Mental Health: Sweating Depression Away
Eric Nagourney, New York Times- 2/1/2005

People with mild to moderate depression can significantly reduce their symptoms if they exercise aerobically, a new study reports. The study appears in the current issue of The American Journal of Preventive Medicine and was led by Dr. Andrea L. Dunn of the Cooper Institute in Golden, Colo.
      Exercise has often been described as a valuable mood enhancer. "People say that all time that 'If I could exercise, I would feel better,' " said a co-author of the study, Dr. Madhukar H. Trivedi of the University of Texas Southwestern Medical Center. But the goal of this study, the researchers said, was to try to establish scientifically if exercise really helped with depression and, if so, how much was needed. The researchers took 20 adults ages 20 to 45 with diagnoses of depression and separated them into groups.
      Some did differing amounts of aerobic activity, working on a treadmill or exercise bike. One did flexibility exercises. None were taking medication for depression. After 12 weeks, the researchers found that patients who worked out for half an hour three to five times a week reported half the symptoms of depression that they had before the program began. The more they worked out, the less depressed they reported feeling. Too little aerobic activity produced the same results as the stretching group.
      The study noted that the exercise was done in groups, so the social support may also have played a role in the improvement. But whatever the explanation, the benefits were comparable to those achieved with medication or therapy, the study said.

Hazards: Injuries and Alcohol Often Mix
Eric Nagourney, New York Times- 2/1/2005

Problem drinkers are well known to be at higher risk for the kinds of accidents that send them to the hospital. But a close look at who shows up in the emergency room has found an equally strong connection between occasional drinking and injury.
      Researchers studied more than 2,500 admissions at three Missouri emergency rooms over a two-year period and found that drinking at levels often considered safe was associated with about 4 percent of the injuries reviewed -- about the same level found for patients with an alcohol dependency. The study appears in Annals of Family Medicine and was written by Dr. Maria C. Spurling and Dr. Daniel C. Vinson of the University of Missouri.
      The researchers asked patients how much they had drunk over the two days before they were injured and gave them questionnaires about their drinking habits. The study defined unsafe alcohol consumption as more than four drinks for men and more than three for women, but offered a warning. "What is often considered moderate drinking is not totally safe," the authors wrote. And when the researchers narrowed their focus to more serious injuries, they found an even greater association with moderate drinking.
      From a public health point of view, the findings demonstrate a concept known as prevention paradox: while a heavy drinker is individually at greater risk, society over all bears a heavier cost for people considered nonproblem drinkers because there are so many of them. The findings suggest that moderate drinkers consider limiting themselves to just one or two drinks and not mix drinking with leisure time activities like sports where there is a chance of injury, Dr. Vinson said.

Ultrasound Urged for Older Male Smokers
Associated Press, 2/1/2005

PHILADELPHIA -- Men ages 65 to 75 who have been smokers should get a one-time ultrasound to reduce their chances of dying from a ruptured artery, an influential federal health task force recommends. The findings by the U.S. Preventive Services Task Force represent a shift from its last recommendation, in 1996, on screening for abdominal aortic aneurysms -- a ballooning of the body's main artery in the abdomen. At that time, the group didn't find enough evidence to take a stand on widespread screening. Studies published between 1998 and 2003, however, have shown convincing evidence that the screenings could significantly help reduce the risk of death in the millions of men between 65 and 75 who have smoked.
      The recommendations, published Tuesday in the Annals of Internal Medicine, are based on a study of four randomized, controlled trials involving more than 120,000 men ages 65 and older in Australia, Denmark and the United Kingdom. The findings showed a 43 percent reduction in the number of fatal ruptured aortas in those who were screened. ``This body of evidence is a very convincing body of evidence,'' said Dr. Diana Petitti, vice chair of the task force, an independent panel of medical experts that advises the federal Agency for Healthcare Research and Quality. ``This was not a difficult call for the task force.''
      The major risk factors for abdominal aortic aneurysms are age, history of smoking and gender. Abdominal aortic aneurysms, found in 4 percent to 8 percent of older men and 0.5 percent to 1.5 percent of women, occur when the aorta expands to 3 centimeters or greater. Once an aneurysm ruptures, there is very little doctors can do. The aorta, the body's main artery connects the heart's left ventricle with all the main arteries in the body. Aortic aneurysms account for about 15,000 deaths annually in the United States; of those, 9,000 are related to aortic aneurysms in the abdomen and the rest occur in the chest.
      Since about 70 percent of men aged 65 to 75 have smoked at least 100 cigarettes in their lifetime, Petitti said, the recommendation likely affects between 6 million and 7 million people. While treatment of some aneurysms can be risky, Petitti suggested patients who need surgery carefully select a doctor and hospital. ``People should shop around for the right surgeon,'' she said. Investigators in the study found no risk in the ultrasound screening, other than normal psychological stress.
      Aneurysms over 5.5 centimeters have the greatest risk of rupture, while concern is typically raised at 4 centimeters, said Dr. Craig Fleming, a clinical investigator at the Kaiser Center for Health Research, in Portland, Ore., who was the lead investigator in the study. ``It is a very significant indication that this is a benefit,'' Fleming said. ``There is a pretty definite benefit for screening for men in this age group.''
      On the Net: http://www.annals.org

