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Psychology, psychiatry and mental health news and research findings, every weekday.
Updated: 1 hour 17 min ago

New Technique May Aid Diagnosis of Autism

Wed, 07/10/2019 - 6:00am

While prevention of autism remains elusive, early detection of autism can make a significant difference in the lives of children and their families. New research utilizes an infrared eye-tracking device to help improve the accuracy and timeliness for detection of autism spectrum disorder (ASD) in children.

In the study, University of Waterloo researchers characterized how children with ASD scan a person’s face differently than a neuro-typical child. Based on the findings, investigators were able to develop a technique that considers how a child with ASD transitions his or her gaze from one part of a person’s face to another.

According to the developers, the use of this technology makes the diagnostic process less stressful for the children and if combined with existing manual methods could help doctors better avoid a false positive autism diagnosis.

The study appears in the journal Computers in Biology and Medicine.

“Many people are suffering from autism, and we need early diagnosis especially in children,” said Mehrshad Sadria, a graduate student in Waterloo’s Department of Applied Mathematics.

“The current approaches to determining if someone has autism are not really child-friendly. Our method allows for the diagnosis to be made more easily and with less possibility of mistakes.

“The new technique can be used in all ASD diagnosis, but we believe it’s particularly effective for children.”

In developing the new technique, the researchers evaluated 17 children with ASD and 23 neuro-typical children. The mean chronological ages of the ASD and neuro-typical groups were 5.5 and 4.8, respectively.

Each participant was shown 44 photographs of faces on a 19-inch screen, integrated into an eye-tracking system. The infrared device interpreted and identified the locations on the stimuli at which each child was looking via emission and reflection of wave from the iris.

The images were separated into seven key areas of interest (AOIs) in which participants focused their gaze: under the right eye, right eye, under the left eye, left eye, nose, mouth and other parts of the screen.

The researchers wanted to know more than how much time the participants spent looking at each AOI, but also how they moved their eyes and scan the faces. To get that information, the researchers used four different concepts from network analysis to evaluate the varying degree of importance the children placed on the seven AOIs when exploring the facial features.

The first concept determined the number of other AOIs that the participant directly moves their eyes to and from a particular AOI. The second concept looked at how often a particular AOI is involved when the participant moves their eyes between two other AOIs as quickly as possible.

The third concept is related to how quickly one can move their eyes from a particular AOI to other AOIs. The fourth concept measured the importance of an AOI, in the context of eye movement and face scanning, by the number of important AOIs that it shares direct transitions with.

Currently, the two most favored ways of assessing ASD involve a questionnaire or an evaluation from a psychologist.

“It is much easier for children to just look at something, like the animated face of a dog, than to fill out a questionnaire or be evaluated by a psychologist,” said Dr. Anita Layton. Layton is a professor of Applied Mathematics, Pharmacy and Biology at Waterloo and is Sadria’s supervisor.

“Also, the challenge many psychologists face is that sometimes behaviors deteriorate over time, so the child might not display signs of autism, but then a few years later, something starts showing up.

“Our technique is not just about behavior or whether a child is focusing on the mouth or eyes. It’s about how a child looks at everything.”

Source: University of Waterloo

Migraine May Up Risk of Complications in Pregnancy, Childbirth

Tue, 07/09/2019 - 6:30am

A new Danish study finds that migraines in pregnant women are linked to higher blood pressure, caesareans, preterm births, abortions and babies with low birth weight.

“The study shows that pregnant women with migraine more often have complications in connection with their pregnancy and childbirth than women who don’t suffer from migraine,” said lead author Nils Skajaa, B.Sc., a researcher at the department of clinical epidemiology at Aarhus University and Aarhus University Hospital in Denmark.

“Newborn babies whose mothers suffered from migraine during pregnancy also have an increased risk of complications such as respiratory distress and febrile seizures.”

The researchers used the Danish health registers to identify more than 22,000 pregnant women with migraine who were in contact with a hospital as a result of their migraine or had received at least two prescriptions for migraine medication.

The migraine group was compared with an approximately 10 times larger group of pregnant women without known migraine.

The researchers found that the risk of having a caesarean section was between 15 to 25 percent higher for pregnant women with migraine compared with pregnant women without migraine. Around 20 percent of all births in Denmark are by caesarean section.

The team used the same data to conclude that migraine medication possibly prevents some of the complications. However, the results must be interpreted with caution,  researchers said.

“The study was not specifically designed to examine this aspect. However, we show that the risk of complications generally was lower for pregnant women with migraine who took medication when compared with the pregnant women with migraines who were not treated,” said Skajaa.

“This also indicates that the migraine medication isn’t the cause of the complications, but rather the migraine itself. This is important knowledge for pregnant women with migraines.”

Migraines are relatively common and affect twice as many women as men. The actual cause remains unknown, but previous research suggests that migraines may be triggered by stress, fatigue, or hormonal changes such as pregnancy.

Migraines have also been linked to psychiatric disorders, such as depression, bipolar disorder and attention-deficit hyperactivity disorder (ADHD).

“Paradoxically, women of childbearing age are particularly hard hit by migraines. Although experience shows that migraines become milder during pregnancy, this study emphasises that the health care service should be particularly aware of pregnant women with migraine,” Skajaa said.

The findings are published in the journal Headache.

Source: Aarhus University

For Many, Honest But Biased News is Less Credible

Tue, 07/09/2019 - 6:00am

“Fake,” or untruthful, news may not be the only way an information source can lose credibility with consumers. A new study finds that any information seen as biased is often deemed as less trustworthy, even when the consumer believes the source is scrupulously honest.

“If you want to be seen as a credible source, you have to be objective, as well as honest and knowledgeable,” said Dr. Laura Wallace, lead author of the study and postdoctoral researcher in psychology at The Ohio State University.

The findings, published in the journal Personality and Social Psychology Bulletin, are important because most research has suggested that source credibility is a combination of trustworthiness and expertise. Bias had not been considered or was viewed as part of trustworthiness.

“I use the example of grandparents,” Wallace said. “Most everyone agrees that grandparents are honest. But if Grandma says that her grandson Johnny is the best soccer player around, most people will smile politely but not believe her. She’s obviously biased.”

For the research, Wallace conducted several experiments with Ohio State psychology professors Drs. Duane Wegener and Richard Petty.

In one study, 169 undergraduate students read a fictitious conversation between highly trained aid workers trying to decide how to distribute resources at the beginning of an Ebola outbreak in the Congo. They had to decide whether to allocate limited resources to Rutu, a rural area where the outbreak started, or Poko, a nearby city where the disease had spread.

One aid worker, Roger, advocated for sending resources to Rutu. For some participants, Roger was also described as having worked in that area as a Peace Corps volunteer; information that might indicate that he is biased. For other participants, this information was omitted, leaving no indication of bias.

