 
Article Date: 08 Sep 2010 – 2:00 PDT
Acamprosate reduces the number of patients being treated for alcoholism who return to drinking, according to a new Cochrane Systematic Review. The drug showed moderate benefits in trials when used in addition to non-drug treatments.
Drinking too much alcohol increases the risk of ill health. According to the World Health Organization, alcohol misuse is at the root of around a quarter of all cases of oesophageal cancer, liver disease and epilepsy, as well as road accidents and homicides. Acamprosate and naltrexone are drugs used alongside psychosocial methods to help prevent relapse in alcoholics who are trying to stop drinking.
The researchers reviewed data from 24 randomised controlled trials, considered the gold standard for clinical studies. Altogether these trials involved 6,915 alcohol dependent patients who were also undergoing psychosocial therapies. Acamprosate prevented relapse in one in every nine patients who had stopped drinking and increased the number of days patients spent not drinking by an average of three days a month. The researchers showed that the risk of a patient on acamprosate returning to drinking was 86% of that of a patient who took a placebo instead. Diarrhoea was the only side effect that was more frequently reported under acamprosate than placebo.
“Acamprosate is certainly no magic bullet, but it is a safe and effective treatment for patients who are trying to stop drinking,” said lead researcher Susanne Rösner of the Psychiatric Hospital at the University of Munich, Germany. “The benefits we have seen in these trials are small. However, we must remember that these are additional benefits on top of those from other non-drug therapies.”
The researchers stress the need to respect a patient’s right to choose by providing all the necessary information about the benefits and drawbacks of the drugs when recommending a therapeutic strategy. “Patients’ doubts and reservations against a strategy that uses one substance to treat dependency on another should be taken seriously, while interventions that have been shown to work should not kept back from patients,” said Rösner.
Sources: Wiley – Blackwell, AlphaGalileo Foundation.
 
Written by Nestor Lopez-Duran PhD on Wednesday, September 8.2010
The New York Times recently released two interesting reports about mental health issues in young children. The first examined the concept of preschool depression (see also here for one of our previous reviews about depression in young children). The second examined the practice of prescribing antipsychotic medications in young children. Both articles touched on an issue that is always present in all discussions about early childhood mental health: how do we differentiate between symptoms of a psychiatric disorders and normative behaviors that are expected at certain ages? Are we simply pathologizing childhood when we diagnosed conditions such as ADHD or Oppositional Defiant Disorder?Â
This debate is not limited to public discussions between some fringe anti-psychiatry movement and clinicians/researchers. Even clinicians vary to the extent that they are comfortable with diagnosing a young child with a psychiatric disorder. When I talk to my students about this issue I push them to take a pragmatic perspective. I ask two questions: 1) what evidence would you like to see that would make you conclude, with certainty, that a true disorder is present or not? And 2) if the disorder is present, what is the utility of the diagnosis?
Although there are many answers to these questions, most students focus on two issues. Is there continuity of this disorder/symptoms/behaviors? That is, if you diagnose a child with X, does the child continue to show the same symptoms over time? The assumption is that if the symptoms are temporary, it is possible that the symptoms are part of a normal phase of childhood (e.g., a physically aggressive 2 year old child). In contrast, if the symptoms become chronic over time, then it is more likely that we are not just seeing kids being kids, but that instead we are looking at something more serious. The second issue most students focus on is impairment. If the symptoms cause or lead to real impairment in the child’s educational, social, or family life (or occupational life in the future), then it is likely that we are not simply observing kids being kids. The assumption here is that normative behaviors in childhood should not lead you to experience significant impairment, such as getting arrested, being unable to make friends, being unable to attend school, etc. Both of these issues help us understand the question of utility: if a disorder is chronic and cause impairment, then providing a diagnosis may help the child obtain the right type of intervention and hopefully alter the disorder’s course.
In the recent issue of the Journal of Child Psychology and Psychiatry, Dr. Kate Kennan and a multidisciplinary team from multiple universities reported the results of a very timely study on the stability of Oppositional Defiant Disorder (ODD) and Conduct Disorder (CD) in early childhood. The authors wanted to examine what happen to children who are diagnosed with ODD or CD in early childhood. Specifically, how many of these kids continue to have ODD or CD 1, 2, or 3 years later. In essence, if a preschool child is diagnosed with ODD or CD, what are the odds that he/she will continue to show the same behaviors in the future?
To answer these questions the authors followed 223 preschoolers over a period of 3 years. This group included 123 kids who were referred to a clinic because of problems with aggression, defiance, or controlling temper. The rest served as a comparison group and were recruited from pediatrician offices. The children underwent a structured diagnostic interview at the beginning of the study, as well as 12, 24, and 36 months later.
The results:
Below is a graph showing the number of kids who continued to have the disorder or symptoms during the follow up period of the study.
As you can see, 84 children were diagnosed with ODD at intake. From these, 82% continued to have the disorder some time during the follow up period (anytime during the 12, 24, and 36-month evaluation). About 17% had some symptoms of ODD in the future, and only 1% didn’t show any symptoms of ODD during follow up.  This sounds pretty discouraging but if you break the results by “follow up period†the results are not as grim. Specifically, of the kids diagnosed with ODD at the start of the study, 72% had the diagnosis after 12 months, 66% had it after 24 months, 52% had it after 36 months. That is, about ½ of the preschoolers diagnosed with ODD will continue to have ODD 3 years later.
The case with conduct disorder is very similar. 72 children were diagnosed with CD at intake. From these, 61% continued to have the disorder some time during the follow up. About 30% had some symptoms of CD in the future, and 8% didn’t show any symptoms of CD during follow up. Breaking down the data by year: Of the kids diagnosed with CD at the start of the study, 48% had the diagnosis after 12 months, 33% had it after 24 months, 26% had it after 36 months. That is, about 1/4 of the preschoolers diagnosed with CD will continue to have CD 3 years later.
 