Test May Help Detect Alzheimer's Earlier
Associated Press, 2/1/2005

WASHINGTON -- A highly sensitive new test could lead to a different way to diagnose people with Alzheimer's disease, possibly helping find the illness in its early stages when there might be time for treatment. While as many as 4 million Americans are thought to suffer from the memory-destroying illness, the only way to diagnose it definitively is by studying brain tissue during an autopsy.
      It is important to have some way to diagnose the disease while the patient is still alive, especially during its early stages, so experimental treatments can be evaluated, and to catch it at a time when the disease might be treatable. ``If you can't diagnose it, you're not going to have a therapy for it,'' said Chad A. Mirkin of Northwestern University. Many companies have experimental therapies, he said, ``But those therapeutics aren't very good if you can't definitively diagnose and follow a disease,'' explained Mirkin, a lead researcher -- along with William L. Klein -- on a team that developed the new test, which can detect small amounts of proteins in spinal fluid. The team's findings are reported in Tuesday's issue of Proceedings of the National Academy of Science.
      The new test, called a bio-barcode assay, is 100,000 times to 1 million times more sensitive than other available tests, Mirkin said in a telephone interview. It was first used last year in testing for a marker for prostate cancer, and Mirkin said he invited other investigators to suggest subjects for further testing
      Klein, also at Northwestern, had done research associating Alzheimer's with a protein in the brain called amyloid-beta-derived diffusable ligand, or ADDL, Mirkin said. So the research team set out to try and detect ADDL in spinal fluid. They got samples of the spinal fluid of 30 people, 15 who had Alzheimer's disease and 15 who did not.
      The researchers found at least some ADDL in all the patients, which Mirkin said is an indication that everyone may have a baseline level of the protein. ``What was really encouraging,'' he said, is that the concentration of ADDL increases as the disease gets worse, so the progression of the illness could be followed. ``Do we have a new diagnostic for Alzheimer's?'' Mirkin said. ``That's a bit premature.'' The method needs to be repeated and tested on more patients, he said. Also tests need to be done to see if high levels of ADDL occur in other memory loss diseases. But, the researchers said in their paper, the work provides a ``potential reliable detection method for diagnosing'' Alzheimer's Disease. In addition, Mirkin said, the researchers are hoping to use the new test to search for proteins and other chemicals that can offer early diagnoses of other diseases, ranging from cancers to AIDS to mad cow.
      ADDLs are small soluble proteins. To detect them the researchers used nanoscale particles that had antibodies specific to ADDL. Some particles were magnetic and some of gold with strings of DNA attached. The antibodies bind to the ADDL, sandwiching the protein between the two particles. They are then removed from the solution magnetically and the hundreds to thousands of DNA strands attached to the gold particles serve as a barcode because they can be used to label the specific target with standard detection methods.
      Dr. Samuel Gandy, who was not part of the research team, said the report is impressive but needs to be repeated with larger numbers of subjects. If the test can, in fact, correlate the presence of ADDLs with brain function, ``this is good news indeed for identifying who is at risk for Alzheimer's and potentially for following the effectiveness of many new anti-amyloid medicines that are now in clinical trials,'' said Gandy, vice chair of the National Medical and Scientific Advisory Council of the Alzheimer's Association and director of the Farber Institute for Neurosciences at Thomas Jefferson University in Philadelphia.
      Stephen Snyder, who directs the National Institute on Aging program studying the causes of Alzheimer's, said the finding has future implications for both diagnosis and treatment of the disease. ``For many years the ADDLs have been thought to be involved in diminishing aspects of cognition and this is proof of principle that they exist and can be found'' in spinal fluid, said Snyder, who was not part of the research team. The research was funded by the National Science Foundation, Nanoscale Science and Engineering Center and the National Institutes of Health.
      On the Net: Proceedings of the National Academy of Science: http://pnas.org

Until Deception Do Us Part: Scenes From 3 Chilly Marriages
Stephen Holden, 2/1/2005