After reading the conversation, participants completed a questionnaire in which they evaluated the aid workers’ proposals.

The results showed that when Roger was described as having a previous connection to Rutu, participants thought Roger was biased in his recommendation to send aid to Rutu — even though they also believed he was trustworthy, an expert in the field, and likable.

As a result, study participants who read that Roger had previously worked in the area thought his suggestion to send aid to Rutu was less credible.

“The guys in this scenario are all trying their best to contain this Ebola outbreak, they all know what they’re doing, and they are all seen as very honest,” Wallace said. “But people believe that Roger’s experience in one of these regions is affecting his judgment and that he just can’t see things objectively.”

The findings suggest that bias may damage credibility, just as untrustworthiness does. But that doesn’t mean that bias and untrustworthiness always have the same consequences.

“In the case of biased, but honest sources, the information they present might only support one side of the issue, but at least people can treat the information as useful for understanding that side,” Wallace said.

“Untrustworthy sources may never be that useful.”

Furthermore, the difference between a biased source and an untrustworthy source has a big impact if the source changes positions. In a different study that has not yet been published, the same researchers found that when untrustworthy sources change their position, it does not make them any more or less persuasive.

“Untrustworthy sources are seen as unpredictable. You can’t tell what position they are going to take and it is not seen as meaning anything if they flip-flop,” she said.

But the study found that it was quite surprising when biased sources changed their positions on an issue. This surprise had a positive effect on persuasion.

“People believe there must be new evidence that is really compelling to get a biased source to change positions and take the opposite side,” Wallace said. “So there are sometimes differences in how effective biased sources are compared to untrustworthy ones.”

Wallace noted that the researchers used unique situations in the studies so that participants couldn’t have pre-existing beliefs about them. As a result, the study can’t say how people with their own biases would react to sources with similar or opposing biases.

But, she said, previous research has shown that people tend to believe that those who agree with them are less biased than those who disagree with them.

Source: Ohio State University

 

Canadian Study: Concussion Twice as Prevalent as Once Thought

Mon, 07/08/2019 - 6:00am

New research shows that concussions are more common than we thought.

Researchers at Toronto Rehabilitation Institute-University Health Network discovered that150,000 Ontario residents — 1.2 percent of the province’s population — are diagnosed with a concussion each year. That’s almost twice as high as previously recorded, and may represent a closer estimate of the true picture of concussion in Ontario, they say.

“Past research has looked at the incidence of concussion by examining a particular population, cause of injury, or use a single reporting source, such as records from the Emergency Department. This can under-represent estimates of the real incidence of concussion,” said lead author Laura Langer.

“Our study revealed concussion rates that are almost double what has been previously reported, and highlights the critical importance of looking at everyone who sought medical attention for their concussion.”

Using the ICES Data Repository, a province-wide archive that integrates multiple clinical and administrative health databases, the researchers looked at concussion rates in Ontario between 2008 and 2016.

They discovered:

  • about 150,000 Ontarians experience a concussion each year;
  • children under 5 years old experience the highest rate of concussion among all Ontarians;
  • adults over 65, especially women, experience a higher rate of concussion than younger adults;
  • 26 percent all of concussions are diagnosed in the summer;
  • rural communities experience a higher rate of concussion than non-rural communities; and,
  • although most concussions are diagnosed in the Emergency Department, more and more patients with concussion symptoms are visiting their own doctors.

According to the researchers, the high rate of reported concussions is influenced by a number of factors, including increased public awareness from athletes and the media, new mandatory reporting laws, and the release of numerous diagnostic and management guidelines for physicians and patients.

As patients increasingly look to their own doctors for a diagnosis, the researchers say there is a need to continue raising awareness about causes and symptoms, and a growing obligation to educate doctors on concussion care.

Additionally, one in seven Ontario residents with a concussion will experience persistent, post-concussive symptoms. That means it is “critical to develop tools to identify who will face long-term problems, so we can individualize early treatments to prevent long-term complications,” researchers said in the study, which was published in the Journal of Head Trauma Rehabilitation.

Source: University Health Network

Walking on Treadmill Can Reduce Period Pain, Improve Quality of Life

Sat, 07/06/2019 - 6:50am

A new study shows that walking on a treadmill on a consistent basis can reduce period pain and improve long-term quality of life.

For the study, women between the ages of 18 and 43 were asked to take part in a supervised aerobic training regime three times a week for four weeks, beginning the day after the end of their menstrual period, followed by unsupervised home exercise for six months. Their results were compared with a control group, who carried out their usual regimes.

The study found that the women who took part in the supervised exercise reported 6 percent less pain after four weeks and 22 percent less pain in the six months of doing the exercise on their own.

Significant benefits of exercise were reported after the seven-month reporting period for other study measures, including higher quality of life and improved daily functioning, researchers reported. However, the participants did not report any increase in sleep quality following the trial.

“Women who have painful periods often take steps to actively avoid exercise,” said Dr. Leica Claydon-Mueller, a Senior Lecturer at Anglia Ruskin University in the UK. “After all when you are in pain it is often the last thing that you want to partake in.

“However, this trial demonstrated that exercise significantly reduced pain for those people taking part in the program, and they also reported reduced pain levels after four and seven months,” she continued.

“The improvements in quality of life scores after seven months were noteworthy, although it was perhaps surprising that there was no significant difference in sleep quality to that of the control group,” added Dr. Priya Kannan of Hong Kong Polytechnic University. “These multiple benefits might be considered a ‘package deal’ by women. The evidence supporting the use of aerobic exercise for managing pain, improving quality of life, and improving daily functioning has been strengthened by the findings from this research.”

The study was published in the journal Contemporary Clinical Trials.

Source: Anglia Ruskin University

Many People with Pain, Insomnia May Be Turning to Legal Cannabis

Sat, 07/06/2019 - 6:30am

A new study finds that a large number of adults who buy legalized cannabis have been able to cut back or completely quit taking their pain and/or sleep prescription drugs.

The findings, published in the Journal of Psychoactive Drugs, add weight to the theory that widening access to medical cannabis could reduce the use of prescription painkillers, allowing more people to manage and treat their pain without relying on opioid prescription drugs.

For the study, the researchers surveyed 1,000 people who purchased cannabis from two Colorado retail stores: 65% of the participants reported buying cannabis for pain and 74% for insomnia.

Among those taking cannabis for pain, 80% found it to be very or extremely helpful. In addition, this led to 82% of these individuals being able to reduce or stop taking over the counter pain medications, and 88% were able to stop taking opioid painkillers.

Among those taking cannabis for insomnia, 84% said it was a helpful sleep aid, and more than 83% of these said they had been able to reduce or stop taking over-the-counter or prescription sleep aids.