Wednesday 8 September, 2010
More than 7,000 community treatment orders (CTOs) for people with a mental illness have been issued to date – a far higher number than was expected, experts have said.
The surge raises concerns about the number of people under compulsory treatment for mental health issues, according to a study from the Mental Health Alliance.
Patients detained in hospital can be discharged under CTOs and supervised by a doctor, nurse or social worker.
Care plans include medication and therapeutic treatments, but can also include detail to restrict a patient’s movements.
If a patient refuses to take medication, they can be sent back to hospital.
The report said the Department of Health significantly underestimated CTO use in the first 12 months following their introduction in November 2008.
Rather than the expected 400 to 600, around 4,000 CTOs were issued across England and Wales in the first year, and more than 6,000 had been issued by the end of March this year. “The (total) number is likely to have risen to over 7,000 by the end of July 2010, with some 4,000 to 5,000 patients under a CTO at that date,” the study said.
The report pointed to “serious concerns” about the increase, including the “disproportionate use” of CTOs for people from black and minority ethnic communities and the possibility people are being discharged from hospital earlier than they should be. Experts also pointed to shortcomings in community support and delays for patients in obtaining second opinions to authorise treatment.
Alison Cobb, chair of the Mental Health Alliance, said: “We are concerned about the large numbers of people made subject to CTOs, given their coercive nature and the limited international evidence for positive effects.”
A spokeswoman for the Department of Health said: “We welcome this report. Community treatment orders are a potentially useful tool when used properly. But we must all remain vigilant to ensure that they are not being used unnecessarily or ineffectively. In the months ahead, we will be working across Government to reshape the mental health strategy to set clear outcomes and offer a roadmap for delivering them.”
Source:Â http://uk.news.yahoo.com/21/20100907/thl-concern-over-mental-health-orders-d831572.html
 
September 5th, 2010 3:03 pm MT
Imagine meeting a man that has memorized and recited correctly over 22,000 digits of Pi. Imagine him telling the story of how he successfully learned Icelandic in seven days. Imagine him telling of the difficulties of being an autistic savant, but also the great opportunities and accomplishments that have accompanied it.
Imagine meeting Daniel Tammet.
Tammet was diagnosed with Asperger’s syndrome, a rare form of autism, at the age of twenty-five. With this syndrome Tammet is able to accomplish amazing mental feats, all of which he has written about in his first memoir, Born on a Blue Day: Inside the Extraordinary Mind of an Autistic Savant.
In his book, Tammet describes how he “sees†numbers as shapes and colors and explains how he can calculate math equations in a matter of seconds. He also writes about his experience meeting Kim Peek, the famous autistic savant in which Dustin Hoffman’s character in the film Rain Man was based off. All of the accounts written about allow readers to explore the mind of an autistic savant, to learn about autism and how it affects people and their families, and to recognize that everyone has a talent to share.
Read in Full:Â http://www.examiner.com/writing-in-idaho-falls/an-autistic-savant-s-remarkable-story
 