It may be the mood cast by all that chilly winter light, but humor has never been a strong suit of Swedish cinema. Although a few half-smiles crack through the gloom of Bjorn Runge's harrowing drama, "Daybreak," they are vengeful smirks devoid of levity. The emotional climate of the film, which eviscerates the rot of three middle-class marriages, is harsh enough to produce frostbite. Even the atmosphere of Ingmar Bergman's "Scenes From a Marriage" seems temperate by comparison.
      The most developed of this movie's three interwoven tales observes the precipitous downfall of Rickard (Jakob Eklund), a successful heart surgeon and casual philanderer, married with two children, who has succumbed to the dreaded is-that-all-there-is? syndrome. In the space of 24 hours, Rickard is denied the dream job he was promised and coldly breaks up with his girlfriend, Sofie (Marie Richardson), only to be told that she is pregnant with his child and not about to have an abortion.
      In a fiendish twist, we soon learn that Sofie is married to Mats (Leif Andree), one of Rickard's closest friends and medical colleagues, who has given up on their having children. As Rickard's deceptions and betrayals are exposed during an excruciating evening that Mats and Sofie spend at the seaside dream house Rickard shares with his grim wife, Agnes (Pernilla August), Mats and Sofie relish carving up their best friends' lives. By the end of evening, when Rickard and the shellshocked Agnes, driving separate cars, chase each other in circles around a mud flat, Rickard is faced with an emptiness much more terrifying than his case of the marital blahs.
      Even more punishing in its cruelty is the story of Olof (Peter Andersson) and his abandoned wife, Anita (Ann Petren). Ever since their 26-year marriage ended after Olof fell in love with his young physical therapist, Petra (Sanna Krepper), during his recovery from a car accident, the grizzled, hatchet-faced Anita has stewed in a pressure-cooked rage.
      On the same evening that Rickard's life shatters, Anita pays an uninvited call on Olof and Petra as they are preparing dinner. Armed with a stun gun that she got by trading her prescription drugs in an underground parking garage, Anita orders Petra to tie up her ex-husband. On the brink of a psychotic explosion, Anita conducts a brutal all-night interrogation of Olof, which leaves her temporarily wrung out of fury.
      The third and craziest couple, Knut (Ingvar Hirdwall) and Mona (Marika Lindstrom), are paranoid xenophobes who hire Anders (Magnus Krepper), a greedy workaholic bricklayer whose own marriage is crumbling from neglect, to wall up the windows and front door of their apartment. Obsessed with their runaway daughter's marriage to a Nigerian, and convinced the world is falling apart, they threaten to remain in their bunker, subsisting on canned beans for the rest of their lives.
      If "Daybreak," which opens today at Film Forum in Manhattan, weren't so powerfully acted, its accumulating anguish would be too much to bear. As it is, all three couples, especially Knut and Mona, verge on caricature. It comes as a small relief when a tablespoon of redemption is sprinkled at the end of the movie like powdered sugar on an icebox cake. But this respite amounts to too little, too late, and the movie's glimmerings of hope feel more like afterthoughts than organic changes of heart.
      Once you've experienced "Daybreak," however, it's unlikely you'll forget it. Ms. Petren's avenging demon, in particular, is as frightening a surrogate for every wife who has been dumped for a younger woman as the screen has produced. The movie would like us to believe that by going to the brink, catharsis for someone like Anita is possible. Maybe so, but "Daybreak" leaves me unconvinced.
      'Daybreak' Written (in Swedish, with English subtitles) and directed by Bjorn Runge; director of photography, Ulf Brantas; edited by Lena Dahlberg; produced by Clas Gunnarsson; released by Newmarket Films. Running time: 108 minutes. This film is not rated. WITH: Pernilla August (Agnes), Jakob Eklund (Rickard), Leif Andree (Mats), Marie Richardson (Sofie), Ingvar Hirdwall (Knut), Ann Petren (Anita), Magnus Krepper (Anders), Markia Lindstrom (Mona), Peter Andersson (Olof) and Sanna Krepper (Petra).

Doctor Questions Beliefs on ADHD
Anne Reuter, Ann Arbor News- 2/2/2005

Rick Solomon doesn't hesitate to ask provocative questions. Take the title of his upcoming talk at a branch of the Ann Arbor District Library, "Does ADHD Really Exist?" Some parents, educators and physicians -- and, if they're listening, the makers of Ritalin and other medications used to treat attention deficit hyperactivity disorder -- are likely to react with, "What do you mean, no ADHD?!"
      It's that last D, for "disorder," that Solomon is adamantly against. Trained as a developmental and behavioral pediatrician, he recently left his faculty post in pediatrics at the University of Michigan to devote himself full time to a private center he has founded to promote his family-based approach to children's learning difficulties, including ADHD and autism.
      At his talk Tuesday, Solomon will describe a different way for parents and educators to think about children labeled with ADHD, and ways to help them learn. "I don't deny there are some boys who do have problems with attention span," he says. "But just because you have a problem with attention span, does that mean you have a disease?" Solomon takes issue with the ways doctors, schools and parents frequently deal with children who have problems paying attention.
      Among his views:
* ADHD is vastly overdiagnosed.
* Medicines freely prescribed for ADHD are not appropriate for many children.
* The current widespread use of the ADHD label puts children who have very different types of attention problems, mild to severe, in the same box. He believes what each child needs is an individualized plan to identify specific attention problems and to help tap the child's natural eagerness to learn.
      Karen Schulte, an assistant professor in special education at Eastern Michigan University, hopes to make it to Solomon's talk. Many professionals in her field tend to agree with Solomon's views, she says. "There's a huge body of research growing, showing we're just overdiagnosing kids with attention deficit disorder," says Schulte.
      In the talk, Solomon will draw from scientific studies and his own experience working with children who have difficulties in school. He says the label ADHD is too hastily applied to children who have a wide range of attention difficulties, but also strengths. "I look at the whole child," he says. "I look at all the different minds that children have." Solomon is a fan of the ideas of educator Mel Levine, who promotes the concept that children have several kinds of intelligence.
      Solomon wants his new center, the Ann Arbor Center for Developmental and Behavioral Pediatrics, www.aacenter.org, to help parents respond to their children's learning needs. He says he left the academic world to devote more time to the new center and to promote his "play project," a home-based approach for autistic children now in use at 20 centers nationally. He's been invited to describe that work on NBC's "Today" show. He would like to see his approach to family-based, individualized help for children labeled with ADHD also spread more widely.
      Like Solomon, EMU's Schulte says it's useful to think of people lumped together under "ADHD" as people who in reality display a wide spectrum of attention abilities. Right now, she says, plenty of people considered to have attention deficit disorder have attention difficulties, but don't have the neurological irregularities or early signs -- usually obvious by age 6 -- that help define a real diagnosis of the condition.
      Schulte sees other reasons behind the explosion in children labeled with ADHD that began in the 1990s. Outside school, she says, "We overload kids with all sorts of stimulation from the very beginning," especially visual pastimes like computer games and TV. Should we be surprised, she asks, "if you take a child used to all this visual input into a classroom, where all they're getting is audio input, and all of a sudden they have trouble paying attention?"
      For insights into ADHD, Solomon looks at humans' long history as hunter-gatherers and farmers. "It's only in the last 70 years that we've had mandatory schooling," he says. Boys who eons ago excelled at responding to frequent stimuli now sit in rows in class and are told to concentrate. "As we become this information-based society, the hunter-gatherer traits that served us so well have been cultured out of us," he says. "It used to be that when a farmer had a hyper boy, other farmers would say, 'Can I borrow him?"' Today, he says, "there are criteria for ADHD that one of these boys would fit."
      For more on Solomon's work with children, visit www.aacenter.org. For more on the ideas of educator and author Mel Levine, visit www.allkindsofminds.org. Books of interest to parents of children with attention difficulties include Mel Levine's "A Mind at a Time" and "The Myth of the ADD Child" by Thomas Armstrong.