“Approximately 20% of American adults suffer from chronic pain, and one in three adults do not get enough sleep,” said Dr. Gwen Wurm, Assistant Professor of Clinical Pediatrics at the University of Miami Miller School of Medicine.

Traditional over the counter medications and painkillers can help, but they often have serious side effects. For example, opioids depress the respiratory system which can be fatal in large doses.

“People develop tolerance to opioids, which means that they require higher doses to achieve the same effect,” said Dr. Julia Arnsten, Professor of Medicine at Albert Einstein College of Medicine. “This means that chronic pain patients often increase their dose of opioid medications over time, which in turn increases their risk of overdose.”

Sleeping pills can also lead to dependence as well as cause grogginess the next day, interfering with people’s work and social lives. As a consequence, some people are looking to cannabis to help with their symptoms.

To find out more about people who have started buying cannabis for pain and/or insomnia, the researchers used survey data from people who purchased cannabis from two retail stores in Colorado, where it is legal for both medical and recreational use — meaning any adult over 21 with a valid government ID may purchase product.

“In states where adult use of cannabis is legal, our research suggests that many individuals bypass the medical cannabis route (which requires registering with the state) and are instead opting for the privacy of a legal adult use dispensary,” says Wurm.

Although the survey was conducted among customers willing to participate — meaning the results may not reflect the overall population of dispensary customers — other national survey data, and data from medical patients at medical cannabis dispensaries, also show that people who use cannabis to treat symptoms both decrease and stop their use of prescription medications.

In fact, previous research has shown that states with medical cannabis laws have a 6.38% lower rate of opioid prescribing, and that Colorado’s adult-use cannabis law is associated with a relative reduction in opioid overdose death rate from 1999 to 2010.

“Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen cause GI bleeding or kidney damage with chronic use. Paracetemol (Acetaminophen) toxicity is the second most common cause of liver transplantation worldwide, and is responsible for 56,000 ER visits, 2600 hospitalizations, and 500 deaths per year in the U.S,” said Wurm.

Still, the researchers say that more research is needed to better understand the health benefits and side effects of cannabis.

“The challenge is that health providers are far behind in knowing which cannabis products work and which do not. Until there is more research into which cannabis products work for which symptoms, patients will do their own trial and error experiments, getting advice from friends, social media and dispensary employees,”  Wurm said.

Source: Taylor & Francis Group

Reminding Kids of Their Many Roles in Society May Improve Problem Solving

Sat, 07/06/2019 - 6:00am

Simply reminding children of their many roles in society — helper, friend, neighbor, son or daughter — can lead to better problem-solving and more flexible thinking, according to a new study at Duke University.

“This is some of the first research on reminding kids about their multifaceted selves,” said lead author Dr. Sarah Gaither, an assistant professor of psychology and neuroscience at Duke. “Such reminders boost their problem-solving skills and how flexibly they see their social worlds, all from a simple mindset switch.”

After considering their own various identities, children showed more flexible thinking about race and other social groupings, which could be valuable in an increasingly diverse society.

The study involved a series of experiments with 196 children, ages 6 and 7. All were native English speakers.

In one experiment, the first group of children was reminded they have various identities, such as son, daughter, reader or helper. A second group of children was reminded of their multiple physical attributes (such as a mouth, arms and legs).

In another experiment, one group of children was again reminded they have various identities. A second set of children received similar prompts but about other children’s many roles, not their own.

All of the children were then given a series of tasks to complete. Children who were reminded of their various identities demonstrated stronger problem-solving and creative thinking skills.

For example, when shown pictures of a bear gazing at a honey-filled beehive high up in a tree, these children had more creative ideas for how the bear might reach the honey, such as flipping over a bowl so that it becomes a stool. In other words, they saw a new use for the bowl.

Children who were reminded of their multiple roles also demonstrated more flexible thinking about social groupings. When asked to categorize different photos of faces, they suggested many ways to do so. For instance, they identified smiling faces versus unsmiling ones, and old versus young faces. The other children, meanwhile, primarily grouped people’s faces by race and gender.

The findings suggest simple ways to encourage flexible, inclusive thinking for the young, and this could be especially valuable for teachers, Gaither said.

“We have this tendency in our society to only think about ourselves in connection with one important group at a time,” Gaither said.

“When we remind kids that they have various identities, they think beyond our society’s default categories, and remember that there are many other groups in addition to race and gender. It opens their horizons to be a little more inclusive.”

The findings are published in the journal Developmental Science.

Source: Duke University

 

Specific Factors Influence Long-Term Effects of Bullying

Fri, 07/05/2019 - 7:30am

New research suggests some young adults who were bullied as a child could have a greater risk of ongoing depression due to a mix of genetic and environmental factors. In the study, University of Bristol investigators sought to determine why some people respond differently to risk factors such as bullying, maternal postnatal depression, early childhood anxiety and domestic violence.

Investigators especially targeted factors that influence depression in young adults between the ages of 10 and 24. To do this, they reviewed detailed mood and feelings questionnaires and genetic information from 3,325 teenagers who are part of Bristol’s Children of the 90s study.

Researchers compared risk factors and mood feelings at nine points in time. From this review, they found that childhood bullying was strongly associated with trajectories of depression that rise at an early age.

Children who continued to show high depression into adulthood were also more likely to have genetic liability for depression and a mother with postnatal depression. However, children who were bullied but did not have any genetic liability for depression showed much lower depressive symptoms as they become young adults.

University of Bristol PhD student Alex Kwong explains:

“Although we know that depression can strike first during the teenage years, we didn’t know how risk factors influenced change over time. Thanks to the Children of the 90s study, we were able to examine at multiple time points the relationships between the strongest risk factors such as bullying and maternal depression, as well as factors such as genetic liability.”

Researchers believe the study findings help to identify which children are more at risk of depression long after any childhood bullying has occurred.

“Our study found that young adults who were bullied as children were eight times more likely to experience depression that was limited to childhood. However, some children who were bullied showed greater patterns of depression that continued into adulthood and this group of children also showed genetic liability and family risk.

“However, just because an individual has genetic liability to depression does not mean they are destined to go on and have depression. There are a number of complex pathways that we still don’t fully understand and need to investigate further,” explains Kwong.

“The next steps should continue to look at both genetic and environmental risk factors to help untangle this complex relationship that would eventually help influence prevention and coping strategies for our health and education services.”

Dr Rebecca Pearson, a lecturer in Psychiatric Epidemiology at the University of Bristol explains that the results can help us to identify which groups of children are most likely to suffer ongoing symptoms of depression into adulthood and which children will recover across adolescence.

“For example, the results suggest that children with multiple risk factors (including family history and bullying) should be targeted for early intervention but that when risk factors such as bullying occur in isolation, symptoms of depression may be less likely to persist.”