By Diana Costello • dcostell@lohud.com • September 8, 2010
PLEASANTVILLE — Just days after a film based on her life story earned HBO five Emmy Awards, Temple Grandin took the stage at Pace University to impart her own words of wisdom to an enraptured crowd of roughly 3,000 students and fans.
And she had plenty to say.
In succinct bursts, the accomplished advocate for those with autism spoke out on a range of topics including her disdain for derivatives trading, the need for more science teachers in high school, the faults of modern health care
and the outsourcing of creative labor.
She even disparaged President Barack Obama’s Labor Day call to upgrade the nation’s roads, rail lines and runways to help spur job creation, saying it should have been done two years ago.
One thing she didn’t do as the keynote speaker for the convocation event was boast.
“We need to get back into doing real stuff,” she said, railing against ideology.
As a woman who grew up with autism during a time when it was gravely misunderstood, Grandin today is one of the world’s most famous activists and successful professionals with the developmental disorder.
Drawing on her own abilities as an extremely visual learner — “Without a picture, I can’t think,” she said — Grandin has been a pioneer in the understanding of animals, designing humane handling systems that are used in half of the nation’s cattle-processing facilities.
This winter, HBO aired a feature-length film on her early years starring actress Claire Danes.
Titled “Temple Grandin,” the film received five awards at the Aug. 29 Emmys, including “Outstanding Made for Television Movie” and “Best Actress in a Drama.”
Grandin made no mention of winning the awards while speaking at Pace, though she did praise Danes and others involved for capturing her story so accurately.
“Temple Grandin is an inspiration to every single person in this room,” said Pace University President Stephen J. Fiedman. “Just imagine being born in a world of people who don’t think like you.”
Read in Full:Â http://www.lohud.com/article/20100908/NEWS02/9080323/Fresh-off-her-Emmy-Award-buzz-Temple-Grandin-speaks-at-Pace-University
 
The Australian Psychological Society (APS) congratulates Julia Gillard on her re-appointment as Prime Minister of Australia and looks forward to working productively with the Gillard government to address pressing community issues including health reform.
“This government is coming in at a time when the community is facing major challenges,” APS president Professor Bob Montgomery said. “The APS is calling on this new government to address those challenges including inclusive health reform, improving access to mental health care and addressing the impact of climate change on the community.”
He said that strong leadership would ensure that key issues were addressed including ensuring the delivery of treatment for common mental health disorders, providing schools and students with fully trained school psychologists, ensuring fair quality of life for those with a disability, as well as addressing issues such as the psychological wellbeing of asylum seekers, closing the gap in Indigenous health and managing the effects of climate change.
Professor Montgomery said that through their work with many Australians, from infants through to the elderly, psychologists and the APS were acutely aware of the need for major reforms, which could make a significant difference to improved health care, community wellbeing and national productivity.
There are over 24,000 psychologists in Australia. With over 19,000 members and 40 Branches across the country, the Australian Psychological Society (APS) is the largest of all the non-medical health professional associations in Australia and represents the largest mental health and psychological workforce.
He said the APS had access to a vast pool of psychological expertise from both academic and professional service delivery perspectives that could assist in the reforms across a range of policy areas.
“We hope to work productively with the government and the APS believes we can contribute expertise that will lead to a better healthier Australia,” Professor Montgomery said.
 
Using ultrasound and a minimally-invasive procedure, radiologists can identify and treat patients who engage in a disturbing self-injury behavior known as self-embedding, according to a new study published in the online edition and October print issue of the journal Radiology.
“This is a new way for radiologists to impact public and mental health,” said the study’s senior author, William E. Shiels II, D.O., chairman of the Department of Radiology at Nationwide Children’s Hospital in Columbus, Ohio, and president of The Children’s Radiological Institute. “Radiologists can be in a position to interrupt a cycle of self-harm with effective, early diagnosis and referral for appropriate behavioral health and foreign body removal.”
Self-injury, or self-harm, refers to a variety of behaviors in which a person intentionally inflicts harm to his or her body without suicidal intent. It is a disturbing trend among adolescents, particularly girls. Prevalence is unknown because many cases go unreported, but recent studies have reported that one in five high school students has practiced deliberate self-injury at least once. More common forms of self-injury include cutting of the skin, burning, bruising, hair pulling, breaking bones or swallowing toxic substances. In cases of self-embedding, objects are used to puncture the skin or are embedded into the wound after cutting.
Dr. Shiels and colleagues studied 21 episodes of self-embedding behavior in 11 teenagers, including nine girls and two boys, age 14 to 18. Objects had been present for time periods between 2 days and an unknown number of years. Using ultrasound and/or fluoroscopic guidance, interventional pediatric radiologists removed 68 of the 76 embedded foreign objects found in the patients. The embedded objects included metal, glass, wood, plastic, graphite, crayon and stone. The objects were embedded during injuries to the arms, ankles, feet, hands and neck. One 18-year-old patient with repetitive behavior had self-embedded 35 objects over two years, including staples, a comb tooth, a fork tine, a cotter pin and nail polish wands.
Ultrasound guidance allowed the researchers to detect the presence and location of wood, crayons and plastic objects, not detectable on x-ray examinations. Removal was performed through small incisions in the skin that left little or no scarring and was successful in all cases. There was one incident of fragmentation, but all fragments were removed.
“Early detection and removal of these foreign bodies are key steps for these teenagers to engage in effective therapy and interrupt their cycle of self-harm, so they can recover and grow as healthy and successful adults with good coping skills,” Dr. Shiels said.
“Self-embedding Behavior: Radiologic Management of Self-inserted Soft-Tissue Foreign Bodies.” Collaborating on this paper with Dr. Shiels were Adam S. Young, B.S., James W. Murakami, M.D., Brian D. Coley, M.D., and Mark J. Hogan, M.D.
 