Fewer Kids Prescribed Drugs for Depression
Shankar Vedantam, Washington Post- 2/2/2005

The number of American children taking antidepressant drugs fell sharply last year, after months of controversy over evidence that the medications increase the risk of suicidal thoughts and behavior among some children. The steep decline among children is a dramatic reversal of a decade-long trend of soaring prescription rates for drugs such as Prozac, Paxil and Zoloft, and the pattern of the data suggests the numbers could fall even further.
      Activists who had urged the Food and Drug Administration to require a black-box warning about the risks of the drugs said the drop reflects the better decisions that parents and physicians are making after being warned about the medications. But medical groups such as the American Psychiatric Association and the American Academy for Child and Adolescent Psychiatry warned that the government had unwittingly unleashed an uncontrolled experiment that would cause many depressed children to go without treatment and ultimately lead to more suicides. The turnaround in prescription trends was reported yesterday by Medco, which manages drug benefits for about 60 million Americans.
      Various studies have shown a three- to tenfold rise in the use of antidepressants among children between 1987 and 1996, and an additional spike of 50 percent between 1998 and 2002. There was a further increase of about 9 percent between 2002 and 2003, but the new data revealed a 10 percent decline last year, said Robert Epstein, chief medical officer at Medco. The decline was gradual at the start of the year but gathered momentum, Epstein said. While the raw data do not indicate why fewer children were getting medications, Epstein said the fall coincided with FDA warnings last year that culminated in October with a requirement that antidepressant manufacturers place the black-box label on their drugs.
      That warning states that antidepressants increased the risk of suicidal thoughts and behavior in short-term trials involving depression and other psychiatric disorders. Doctors who use such medications "in a child or adolescent must balance this risk with the clinical need. Patients who are started on therapy should be observed closely for clinical worsening, suicidality, or unusual changes in behavior."
      Medical organizations said that language was making it increasingly difficult for general physicians and pediatricians to prescribe the drugs. The requirement to closely monitor patients presents a difficult hurdle, said Darrel Regier, director of the division of research at the American Psychiatric Association, because insurance plans often do not provide the same level of coverage for mental illness as for physical ailments. Regier said that pediatricians renewing their malpractice insurance policies are being asked whether they prescribe antidepressants and that they face higher premiums if they say yes. Epstein said the data indicated that psychiatrists as well as general physicians were writing fewer prescriptions.
      At an APA news briefing announcing a new information site for parents and physicians -- ParentsMedGuide.org -- one member of the advisory committee that recommended that the FDA require a black-box warning said she would not have voted for it if she had known it would have such dramatic consequences. "If I knew how much prescriptions would fall, I would not have voted in favor of the black-box warning," said Gail Griffith, who was the patient representative on the panel.
      David Fassler, a child and adolescent psychiatrist in Burlington, Vt., said that while there may be some inappropriate prescribing for children, there are many more youngsters who need help and are going untreated. He and Regier said untreated depression is a far greater risk for suicide than any risks caused by the medications.
      FDA spokeswoman Susan Cruzan said the agency would monitor the use of the drugs, including prescription trends. But asked whether the FDA would revisit the data, she said, "We just had a long, deliberative process. We had two advisory committee meetings, we worked with manufacturers to get the wording right."
      With the exception of Prozac, none of the drugs involved is specifically approved to treat depression in children, and the majority of clinical trials of the drugs have not shown they are superior to placebos, or dummy pills. Part of the controversy last year focused on the fact that manufacturers had not informed physicians and the public about the negative trials. "When parents and physicians were kept in the dark about the scientific evidence, they trusted the drug advertisements that promised wonderful results with no risk," said Vera Hassner Sharav, founder of the Alliance for Human Research Protection, a patients' rights organization. "When given an opportunity to weigh the risks and benefits after learning the facts, parents are making responsible choices for their children," she said. "They are being cautious and skeptical, as they should be."

Health Experts Aim to Lower Wyoming's Suicide Rate
Associated Press, 2/2/2005

CHEYENNE, Wyo. -- Mental health professionals and others gathered here to try to reduce Wyoming's suicide rate, currently the highest in the nation. Statistics from the American Association of Suicidology show that in 2002, the most recent year for which statistics were available, 105 people in Wyoming took their own lives, or a rate of 21 deaths by suicide per 100,000 people. ``We need to do something about that,'' Laramie police Sgt. Dave Smith said Tuesday at a gathering of the Wyoming Suicide Prevention Coalition. ``We don't want to be Number 1.''
      Smith said suicide was the second-leading cause of death among people ages 15 to 24 in Wyoming. Many of those deaths were preventable, he said, but people often ignore the warning signs because they don't like to talk about suicide. ``The stigma has to go away,'' Smith said. ``Suicide is preventable.'' Wyoming's first lady, Nancy Freudenthal, said alcohol abuse is a major contributor to the suicide rate. Psychologist John Sanford said children as young as 10 years should start learning about suicide prevention.

