who had supposedly died of the SARS infection. That rumor led to a decrease in travel to that area. Likewise, they note, a recommendation from the Centers for Disease Control and Prevention in 2003 to avoid nonessential travel to SARS-infected nations led to a dramatic reduction in travel to those areas. Weiss acknowledges that strong communications about such dreaded diseases as Ebola could create public panic. In those rare cases, public health officials will have to weigh the benefits against the risks. "In general, our advice to public health officials anywhere in the world is not to hold back," he added. "They should get out the news about infectious disease outbreaks loudly and quickly. It's clear that vigorous media reporting can have a substantial effect on reducing the impact of an outbreak." SOURCE Georgia Institute of Technology and Marshall University