 
I have found what is reportedly the first description of a hallucinogenic ‘magic mushroom’ trip in the Western medical literature. It is from a 1926 paper on different types of mushroom poisoning that was published in the Journal of Pharmacology and Experimental Therapeutics and was written by William. W. Ford.
He lists various types of poisoning, including stomach upsets, cramps, vomiting and convulsions, but the final category is where he tackles the effects of what are now known as ‘magic mushrooms’ that contain the naturally occurring hallucinogenic drug psilocybin.
5. Mycetismus cerebralis. Here the patients show peculiar cerebral symptoms four or five hours after the fungi are eaten. They are greatly exhilarated, laugh immoderately on slight occasion, develop a staggering gait and show peculiar disturbances of vision. The symptoms are transient, the patients being restored to health in twenty-four to forty-eight hours, except for a peculiar sensation which they describe as a feeling “as if they were walking on air.†This subjective sensation may last several days.
The plants responsible for this peculiar poisoning are Panaeolus papilionaceus and Panaeolus campanulatus. They are of interest to us chiefly in that they grow on lawns together with the edible mushroom, Agaricus campestris, and also rarely in beds for the artificial propagation of this species.
Although leaders of the psychedelic movement have created back histories about Western use of hallucinogenic mushrooms – suggesting they were used for spiritual purposes by druids, the Ancient Greeks, and folk healers to the present day – historian Andy Letcher has noted that the effects of these fungi have, as far as we know, always been treated as accidental poisoning.
Read in Full:Â http://mindhacks.com/2010/09/07/peculiar-disturbances-of-vision/
 
Treating Nausea: 12 Common-Sense TipsÂ
Nausea isn’t inevitable. You can minimize the most common causes — motion sickness, medications, and tainted food. And if a bout of nausea strikes, you can takes steps to relieve it. Follow these 12 tips.
Avoiding nausea …
- Eat smaller, more frequent meals at a slower pace. This will allow your stomach to digest foods at a reasonable rate.
- Be careful what you eat, especially while traveling in foreign or tropical locales. Don’t eat raw or undercooked meat or seafood or food that appears to have been sitting out for a long time. In countries with poor sanitation, don’t drink tap water or consume any fruits or vegetables that you can’t peel or boil before eating.
- Wash your hands frequently to cleanse away any bacteria or viruses.
- Monitor your medication use closely, particularly when you first start taking a drug, to see if it causes stomach upset. Often the nausea will go away within a few days or weeks of taking the medication. If nausea doesn’t go away, talk with your doctor.
- Avoid nausea by sitting in the front seat of a car, if possible, and don’t read while riding.
- If you’re in a boat, focus on a stationary object on the horizon and stay in the midsection of the ship, where it’s most stable. On a train, sit facing the direction in which the train is moving.
- Over-the-counter nausea drugs such as dimenhydrinate (Dramamine) and meclizine (Bonine) or the prescription medication scopolamine, which is available as a patch (Transderm Scop) or pill (Scopace), should be taken 30 to 60 minutes before you get in the vehicle to avoid nausea.
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Treating Nausea ..
- Rest. Activity can make your nausea worse, so rest as much as possible. If you’re experiencing motion sickness, stay as still as possible and get out of the vehicle as soon as you can.
- Sip clear fluids to settle your stomach. Chamomile, lemon balm, or ginger tea as well as ginger ale are good choices for nausea. If you’re vomiting, suck on ice cubes and drink water, broth, or sports drinks like Gatorade to prevent dehydration.
- Avoid strong food odors. Many odors can worsen nausea, so avoid cooking, grocery shopping, or going to a restaurant.
- Eat bland foods, like crackers or dry toast, to absorb excess stomach acid. You should also avoid fatty, acidic, or spicy foods, which can upset the stomach further. Wait about six hours after the last time you vomited to eat solid food.
- Take antacids (Maalox, Rolaids, Tums) to neutralize stomach acid or bismuth subsalicylate (Kaopectate, Pepto-Bismol) to coat your stomach. Talk with your doctor if you’re taking prescription medications or aspirin; bismuth contains a drug similar to aspirin, so you could be taking a double dose without knowing it.
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