Suicide Rate Down in the Era of Prozac
Alan Zarembo, Los Angeles Times-2/3/2005

The U.S. suicide rate has fallen steadily since Prozac and related antidepressants came into use in the late 1980s, according to an analysis by researchers worried that evidence linking the drugs to suicide in children could reduce their use. The suicide rate, which reached a peak in 1988 of nearly 13 deaths per 100,000 people, fell steadily to about 10.5 in 2002.
      Most suicides are the result of untreated depression, not adverse reactions to antidepressants, wrote Dr. Julio Licinio and Dr. Ma-Li Wong, psychiatrists at UCLA, in an opinion piece released Wednesday by the journal Nature Reviews: Drug Discovery. But Vera Sharav, president of the Alliance for Human Research Protection, said the conclusions of the analysis might not be valid because the decline could just as easily be explained by laws introduced around the same time reducing access to firearms — a common means of committing suicide.
      The number of people being treated for depression rose more than 50% during the 1990s, an increase largely due to the availability of drugs known as selective serotonin reuptake inhibitors, or SSRIs. Studies conducted in Denmark and Sweden have shown that fewer than a fifth of suicide victims were taking antidepressants when they killed themselves.
      The drugs, however, have recently become the focus of a medical debate after clinical trials data showed that they increased the risk of suicidal thoughts in children and adolescents. Starting this month, the drugs will carry a label warning of the dangers in minors. Licinio said that he feared that the concern about the use of the drugs in children could deter adults from taking them. "And then we will have the reverse problem — more people committing suicide because they are not taking antidepressants," he said.
      The UCLA professors did not look at the suicide rate in minors. But according to data from the Centers for Disease Control and Prevention, suicides per 100,000 people age 10 to 19 peaked at 6.6 in 1988 and dropped steadily to 4.3 in 2002. This week, Medco Health Solutions Inc., a pharmacy benefits management company, released data showing that prescriptions of antidepressants for patients under 18 fell sharply after the Food and Drug Administration announced its warning label requirement in October.

Autism Network Seeks to Improve Level of Care Nationwide
Julie Davidow, Seattle Post-Intelligencer- 2/3/2005

For Tammy Jarbo-Blankenship, keeping her autistic sons healthy means a battle on two fronts: with her boys and with their doctors. Each trip to the doctor can set off a traumatic cascade of new people, restraints, needles and breathing tubes. The boys must be sedated for almost any exam or procedure. "If your child starts to act up, the doctors leave the room," Jarbo-Blankenship said. That's not acceptable, say members of a new national, non-profit coalition of doctors, researchers and parents announced today.
      The Autism Treatment Network is the first major initiative aimed at improving medical care for autistic children, who often miss out on the benefits of behavioral therapies because they're suffering from lack of sleep or gastrointestinal pain, say experts. The network is organized around six autism treatment centers, including the University of Washington Autism Center.
      In the past decade, the number of children diagnosed with autism has swelled, but many doctors remain uncomfortable treating kids who can't communicate their symptoms and are prone to violent outbursts in their offices. The network's goal is to make sure autistic children get the same medical care as other children by establishing guidelines doctors can follow to overcome the hurdles of examining and treating an autistic child. "We've got a group of non-verbal kids who can't say 'my stomach hurts,' or 'my head hurts,' " said Dr. Margaret Bauman, medical chairwoman of the network and director of a program for children with developmental disabilities at Massachusetts General Hospital. "We're just saying these kids are kids, too, and they deserve a work up."
      The network will also gather data to determine if autistic children suffer disproportionately from any medical conditions. Parents and doctors who specialize in caring for autistic children say gastrointestinal distress, including constipation and diarrhea, and trouble sleeping through the night are common complaints.
      An estimated one in 150 children in the United States will be diagnosed with some form of autism spectrum disorder before age 3, according to the network. Still, the medical needs of children with autism are one of the least studied aspects of the mysterious condition, which was once considered a psychological response to cold, disengaged mothers. Experts now agree autism is a neurological disorder, which appears to respond well to early diagnosis and behavioral therapy. But those therapies lose their effectiveness if children suffer from distracting medical conditions, said Geraldine Dawson, director of the UW Autism Center.
      In frustration, a child who can't communicate pain lashes out. If doctors label the behavior a symptom of autism, they might miss the real problem. "It could be due to some underlying gastrointestinal distress and once this is treated the child is able to calm down," Dawson said.
      With funding from the network, Dawson hopes to beef up the center's medical staff, which now includes two psychiatrists and a developmental pediatrician who sees patients one day a week. She also wants to hire a gastrointestinal specialist and increase the pediatrician's hours.
      Jarbo-Blankenship said she rarely encounters a doctor or nurse who knows how to interact with her sons, ages 8 and 10. "I would have such peace of mind knowing when we walk in that door, they understand," the Kent mother said. Pepsy Wirth's 4-year-old son, Daniel, was diagnosed with autism last year. When he started having seizures, she went online to seek advice from other parents. Her pediatrician and neurologist told her they'd never heard of a link between autism and seizures, but agreed to look into it. "It is kind of unnerving when the parent is telling the doctor this is what you have to do and they're going, 'OK,' " Wirth said.