Karen Black, Chief Executive Officer for Bristol’s Off the Record adds: “At Off The Record we see a diverse mix of young people presenting with a range of needs, often depression and anxiety. Understanding some of the factors that influence this will further help us to shape services and our offer for young people.

I would also hope that studies such as these will help change policy direction and spending so that we start to get upstream of the issues that we know affect mental health including education and family, prevention rather than cure ideally.”

The study, “Genetic and environmental risk factors associated with different trajectories of depression symptoms from adolescence to young adulthood,” appears in JAMA Open Network.

Source: University of Bristol

Underlying Motivations Influence Expression of Emotions

Fri, 07/05/2019 - 7:00am

New research reveals that a person’s emotional reaction to a situation is linked to the degree to which they are motivated to feel or not feel certain emotions about the situation. This insight challenges the belief that a person’s emotions are influenced automatically — in an unconscious, immediate response to other people’s emotions.

In the study, Stanford psychologists examined why some people respond differently to an upsetting situation. Their study found that when participants wanted to stay calm, they remained relatively unfazed by angry people, but if they wanted to feel angry, then they were highly influenced by angry people.

The researchers also discovered that participants who wanted to feel angry also got more emotional when they learned that other people were just as upset as they were, according to the results from a series of laboratory experiments the researchers conducted.

Their findings reveal that people have more control over how their emotions get influenced than previously realized, the researchers said. The study appears in the Journal of Experimental Psychology: General.

“We have long known that people often try to regulate their emotions when they believe that they are unhelpful,” said James Gross, a professor of psychology at Stanford’s School of Humanities and Sciences.

“This set of studies extends this insight by showing that people can also regulate the way they are influenced by others’ emotions.”

To learn how people react to upsetting situations and respond to others around them, the researchers examined people’s anger toward politically charged events in a series of laboratory studies with 107 participants. The team also analyzed almost 19 million tweets in response to the police shooting of Michael Brown in Ferguson, Missouri, in 2014.

In the laboratory studies, the researchers showed participants images that could trigger upsetting emotions, for example, people burning the American flag and American soldiers abusing prisoners in Abu Ghraib prison in Iraq. The researchers also told participants how other people felt about these images.

The researchers found that participants who wanted to feel less angry were three times more likely to be more influenced by people expressing calm emotions than by angry people.

But participants who wanted to feel angry were also three times more likely to be influenced by other people angrier than them, as opposed to people with calmer emotions.

The researchers also found that these participants got more emotional when they learned that others also felt similar emotions to them.

“The degree to which people said they were motivated to feel or not feel certain emotions predicted how much they would be influenced when they were exposed to emotions from other group members,” said Amit Goldenberg, the lead author on the study and a Stanford doctoral candidate in psychology.

Investigators also looked at social media where they could see how emotions played out in real time. To do this, they focused on the unrest that emerged on Twitter following the shooting of Michael Brown in Ferguson, Missouri, in 2014.

After analyzing almost 19 million Twitter posts, the researchers found that Twitter users were more influenced by stronger emotions expressed by people in their social network compared to weaker and calmer reactions.

They also found that when Twitter users responded to tweets that were similar in emotional intensity to their earlier reactions, the users amplified their emotions to express stronger outrage than others in their social network.

“The social dimension of emotions, particularly in response to socio-political events, is becoming increasingly important with the use of social media and people’s constant exposure to the emotions of others in online platforms,” wrote the study’s authors.

Historically, researchers have largely assumed that people’s emotions get influenced automatically — in an unconscious, immediate response to other people’s emotions, said Goldenberg. His team’s new research challenges that perspective, he said.

“Our emotions are not passive nor automatic,” Goldenberg said.

“They are a little bit of a tool. We have the ability to use our emotions to achieve certain goals. We express certain emotions to convince other people to join our collective cause. On social media, we use emotions to signal to other people that we care about the issues of a group to make sure people know we’re a part of it.”

Further research needs to be done in order to understand the relationship between people and their emotions. One area of future investigation is whether the desire of people to want to see and experience certain emotions around them lies at the core of how they choose their network of friends and other people around them.

“It seems that the best way to regulate your emotions is to start with the selection of your environment,” Goldenberg said.

“If you don’t want to be angry today, one way to do that is to avoid angry people. Do some people have an ingrained preference for stronger emotions than others? That’s one of my next questions.”

Source: Stanford University

Parents Play Key Role in Preparing Autistic Teens for Driving

Fri, 07/05/2019 - 6:30am

When parents of teens with autism prioritize independence, it can significantly help prepare their children for driving, according to a new study published in the journal Autism in Adulthood.

The study, compiled by researchers at Children’s Hospital of Philadelphia (CHOP), involved in-depth interviews with specialized driving instructors who have worked specifically with young autistic drivers.

“What these specialized driving instructors told us about the disconnect between driving and other life skills was surprising,” said Benjamin E. Yerys, PhD, study author and psychologist at the Center for Autism Research at Children’s Hospital of Philadelphia.

“Some parents may not let their autistic adolescents use a stovetop oven, but are asking if their teens are ready to drive. Whether or not their children decide to drive, parents should encourage greater independence by encouraging them to get around on their own. Traveling independently by driving or other modes of transportation is key to continuing their education, working, and staying connected with friends and family.”

Driving instructors are an important resource for families, particularly for those with autistic teens learning to drive. However, because not much is known about the specific experience of teaching autistic teens how to drive, there are very few resources available to provide adolescents and families with proper guidance for the learning-to-drive process.

To help bridge this gap, researchers conducted in-depth interviews with specialized driving instructors who had experience working with autistic adolescents and young adults. The study is the first to examine the process and experience of driving instructors who provide behind-the-wheel training specifically for this population.

The findings reveal that driving instructors view parents as essential partners in supporting their efforts in teaching driving skills and promoting independence.

Participating instructors said parents can support and prioritize independence by encouraging their autistic adolescents to develop life skills, such as mowing the lawn, cooking, and taking public transportation, before learning to drive.

The driving instructors note that specific approaches must be tailored to meet the unique needs of each autistic adolescent driver, reflecting the spectrum that affects each adolescent differently.

“Through our interviews with specialized driving instructors, we learned they believe parents are a critical partner in preparing for and undertaking independent driving,” said Rachel K. Myers, PhD, lead author of the study and scientist at the Center for Injury Research and Prevention at Children’s Hospital of Philadelphia (CHOP).

“Instructors recommend that parents help their children develop independent life skills, including the use of alternative forms of transportation such as bicycling or mass transit, and to practice pre-driving skills, such as navigation, before undertaking on-road driving lessons.”

Other suggestions include the use of state-level vocational rehabilitation services to provide financial support for instruction, identifying and promoting prerequisite life skills prior to undertaking driving, parent-supervised driving instruction in partnership with professional driving instruction, and tailoring instruction to address the particular needs of learner drivers.

