Tuesday, September 17, 2013

More Surprising Findings from the Psychiatry Literature

As we did on my posts of November 30, 2011 and October 2, 2012, it’s once again time to look over the highlights of the latest issues of my two favorite medical journals, Duh! and No Sh*t, Sherlock. 

As I pointed out in those posts, research dollars are very limited and therefore precious. Why waste good money trying to study new, cutting edge or controversial ideas that might turn out to be wrong, when we can study things that that are already thought to be true but have yet to be "proven"?  Such an approach increases the success rate of studies almost astronomically. And studies with positive results are far more likely to be published than those that come up negative.

So, we have a lot of academics weighing in with studies on the obvious. Literally weighing in. Since academic promotions are often based on the quantity of papers, rather than their quality, schools might measure faculty members' progress towards tenure by calculating the physical weight of the paper on which their authored articles have been written. 

If Albert Einstein had only published his two papers on relativity - which literally changed the entire field of physics forever - that obviously would not have been anywhere near enough for him to get tenure at most universities these days.

So here we go with more fantastic additions to our knowledge base.


Early Drinking Associated With Problem Drinking Later

MedPage Today (8/16, Petrochko) reports, "Students who started drinking and getting drunk at an early age were more likely to engage in frequent heavy drinking and associated problems by senior year of college," according to a study published online Aug. 15 in the journal Alcoholism: Clinical and Experimental Research. "A longitudinal analysis of incoming college freshmen showed a significant association not only between younger drinking age and heavy drinking, but also with difficulties in work and school, blackouts, vomiting, and other problems by senior year (P<0.001 for all)," researchers reported.

So self destructive behavior has its roots in childhood experiences, eh?  Someone please tell the psychoanalysts.

And on a related note:

Youth With Conduct Disorder More Likely to Abuse Substances

5/15/13.   A longitudinal study of youth with and without conduct disorder (CD) finds that the former are significantly more likely to abuse substances. The findings are published in the May Journal of the American Academy of Child and Adolescent Psychiatry. Researchers from the University of Colorado prospectively followed 1,165 community-dwelling adolescents without CD, 194 youth in the community with CD, and 268 youth who were in treatment for CD. They were re-interviewed during young adulthood, and self-reports on age of substance initiation for 10 substance classes were analyzed.

Gee, I wonder if family problems and adverse childhood environments lead to both antisocial behavior AND substance abuse? That just never occurred to me before. 

Depression, Mania In Bipolar Disorder Have Differential Social Adjustment Effects
1/23/12.  Medwire (1/23, Cowen) reports, "Results from a UK study show that depression and mania symptoms have specific and differential effects on social adjustment in patients with bipolar disorder (BD). Richard Morriss (University of Nottingham) and team found that depression symptoms have a negative effect on performance and interpersonal behavior, while mania symptoms increase interpersonal friction."

And to think that I used to be under the impression that other people would react to hyperactive, impulsive, hypersexual people in exactly the same way as they would to someone who doesn’t even want to get out of bed or have sex with someone lying naked in the bed next to them.

High Doses of Opioids May Impair Driving

Drivers taking 20 mg of morphine or more per day, or the equivalent, are up to 42% more likely to be involved in road trauma than drivers taking the lowest doses of opioids, according to a new study from the Keenan Research Center of the Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada.

Higher doses of intoxicants lead to more impairment than lower doses?  Who knew?

Anger Due To Delusions May Explain Violent Behavior In Patients With Psychosis

In print and in its "Well" blog, the New York Times (3/11/13) reports that "a new study finds that anger, coupled with psychotic delusions, may be the most significant factor in violence committed by people with mental illness." Medwire (3/12, Piper) reports, "Anger due to delusions appears to be a key factor explaining violent behavior in patients with acute psychosis," according to the results of the 458-patient East London First Episode Psychosis Study published online March 6 in JAMA Psychiatry.  

So people with paranoid delusions that make them feel angry or threatened are more likely to become violent than when they are not experiencing those reactions. So are such people actually psychotic if they act just like everyone else would?

Handling Stress Poorly May Increase Long-Term Risk For Anxiety/Mood Disorders

USA Today (4/4/13) reports that handling "stress poorly...may put you at greater risk for anxiety disorders and other mental health issues 10 years later," according to a study published online in the journal Psychological Science. Researchers from the University of California-Irvine "analyzed data on 711 men and women, ages 25 to 74, who were interviewed two times 10 years apart." Investigators found that "people who responded to stress with more anxiety and sadness than the average person were much more likely to have self-reported anxiety/mood disorders and psychological distress 10 years later."

Oh I get it now! Anxiety is caused by stress. That’s a remarkable insight.

And on a related note:

Association Between Mood and Alcoholism

The Los Angeles Times (5/2/13) A study that was published May 1 in JAMA Psychiatry, found that individuals "who drank 'to alleviate mood symptoms' were three times more likely to become dependent on alcohol than were those who did not use alcohol to calm themselves down or improve their mood."

And mood symptoms are also related to stress, leading to abuse of a psychoactive substance!?!  Even more remarkable.


And we also just learned that actively trying to solve problems rather than just ignoring them is the better way to go. Now that’s counter-intuitive:

Small Study: Way Of Dealing With Emotions Linked To Anxiety Levels

The Time (5/13/14) "Healthland" blog reports, "When faced with a challenge, whether you deny the problems it poses or dive in to solve them in a positive way may determine how much anxiety you feel overall," according to research published in Emotion. The investigators "found that the participants who regularly reframed what was happening to them to view their situation in a better light reported less severe anxiety than the participants who suppressed their emotions in trying situations."

And finally, the question of whether or not the prospect of dying or of someone you love dying leads to psychological distress has at long last been settled by two recent studies.

Parents of Children with Cancer Show High Psychological Distress
5/17/13. A group of researchers associated with several pediatric oncology treatment facilities has published one of the first studies to describe the experience of distress in parents of children with advanced cancer. The researchers found that psycho­logical distress was associated with par­ent perceptions of prognosis, goals of therapy, their child's symptoms/suffer­ing, and financial hardship.


   Anxiety May Be Common Among Cancer Patients, Spouses

7/12/13.  The New York Times (7/12, Hoffman) “Well” blog reports that an analysis published in the Lancet Oncology indicates that “within two years of a cancer diagnosis, the pervasiveness of depression in patients and their spouses tends to drop back to roughly the same levels as in the general population, only to be replaced by another mind-demon: anxiety, which can even intensify as time passes.”

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