Treatment of Depression in Pregnancy Affects Babies
Benedict Carey, New York Times- 2/4/2005

In the wake of a yearlong debate over the risks of antidepressants to minors, an analysis of World Health Organization medical records has found that infants whose mothers took the drugs while pregnant may suffer withdrawal symptoms. The study challenges the assurances that many doctors have long given pregnant women with depression that taking the drugs would not affect their babies.
      But experts said that the study, appearing today in the journal Lancet, was not definitive and must be weighed against the benefits of drug treatment. Untreated maternal depression can also harm a developing fetus, the experts said, and may lead to lasting childhood problems; all of the infants in the study recovered completely from withdrawal symptoms within 24 hours.
      "This study is important in that it gives us a red flag that babies exposed to antidepressants during pregnancy should be closely observed, and may go through unusual behaviors at first," said Dr. Timothy Oberlander, a developmental pediatrician at the University of British Columbia. Dr. Oberlander was not involved in the research and does not conduct research or act as a consultant for pharmaceutical companies.
      Some 10 percent to 15 percent of women suffer bouts of depression during the hormonal chaos of pregnancy, and about a quarter of those women get antidepressant treatment, doctors estimate, usually with drugs like Prozac, Paxil and Zoloft. If not treated, these women may also be at increased risk of postpartum depression, a devastating disorder that not only clouds the relationship between mother and child but can also interfere with the child's social development, according to Dr. Janet DiPietro, a professor at the Johns Hopkins School of Public Health.
      In the new study, researchers in Spain and Sweden searched through a database of adverse drug reactions maintained by the W.H.O. since 1968. They looked for reports of newborns who had been exposed in utero to antidepressants and who had symptoms that included heightened agitation, fever and quickened breathing. Psychiatrists have long observed these kinds of reactions in adults who abruptly stop taking certain antidepressants, and a few smaller studies have also recently noted similar symptoms in infants born to mothers who were taking antidepressants.
      The researchers using World Health Organization records found more than 100 such cases, and narrowed those down to 93 that could be linked strongly to an antidepressant medication, based on the treating doctors' original reports. After conducting a statistical analysis, the authors concluded that the withdrawal reports were more common than would be expected by chance, and should be published to alert doctors and patients. In 13 of the 93 cases, the study found, newborns suffered convulsions, a reaction that has not been widely noted in adults who discontinue antidepressant use. "All we are saying is that the data we have points to the possibility of withdrawal problem, but we would have to investigate each case closely to determine the overall risk," the paper's lead author, Dr. Emilio Sanz of La Laguna Medical School in Spain said in a telephone interview.
      That newborns would show some reaction to months of exposure to mood-changing medication in the womb is not surprising to many doctors. The most widely prescribed antidepressants, called selective serotonin reuptake inhibitors, or S.S.R.I.'s, induce alterations in the sensitivity of nerve cells, among other things, and abruptly stopping these drugs forces the brain to readjust, experts say.
      The antidepressant most often reported in the study to produce withdrawal effects was Paxil, which is cleared more quickly from the body than similar drugs. Dr. Sanz said the effects were stronger for Paxil but acknowledged that factors unrelated to the drug's chemistry could also account for the difference. "Our monitoring so far has not provided clear evidence that Paxil causes neonatal complications," said Mary Anne Rhyne, a spokeswoman for its maker, GlaxoSmithKline.
      The Food and Drug Administration asked antidepressant manufacturers to list possible neonatal complications on labels more than a year ago, after small studies found that infants exposed to the drugs suffered respiratory distress, irritability and seizures, among other troubles. It is not yet clear whether the new study will lead to a new advisory, an F.D.A. spokeswoman said.
      Some experts said that severe depression during or after pregnancy was still a larger threat to a child's well-being than the often mild and transient effects from ending a drug. "But for the worried well, for women who want antidepressants to feel better as opposed to treating serious depression," Dr. DiPietro said, "they may want to ask whether the benefit they are getting outweighs the potential risks to the developing child."

Mental Health Programs to Aid D.C. Foster Children, Families
Theola Labbe, Washington Post- 2/4/2005