According to previous CHOP research, nearly one-third of autistic adolescents obtain a driver’s license by the time they are 21 years old, which may improve their ability to transition into independent adulthood.

The study was conducted by a multidisciplinary team of researchers from CHOP’s Center for Injury Research and Prevention, Center for Autism Research, and Division of Emergency Medicine, as well as the University of Pennsylvania School of Nursing and the Virginia Tech Transportation Institute (VTTI).

Source: Children’s Hospital of Philadelphia

Complex Moral Lessons in Kids’ TV Shows May Require Extra Explanations

Fri, 07/05/2019 - 6:00am

Young children appear to benefit from straight-forward explanations of the more subtle or complex moral lessons often presented in animated television programs, according to new research from the University of California (UC), Davis.

In two separate studies, researchers monitored more than 100 children (ages 4 to 6) of various ethnicities from urban and rural areas in the United States and the Netherlands as they watched popular children’s television shows.

They found that in some instances, watching a TV show positively influenced children’s sense of fairness and right and wrong, such as with theft or interpersonal violence. More complex or nuanced ideas, however, proved difficult for them to comprehend. In many cases, the lessons even backfired, causing children to behave poorly in their own lives because they didn’t understand the nuanced solutions being presented in the show.

For this reason, researchers recommend that children’s programs contain inserts with brief but explicit explanations or discussions of the lessons presented in the program, such as inclusion. When researchers experimented with inserted explanations, children’s responses improved.

“Just putting 30 seconds of explanation in the program helped the children to understand what the lessons were in a 12-minute segment,” said Drew P. Cingel, UC Davis assistant professor of communication and the lead author of the two recent studies.

He explained that the researchers’ inserts were simple, but presented messages literally rather than metaphorically, which promoted prosocial intentions and decreased stigmatization of others.

“This could make a big difference and has such practical implications. I just think of what a significant role media could have in child development — among children that need the most help — with this one improvement.”

Most of the children who did not see the explicit insert expressed more exclusionary attitudes toward other children. For example, in one of the study scenarios, a child was using crutches, another used a wheelchair, and yet another was obese. One child appeared to have an “average body type” without disabilities.

Most children who answered questions about these characters with disabilities said they were not as smart as others, and they expressed other negative feelings about the characters’ differences, suggesting that lessons of inclusivity may be difficult for many children to grasp.

Cingel said these misunderstandings made sense when one considers that in 12 minutes of content, children often see nine minutes of exclusionary behavior or a problem being presented with only three minutes or less of a solution.

This can lead to the child not resonating with the final solution in a positive way. For example, in most cases, the program reinforced or suggested stereotypes and increased stigmatization, rather than educating children to behave otherwise, especially when they viewed the show with other children.

Cingel hopes the research prompts changes in children’s programming. “I want this to matter in the lives of kids, not just academics,” he said.

The findings are published in the journal Communication Research.

Source: University of California- Davis

Suicidal Thoughts Linked to Pain in Those with Rheumatic or Musculoskeletal Disease

Fri, 07/05/2019 - 5:30am

A new survey highlights the significant impact of rheumatic and musculoskeletal diseases (RMDs) on mental health.

“Not enough is being done to identify mental health issues and provide the support needed to RMD patients,” said Professor Thomas Dörner, chairman of the Scientific Programme Committee for the European League against Rheumatism. “This survey highlights the huge importance of pain on the psychological well-being of RMD patients and the critical need to improve the support on offer. These results should act as a wake-up call to services across Europe.”

The survey of more than 900 RMD patients revealed that pain had caused one in 10 to have suicidal thoughts in the previous four weeks. Pain also caused 58 percent to feel that everything was unmanageable for them.

Another important finding was a reciprocal relationship between sleep and pain, where 69 percent identified the quality of their sleep as having a negative influence on their pain, according to researchers.

Two-thirds of patients reported rarely or never feeling fully rested when they woke up in the morning, with 36 percent taking painkillers to improve their sleep, they noted.

“Our study indicates that pain and poor quality of sleep have a huge impact on a patient’s daily life, especially on their mental health,” said Lene Mandrup Thomsen of the Danish Rheumatism Association in Denmark. “We are using the results of this study in our political work to help campaign for better treatment and support for patients with chronic pain in our healthcare system.”

Of the study’s participants, 83 percent had pain daily or several times a week and 46 percent had received strong painkillers over the last year. Despite a strong focus from Danish authorities on reducing their prescriptions, less than a quarter of respondents had been offered an alternative to strong painkillers, researchers report.

The results of the survey were presented at the 2019 Annual European Congress of Rheumatology (EULAR).

Results of another survey, also presented at EULAR 2019, support these findings by revealing a worrying lack of psychological care for patients with rheumatoid arthritis and adult juvenile idiopathic arthritis (AJIA) in the UK.

In this survey, 25 percent of the 1,620 people with rheumatoid arthritis or AJIA were experiencing clinical levels of anxiety or depression. Over half of these had never received a formal diagnosis.

Half of the respondents with rheumatoid arthritis and a third of those with AJIA who had either clinical levels or a formal diagnosis of anxiety or depression had never received any psychological support, according to the study’s findings.

“Our results highlight that, despite guidelines, many patients in the UK are not receiving the psychological support they need,” said Dr. Hayley McBain, a health psychologist at the University of London. “It is imperative for rheumatology services to routinely measure anxiety and depression in order to intervene before the individual is in crisis.”

This survey was conducted by the National Rheumatoid Arthritis Society in the UK and was designed by patients and researchers. Participants were recruited via social media platforms, membership and non-membership lists, and in newsletters and forums.

Source: The European League against Rheumatism

Treating Sleep Apnea Can Ease Depression Symptoms

Thu, 07/04/2019 - 8:02pm

A large Australian study has discovered that medical intervention for obstructive sleep apnea (OSA) can improve depression symptoms in patients suffering from cardiovascular diseases. The study is by far the largest trial of its type and one of very few studies reporting such an effect.

Using data from the Sleep Apnea Cardiovascular Endpoints (SAVE) trial led by Flinders University, researchers discovered treatment via continuous positive airway pressure (CPAP) for moderate-severe OSA among patients with cardiovascular disease has broad benefits in terms of preventing depression, independent of improved sleepiness.

The SAVE trial participants were recruited from more than 80 clinical centers in China, Australia, New Zealand, India, the USA, Spain and Brazil. Participants were predominantly overweight and older males, habitual snorers and had moderately severe OSA. Specific findings include:

  • the positive effect of CPAP treatment on depression symptoms was manifest within six months and persisted during the 3.7 years of follow-up;
  • the positive effect of CPAP treatment on depression symptoms was more pronounced in patients with lower mood scores prior to treatment.

Prior studies investigating the effect of CPAP on mood with various experimental designs and length of follow-up periods have yielded mixed results.

“Patients who have had a stroke or heart attack are prone to suffer from low mood and are 2 to 3 times more likely to develop clinical depression, which then further elevates their risk of future heart attacks and strokes,” said SAVE principal investigator and senior author Professor Doug McEvoy.

The study appears in The Lancet EClinicalMedicine.

With up to 50 percent of patients with CV disease likely to have OSA, the study is “welcome news that treatment of OSA substantially relieves cardiovascular patients’ depressive symptoms and improves their wellbeing.”

The paper’s first author, Dr. Danni Zheng, from the George Institute for Global Health (UNSW), said the 2687 OSA patients enrolled in the SAVE trial were based solely on their history of cardiovascular disease and not on their current mood status.

“After following them for an average of 3.7 years, we found that CPAP provided significant reductions in depression symptoms compared with those who were not treated for OSA. The improvement for depression was apparent within six months and was sustained.”

As expected, those with lower mood scores to start with appeared to get the greatest benefit.

“Our additional systematic review which combined the SAVE study findings with previous work provided further support of the treatment effect of CPAP for depression,” Zheng said.

Source: Flinders University/EurekAlert

Pesticide Exposure Tied to Teen Depression in Agricultural Areas

Thu, 07/04/2019 - 6:03am

Adolescents who are exposed to high levels of pesticides may be at greater risk for depression, according to a new study of Ecuadorian teens living in agricultural communities.

The findings, published in the journal International Journal of Hygiene and Environmental Health, suggest that the link is even stronger among girls and younger teens under 14 years.

Researchers from the University of California, San Diego, have been tracking the development of children living near agriculture in the Ecuadorian Andes since 2008. In this latest study, they observed 529 adolescents between the ages of 11 and 17.

Ecuador is the world’s third-largest exporter of roses, with much of the flower production located near the homes of the study participants. Like many other agricultural crops, flowers are routinely sprayed with organophosphate insecticides, which are known to affect the human cholinergic system, a key system in the function of the brain and nervous system.

To test exposure levels of children, the research team measured levels of the enzyme acetylcholinesterase (AChE) in the blood. Pesticides such as organophosphates and carbamates exert their toxicity by inhibiting AChE activity.

Previous research has demonstrated that cholinesterase inhibition is associated with behaviors of anxiety and depression in mice, and a few existing studies in humans have also suggested such a link; however, prior pesticide exposure research in humans has only been established by self-reported exposure and not through biological measures.

The new findings confirm the researchers’ hypothesis: Adolescents who had lower AChE activity — suggesting greater exposure to cholinesterase inhibitors — exhibited more symptoms of depression, which was measured using a standardized depression assessment tool.

Notably, the link between low AChE activity and depression was stronger for girls (who made up half of all participants) and for teens younger than 14 years.

“Agricultural workers and people in these communities have long offered anecdotal reports of a rise in adolescent depression and suicidal tendencies,” said study leader Jose R. Suarez-Lopez, M.D., Ph.D., assistant professor in the Department of Family Medicine and Public Health at the University of California, San Diego School of Medicine.

“This is the first study to provide empirical data establishing that link using a biological marker of exposure, and it points to a need for further study.”

Symptoms of teen depression may include irritability, severe feelings of sadness, loss of interest or pleasure in usual activities and feelings of worthlessness or guilt.

Source: University of California, San Diego

 

What Do Kids in The Hospital Really Want?

Wed, 07/03/2019 - 6:01am

What matters most to children staying in the hospital? A new study finds that the two strongest desires of hospitalized kids are feeling safe and being able to get to sleep at night.

Researchers from Edith Cowan University’s (ECU) School of Nursing in Australia developed the Needs of Children Questionnaire (NCQ), the first of its kind to measure children’s self-reported psychosocial, physical and emotional needs in pediatric wards. They assessed 193 school-aged children in pediatric settings in Australia and New Zealand.

Lead researcher Dr. Mandie Foster says the study fills a gap in our understanding of how children are feeling in hospital settings.

“Historically the literature on children’s needs and experiences within health care settings have been largely limited to surveys completed by adults answering for children,” said Foster, a nursing lecturer, research scholar and experienced pediatric nurse. “To our knowledge, no instrument has been available to assess the perception of the needs of school-aged children during a hospital stay.”

According to the findings, the children identified their most important needs as:

  • “to know I am safe and will be looked after;”
  • “to get enough sleep at night;”
  • “that staff listen to me;”
  • “to have places my parents can go to for food and drinks;”
  • “to have my mum, dad or family help care for me.”

Foster said it was important to let the hospitalized children speak for themselves.

“As adults, we often make assumptions about children’s needs and wants, but hospitals can be a scary and unfamiliar environment for many children and we shouldn’t assume we know how they are feeling,” said Foster.

“Being listened to and understood can give children an added sense of confidence about the situation they find themselves in. And from a medical point of view, child self-reports are essential to inform healthcare delivery, policy, research and theory development.”

Foster said children’s needs are often interconnected to those of their parents, so if parents feel informed, valued and cared for, then their children are more likely to feel relaxed.

“From a child’s perspective, feeling safe means having mum and dad here to help care for me, smiling nurses, special time spent with me just talking, not treats, just time to get better,” she said.

The study is published in the Journal of Advanced Nursing.

Source: Edith Cowan University

UK Study Identifies Early Warning Signs of Eating Disorders

Tue, 07/02/2019 - 7:25am

A new large-scale data study in the UK provides clarity on early warning signs associated with an eating disorder. Swansea University researchers believe their findings will help primary care physicians detect eating disorders earlier in the course of care.

Investigators discovered that people diagnosed with a disorder had higher rates of other conditions and of prescriptions in the years before their diagnosis. The study appears in the British Journal of Psychiatry.

In the UK eating disorders such as anorexia nervosa, bulimia nervosa and binge eating disorder affect an estimated 1.6 million people. In the U.S., more than 10 million people are affected although the true figures may be higher, as many people do not seek help.

Experts explain that eating disorders predominantly affect women but men are not without risk. Most people are diagnosed during adolescence and early adulthood. Eating disorders have the highest mortality of all mental illnesses, both from physical causes and from suicide.

Yet despite the scale of the problem, resources to treat eating disorders are scarce. There are very few specialized treatment centers. People affected are often young and vulnerable, and may avoid detection. However, the earlier a disorder can be diagnosed, the better the likely outcome for the patient.

Investigators believe this is an area where the new findings can make a big difference. The new knowledge can help primary care physicians understand what could be early warning signs of a possible eating disorder.

The research team, from Swansea University Medical School, examined anonymized electronic health records from primary care practices and hospital admissions in Wales. 15,558 people in Wales were diagnosed as having eating disorders between 1990 and 2017.