The city's mental health and child welfare agencies have hired three new contractors to provide mental health services to District foster children, juvenile delinquents and foster families. The mental health programs, funded through a $3.9 million federal grant, are designed to support foster families and bring stability to the lives of foster children and youth in need of city services.
Based on national models, the programs will include in-home visits and a crisis response team capable of offering overwhelmed foster parents nonstop support for up to three days. At least 100 children and youths and 90 families are expected to receive services in the first year.
      Child welfare experts familiar with the District foster care system's troubles said the programs are innovative and signal that the city is making a significant change. The District's Child and Family Services Agency was previously in receivership, which ended in 2001, and remains under court order to stabilize foster care placements. "Family instability, abuse and neglect, removal from home, multiple placements and other factors too often leave some child and teen victims with serious emotional and behavioral issues," Brenda Donald Walker, director of Child and Family Services, said in a statement. "They deserve expert, caring treatment."
      The agency's records show that 12 percent of the city's estimated 2,300 foster children live in three or more foster homes in a year. Many times they receive little mental health counseling, or they were so traumatized that existing treatment plans don't fit their needs, officials said. "If a child had a medical problem, we would respond quickly," said Martha Knisley, director of the Department of Mental Health. "This to me is the highest priority for us, to make certain that children who come to the attention of the child welfare system get the support services that they need in a timely manner -- not after months of hearing about problems."
      To launch the programs, the city awarded contracts totaling $2.56 million to three companies. One contractor, Youth Villages, is based in Tennessee and has been lauded by the National Institutes of Health. The other contractors are the Lester A. Drenk Behavioral Health Center, which has provided emergency services to 8,000 clients a year in its southern New Jersey offices, and District-based First Home Care, which officials said previously provided therapeutic foster care services for District children. City social workers will make referrals for the new services.
      Youth Villages, which will do in-home counseling for 96 youths ages 10 to 17, has 14 active cases and 12 pending, said Kate Quirk, senior clinical supervisor. Gina Ceneviva, a Youth Villages counselor, said that when she explained to a parent last week that she would visit three times a week and would be available by beeper any hour of the day or night, the parent was excited. "You could almost see the light bulb going off," Ceneviva recalled. "It alleviates the guilt because the parent says, 'Oh, okay, this is not all on me."
      The Drenk behavioral center will serve clients ages 5 to 21. Katherine Gee, the program's director, said her staff is still waiting for clients. She supervises five crisis counselors who will respond to referrals from the city's 24-hour mental health access line, which foster parents can call to request help. "It's critical because the placement could be in imminent danger of being lost," Gee said. "We focus on de-escalating the crisis." The third program, Foundations for Home and Community, is available on a referral basis to 90 families with foster children who have serious emotional disturbances, officials said.
      The District's child welfare system was once plagued by overburdened caseworkers and had trouble keeping track of children. In addition, foster parents who felt overwhelmed by children would leave them at the agency, said Mindy Good, agency spokeswoman. Court monitor Judith Meltzer said that the new services have been long needed. "Child welfare cannot do it's job without good relationships and access to mental health services," Meltzer said. "I think it's a first important step, but I think there's more that's needed."
      Richard Wexler, executive director of the National Coalition for Child Protection Reform, said the District's efforts to model its programs after successful efforts across the country is the right approach. "This indicates that Child and Family Services has been looking to find what really works around the country and bring it to the District," Wexler said. "They deserve a lot of credit for making this attempt."



Study Probes Many Uses for Stimulants
Associated Press, 2/4/2005

WASHINGTON -- About 1.2 million people age 12 and older used the brain-damaging drug methamphetamine or prescription stimulants for non-medical reasons in 2003, unchanged from the year before, the government's substance abuse prevention agency reported Friday.
       Methamphetamines, prescription diet pills and the attention deficit disorder drugs Ritalin and Dexedrine are the most abused stimulants, the Substance Abuse and Mental Health Services Administration said, based on data from the 2003 National Survey on Drug Use and Health.
       More than 12 million people have used methamphetamine for non-medical reasons in their lifetimes, while 8.7 million people have used prescription diet pills in that manner. Some 4.2 million people and 2.6 million people have used Ritalin and Dexedrine, respectively, for non-medical reasons, the agency said. The data also showed that 378,000 people were dependent on or abused stimulants, and most were in the 12-to-25 age group.
      On the Net: National Survey on Drug Use and Health stimulant report: www.oas.samhsa.gov/2k5/stimulants/stimulants.pdf

Meth Addiction Leading to Rotting Teeth
Associated Press, 2/5/2005

MARYVILLE, Mo. -- The growing use of highly addictive methamphetamine throughout the country is creating a prominent scar on an increasing number of users -- rotting, brittle teeth that seem to crumble from their mouths. Methamphetamine can be made with a horrid mix of substances, including over-the-counter cold medicine, fertilizer, battery acid and hydrogen peroxide. Together, the chemicals reduce a user's saliva, which neutralizes acids and physically clears food from the teeth, said Dr. Eric Curtis, an Arizona-based spokesman for the Academy of General Dentistry. ``When the saliva isn't flowing, the bacteria build up a lot faster,'' said Dr. Darrell Morton, an Atlanta dentist.
      Jeffery Lotshaw flossed regularly. He brushed faithfully, sometimes four or five times in a day. All that care makes his condition seem incomprehensible -- at the age of just 33, Lotshaw's grin is toothless. His teeth all broke apart, tarnished with yellow and black. ``Before I started doing meth, I didn't have a cavity in my head,'' said Lotshaw, imprisoned on drug charges at Missouri's Maryville Treatment Center.
      Meth users also may neglect their teeth, or moisten their dry mouths with high-sugar drinks, and anxiety caused by the drug prompts them to grind their teeth, which speeds decay. The problem is particularly noticeable among inmates, whose oral problems have some prison systems struggling to provide dental care. ``They're rotting teeth, missing teeth, rotting way into the gums,'' said Kathy Bachmeier, the head of medical services for North Dakota's prisons. ``It's ugly.''
      There are no statistics on ``meth mouth'' -- as the condition has come to be known -- because addicts are sometimes reluctant to admit their drug use and because it is difficult to distinguish between damage done by bad dental hygiene and that caused by narcotics. But there are signs it is on the rise around the country.
      The head of the company in charge of dental care for Missouri inmates says he is seeing teeth rotted by meth use nearly every day. In North Dakota, the number of days a dentist was serving inmates jumped from 50 in 2000 to 78 in 2004. And the tab for inmates' dental care in Minnesota rose from $1.2 million five years ago to about $2 million last year. ``There are more and more urgent care needs, which pushes back routine care like cleanings,'' said Nanette Schroeder, director of health services for Minnesota's Corrections Department. ``They're seeing just worse mouths, generally. This is really an emerging problem.''
      Missouri pays a company $7.50 per day per prisoner for health care, regardless of what's needed, so no major cost increase has been incurred. '`My dentists always opt for the best treatment we could offer our patients, as we would in private practice,'' said Dr. Ernest Jackson, whose Jefferson City-based company is in charge of dental care for Missouri prisons.
      But that philosophy isn't necessarily at play everywhere. Schroeder said there's a constant juggling act between constitutional obligations to inmates, costs and the risk of lawsuits. ``Do we always think that it's fair to provide some services to our offender population that people on the outside might not get? Of course not,'' Schroeder said. ``On the other hand, we have to balance that with the risk.''
      Bryan Rogers, another inmate at the Maryville facility, which is exclusively for convicts with drug problems, said he noticed other users' teeth were rotting but made sure he brushed regularly. ``I was always thinking that's not going to happen to me because I keep brushing,'' he said. Rogers, 30, has had three teeth pulled since arriving at the prison in August, and he's awaiting a dental plate. Lotshaw's last 11 teeth have been removed since arriving, also in August, and he's waiting for dentures.
      Lotshaw has been drug-free for more than five months, but there's no denying what is to blame for his empty mouth. ``It reminds me a lot of my addiction,'' he said.