In the two years before their diagnosis, data shows that these 15,558 people had:

  • higher levels of other mental disorders such as personality or alcohol disorders and depression;
  • higher levels of accidents, injuries and self-harm;
  • higher rates of prescription for central nervous system drugs such as antipsychotics and antidepressants, and;
  • higher rates of prescriptions for gastrointestinal drugs (e.g. for constipation and upset stomach) and for dietetic supplements (e.g. multivitamins, iron).

Therefore, looking out for one or a combination of these factors can help physicians identify eating disorders early.

Dr. Jacinta Tan, an associate professor of psychiatry at Swansea University led the research. Tan is also a consultant child and adolescent psychiatrist. She comments:

“I cannot emphasize enough the importance of detection and early intervention for eating disorders. Delays in receiving diagnosis and treatment are sadly common and also associated with poorer outcomes and great suffering,” she said.

“This research contributes to the evidence about prevalence of eating disorders and begins to quantify the scale of the problem in the entire country of Wales. The majority of these patients we identified are not known to specialist eating disorder services.

“The increased prescriptions by GPs both before and after diagnosis indicates that these patients, even if not known to specialist services, have significantly more difficulties or are struggling. This underlines the clinical need for earlier intervention for these patients and the need to support GPs in their important role in this.”

Dr. Joanne Demmler, senior data analyst in the National Centre for Population Health and Wellbeing Research, based at Swansea University, noted, “This has been an absolutely fascinating project to work on. We used anonymized clinical data on the whole population of Wales and unraveled it, with codes and statistics, to tell a story about eating disorders.

This ‘storytelling’ has really been an intricate part of our understanding of this extremely complex data and was only possible through a very close collaboration between data analysts and an extremely dedicated and enthusiastic clinician.”

Source: Swansea University/EurekAlert

Harm from ‘Secondhand Drinking’ Called A Significant Public Health Issue

Tue, 07/02/2019 - 6:00am

Each year, one in five adults — an estimated 53 million people — experience harm because of another person’s drinking, according to a new analysis of U.S. national survey data.

These harms, affecting around 21% of women and 23% of men, may include threats or harassment, ruined property or vandalism, physical aggression, harms related to driving, or financial or family problems. The most common harm was threats or harassment, reported by 16% of survey respondents.

Writing in the Journal of Studies on Alcohol and Drugs, the study authors call alcohol’s harm to other people a “significant public health issue.” And they assert that, similar to how policymakers have addressed the effects of secondhand smoke in recent years, society also needs to combat the secondhand effects of alcohol.

“[T]he freedom to drink alcohol must be counterbalanced by the freedom from being afflicted by others’ drinking in ways manifested by homicide, alcohol-related sexual assault, car crashes, domestic abuse, lost household wages, and child neglect,” writes Timothy Naimi, M.D., M.P.H., of the Boston Medical Center in an accompanying commentary.

For the study, researchers from the Alcohol Research Group, a program of the Public Health Institute in Oakland, California, analyzed data of 8,750 respondents, ages 18 and older, from two telephone surveys conducted in 2015: the National Alcohol’s Harm to Others Survey and the National Alcohol Survey.

The findings show gender differences: Women were more likely to report financial and family problems, whereas ruined property, vandalism, and physical aggression were more likely to be reported by men. According to the authors, there is “considerable risk for women from heavy, often male, drinkers in the household and, for men, from drinkers outside their family.”

Additional factors, including age and the person’s own drinking habits, also made a difference. For example, individuals younger than age 25 had a higher risk of experiencing harm from someone else’s drinking.

Further, almost half of men and women who themselves were heavy drinkers said they had been harmed by someone else’s drinking. Even light or moderate drinkers faced two to three times the risk of harassment, threats, and driving-related harms compared with abstainers. Heavy drinking was defined as drinking five or more drinks at a time for men or four or more drinks for women at least monthly.

The findings provide support for alcohol control policies, such as taxation and pricing to reduce alcohol’s harm to persons other than the drinker.

“Control policies, such as alcohol pricing, taxation, reduced availability, and restricting advertising, may be the most effective ways to reduce not only alcohol consumption but also alcohol’s harm to persons other than the drinker,” said study leader Madhabika B. Nayak, Ph.D.

Source: Journal of Studies on Alcohol and Drugs

Study Explores End-of-Life Clarity in Dementia Patients

Mon, 07/01/2019 - 6:00am

An interdisciplinary research team is investigating cases of paradoxical lucidity, a phenomenon in which a person with severe dementia suddenly “wakes up” and exhibits surprisingly normal behaviors, only to pass away shortly thereafter.

Writing in the journal Alzheimer’s & Dementia, the researchers outline what is known and unknown about paradoxical lucidity, consider its potential mechanisms, and detail how a thorough scientific analysis could help shed light on the pathophysiology of dementia.

The study is one of the first to scientifically investigate these phenomena, although these incidents have been reported all throughout history.

“Science is now trying to be thoughtful and attentive to something that has long been reported,” said study leader George A. Mashour, M.D., Ph.D., professor in the department of anesthesiology at Michigan Medicine and director of the Center for Consciousness Science.

“We’ve assumed that advanced dementia is an irreversible neurodegenerative process with irreversible functional limitations. But if the brain is able to access some sort of functional network configuration during paradoxical lucidity, even in severe dementia, this suggests a reversible component of the disease.”

The new paper describes earlier work documenting case studies of individuals with advanced dementia, including Alzheimer’s disease, appearing to be able to communicate and recall in a seemingly normal fashion at the end of life, to the astonishment of their caregivers.

“The accumulation of anecdotal reports about paradoxical lucidity in the scientific literature prompts several important research questions,” said National Institute on Aging (NIA) medical officer Basil Eldadah, M.D., Ph.D.

“We look forward to additional research in this area, such as better characterization of lucidity in its varying presentations, new instruments or methods to assess episodes of lucidity retrospectively or in real-time, tools to analyze speech patterns or other behavioral manifestations of lucidity, and evidence to inform decision-making challenges and opportunities prompted by unexpected lucidity.”

One precedent for studying such events exists in the research of near-death experiences. In 2013, Mashour and his team at Michigan Medicine published a study showing evidence of electrical brain features indicative of a conscious state following cardiac arrest.

“We don’t know that the same thing is occurring with paradoxical lucidity, but the fact that this is usually happening around the time of death suggests there could be some common neural network mechanism,” he says.

Mashour acknowledges that researching paradoxical lucidity will be a challenge, given the fleeting nature of the phenomenon. Case studies report episodes lasting from mere seconds to at most several days in a small minority of cases.

The research team also outlines important ethical implications of this work, including the ability of vulnerable patients to participate in research and how the observation of paradoxical lucidity might change the way caregivers interact with people with dementia.

“Would research that might identify a systematically observable paradoxical lucidity provide comfort, for example, by offering loved ones a potential channel for closure, or might it induce worry if loved ones are left to wonder if a reversible cause of the dementia could have been found? We do not know the answers but these could be important research questions in their own right,” said co-first author Lori Frank, Ph.D., of the RAND Corporation and former Health and Aging Congressional fellow with the National Institute on Aging.

The research team, assembled by the National Institutes of Health’s (NIH) National Institute on Aging, hopes their paper will help raise awareness within the scientific community to help make further progress in paradoxical lucidity research, as well as validate the experiences of a multitude of caregivers.

Source: Michigan Medicine- University of Michigan

Lost Wallets With Lots of Money More Likely to Be Returned

Sun, 06/30/2019 - 8:09pm

The more money there is in a lost wallet, the more likely it is to be returned to its owner, a new global study has found.

According to researchers from the Universities of Zurich, Michigan, and Utah, this surprising finding is because dishonest finders have to adapt their self-image, which involves psychological costs that can exceed the monetary value of the wallet.

The classic economic model predicts that people will typically keep a lost wallet. The financial incentive to keep the wallet is particularly large if it contains a large sum of money. However, this assumption is refuted by the recent study, researchers noted.

In 355 cities in 40 countries, the research team investigated what causes people to return a wallet to its owner. To this end, they handed in more than 17,000 apparently lost wallets at the reception areas of various institutions, such as hotels, banks, museums, post offices, or police stations.

The researchers examined four factors that influence the decision to return the wallet:

  1. The monetary incentive to keep the money;
  2. The effort involved in contacting the owner;
  3. Altruistic considerations about the welfare of the owner, and
  4. The “psychological costs of dishonest behavior.”

The last is caused by the fact that keeping a lost wallet is often perceived as theft, and the finder has to adapt their self-image, the researchers explained.

The researchers were able to show that these psychological costs — the preservation of one’s self-image as an honest person — can explain the finders’ behavior.

“People want to see themselves as an honest person, not as a thief. Keeping a found wallet means having to adapt one’s self-image, which comes with psychological costs,” said Dr. Michel Maréchal, a professor of economics at the University of Zurich.

In an additional survey, participants confirmed that the more money there was in a lost wallet, the more likely not returning it was to be classified as theft, causing higher psychological costs of dishonest behavior.

The wallets contained a business card, a shopping list, a key, and a varying amount of money.

A key is only of value to the owner, but not to the finder, the researchers noted. To measure altruistic concerns, the researchers also handed in some wallets without a key.

A wallet with money, but no key was less likely to be returned than a wallet with the same amount of money and a key.

Based on this finding, the researchers concluded that altruistic considerations play a further role when returning wallets.

Although reality disproves the economic model, an additional survey shows that many academic economists and the general population assume that lost wallets containing large sums of money are less likely to be returned.

“We mistakenly assume that our fellow human beings are selfish. In reality, their self-image as an honest person is more important to them than a short-term monetary gain,” and Alain Cohn, an assistant professor of economics at the University of Michigan and co-author of the study.

Where were the finders most honest?

In countries such as Switzerland, Norway, the Netherlands, Denmark, and Sweden, between 70 percent and 85 percent of the wallets were returned to their owners.

The Swiss are the most honest when it comes to returning wallets containing a key but no money.

Danes, Swedes and New Zealanders were even more honest when the wallets contained larger sums.

In countries such as China, Peru, Kazakhstan, and Kenya, on average only between 8 percent and 20 percent of the wallets were returned to their owners.

Although the proportion of returned wallets varied widely between countries, in almost all countries wallets with large sums of money or valuable contents were more likely to be returned, the researchers reported.

Source: University of Zurich

Antidepressant Trio Can Impair Pain Relief of Opioid Tramadol

Sun, 06/30/2019 - 7:51pm

A new study reveals that several common antidepressants, including fluoxetine (Prozac), paroxetine (Paxil) and bupropion (Wellbutrin), interact with the opioid pain medication tramadol to blunt pain relief.

The findings, published in the journal Pharmacotherapy, have important implications for the opioid epidemic, suggesting that some patients suspected of drug-seeking may in fact be under-medicated and are simply seeking more effective pain relief. In addition, the results may explain why some patients exceed the prescribed dose of tramadol, thereby increasing their risk of addiction.

For the study, researchers from University Hospitals (UH) analyzed the medication records of 152 patients at UH Cleveland Medical Center and UH Geauga Medical Center who had received scheduled tramadol for at least 24 hours. All of the participants had been admitted as inpatients or were under observation status.

The findings show that patients who were taking fluoxetine, paroxetine or bupropion required three times more pain medication per day to control “breakthrough” pain throughout the day, compared with patients not taking those antidepressants.

“As we looked at in secondary analysis, it ended up being four times as much over their entire hospital stay,” said Derek Frost, Pharm.D., lead author of the study.

Prior research with healthy volunteers has shown effects on blood levels when combining tramadol with these particular antidepressants. However, this study is the first to document the effects of this interaction in a real-world setting with patients.

“We knew that there was a theoretical problem, but we didn’t know what it meant as far as what’s happening to pain control for patients,” Frost said.

What explains the interaction between tramadol and these antidepressants?

“Tramadol relies on activation of the CYP2D6 enzyme to give you that pain control,” Frost said. “This enzyme can be inhibited by medications that are strong CYP2D6 inhibitors, such as fluoxetine, paroxetine and bupropion.”

According to Frost, it’s likely that millions of Americans may be suffering the ill effects of this drug-to-drug interaction.

“These drugs are super-common,” he said. “They’re all in the top 200 prescription drugs. In addition, chronic pain and depression and anxiety go hand in hand.”

“Many chronic pain patients are taking antidepressants, mainly selective serotonin reuptake inhibitors (SSRIs), which many of these CYP2D6 inhibitors fit into. There are a lot of patients who experience both, unfortunately. The likelihood that somebody on one of these offending agents and tramadol is relatively high.”

The good news is that this problem has a relatively easy fix, said Frost.

“We have a lot of other antidepressants available that are in the same class of medication that don’t inhibit this particular enzyme, such as Zoloft (sertraline), (Celexa) citalopram and Lexapro (escitalopram),” he said. “You also have other options for pain control, non-opioid medications such as NSAIDs. If we need to use opioids, a scheduled morphine or a scheduled oxycodone would avoid this interaction.”

“For patients who have the combination of chronic pain and depression or anxiety, keep in mind that this interaction does exist,” Frost said. “And for health care providers, if you have a patient approaching you saying this medication isn’t working for me, is there an interaction at play?”

Source: University Hospitals Cleveland Medical Center