The Making of a Molester (click here to read the 1/23 article)
Letters to the New York Magazine, 2/6/2005

Daniel Bergner did an outstanding job of presenting the inner thoughts of a convicted child molester. I felt ambivalence and sadness toward Roy. After a great effort at rehabilitation, he seems to have no grasp of the enormity of his actions. Instead, he blames not only his victim but also her mother, the Internet, pornography, the media and society in general. What makes me most sad for Roy, and more important for his victim, is that he never owns up to the truth of what he did. He seems shocked and surprised to be a sexual predator convicted of his crime.
Jennifer Liquori

Your article suggests that pedophiles are "made": ordinary citizens transformed into predators by external actions — as, with Roy, the comments of a spouse about her daughter reaching puberty. This is contrary to my 30 years' experience prosecuting child abusers. Neither comments nor the Internet "make" pedophiles. They exist among us, disguised as ordinary people, until they reveal themselves to be the criminals they really are. In other words, Roy wasn't made — he was simply unmasked. Roy is not unlike the defendants arrested in undercover Internet stings conducted by my office: defendants with no prior criminal record who appeared to lead normal lives. Many admitted abusing children previously. And sex-offender probation didn't stop a 42-year-old teacher from soliciting a minor a second time. If we fail to recognize that a pedophile always was — and always will be — a pedophile, we do so at our children's peril.
Jeanine Pirro, District Attorney, Westchester County, White Plains, N.Y.

I very much respect the therapeutic focus on learning appropriate social skills and learning how to stop negative behaviors by understanding and responding to triggers, but I see problems. Both Roy and his therapist are placed in a very difficult contractual situation. The therapist is responsible to the probation department. The patient (probationer) is very much aware of this arrangement. How can the therapist expect total honesty in treatment if the patient knows that the therapist reports to the probation officer and if whatever the patient says can be used to take away privileges including time on probation? This is a Catch-22.
Cal Flachner, New York

If one of the key factors in these atrocities is the blurring between fiction and reality in the molester's mind, as Bergner suggests, then what better way to bring reality back, front and center (for both the reader and the molester), than to focus on the way real human lives are brutalized and permanently scarred? I am no therapist, but I believe that Patrick Liddle, the group's therapist, ought to spend less time having these men visualize "a field of tall grass" and confessing their fantasies and more time having them hear from the voices of those they have hurt.
Eileen O'Brien, Williamsburg, Va.

While studies of deviant sexual-arousal patterns are interesting, arousal is only a small part of what makes a molester. What defines a healthy and mature person is not simply the ability to control what we think and feel, but to control what we do with what we think and feel. It is possible to have "socially inappropriate" feelings, and all of us do. It is the loss of awareness of, or worse, indifference to, the impact of our acts on others that makes us monsters.
Barbara Zevin, Roslyn, N.Y.

Bergner establishes that inappropriate erotic thinking can manifest in many individuals, and then he asks why some cross "that clear line" and act on their thoughts. If you stand back from the content of the crime and look at the broader narrative of Roy's life, you see a remarkable absence of "clear lines" all around: like the early involvement with his victim's mother, who was the wife of his childhood friend; his employer's and co-workers' remarkable blindness to the character pathology despite adjudication and sentencing; his new wife's blindness to the significance of her own dissonance, despite saying, "I can't understand how he could write crap like that to a little girl." The run for the fence at the end of the story is the first evidence of any awareness of a clear line in many aspects of Roy's life.
Denise Legacki Tompkins, Naperville, Ill.

I hope the low recidivism rates reported in the article will be interpreted cautiously. The recidivism rate will appear reassuringly low if the study doesn't take into account the molester's window of opportunity to commit another crime. Obviously, if a person is doing some serious jail time, he doesn't have the chance to commit more crimes, and this can skew the results.
Mary Kennedy, Wilmington, Del.

The magazine is to be commended for publishing Bergner's article. Serious public discussion of this topic is virtually nonexistent. There was an attempt to treat this subject in the cinema as far back as 1961, and, given the era and circumstances, it was way ahead of its time. Readers might be interested in this British film, "The Mark," starring Rod Steiger and Stuart Whitman. Steiger plays a psychiatrist and Whitman the part of a man released after serving a sentence in prison for intent to molest a child. The depiction is unflinching. The film offers no easy answer — there is none. But it does offer hope.
Conrad P. Rutkowski, Spring Valley, N.Y.