Noteworthy News Articles on Mental Health Topics, August 24-31, 2005
Canada Reinstates Attention - Deficit Drug
Associated Press, 8/24/2005
TORONTO -- An attention deficit hyperactivity disorder drug that was forced off the market last February by Canadian Health officials is being reinstated, the drug's maker, Shire Pharmaceuticals, announced Wednesday. Adderall XR will be reinstated on the Canadian market effective this Friday, but it will take a bit longer before the drug is available again across the country, company spokesperson Matt Cabrey said in an interview.
The reversal of the federal regulator's decision comes after a panel of experts -- called a new drug committee -- reviewed the safety data on the drug. Shire triggered the review by in effect appealing Health Canada's decision to remove the drug from the market. ''The NDC (new drug committee) came to the conclusion that there was not enough evidence of an increased harm from Adderall compared to other therapies available,'' said Health Canada spokesperson Jirina Vlk. ''The benefits of treating ADHD has to be balanced with the known harms of this class of drugs.''
Health Canada pulled Adderall XR, a once-a-day treatment for ADHD, off the market on Feb. 9 after learning from the company of 20 cases of sudden death and 12 of stroke in people using the drug. None of those cases occurred in Canada. Fourteen of the sudden deaths and two of the strokes were in children. A number of the cases involved children with structural heart defects.
The U.S. Food and Drug Administration reviewed the data on the cases last summer and concluded the rate of sudden deaths and strokes in Adderall users wasn't higher than what's called the background rate -- the rate of such events that would be expected to occur in people not taking the drug. The U.S. regulator agreed with the company that product labels should be modified to warn of the potential problem. But when Shire approached Health Canada to change its product monograph in this country, the federal regulator responded by pulling the drug.
The announcement was criticized by psychiatrists and patients, many of whom had found the drug more useful for treating their symptoms than other available therapies. ''We expect to have the product available for patients within the next 14 to 21 days and we're now in the process of going through all the appropriate steps to ensure that it's available to physicians and pharmacists,'' Cabrey said.
Study Links Daydreaming, Alzheimer's
Associated Press, 8/24/2005
ST. LOUIS -- Scientists who set out to explore changes in the brain as Alzheimer's disease progresses got a surprise: a possible link between daydreaming and the degenerative brain disease that robs memory, language and thought. A new Washington University study shows the part of the brain used to daydream is the same where Alzheimer's disease develops -- in some people -- later in life. It suggests the normal brain activity of daydreaming fuels the sequence of events leading to Alzheimer's.
''The implication, albeit a speculative one, is that those activity patterns in young adults are the foothold onto which Alzheimer's disease forms,'' said lead researcher Randy Buckner, associate professor of psychology. He said they may lead to a life-long cascade that ends in Alzheimer's disease in some people. ''It suggests a new hypothesis and opens an avenue in exploration,'' Buckner said. ''By no means is it definitive.'' The study appears in this week's The Journal of Neuroscience.
Researchers at Washington University and the University of Pittsburgh used five imaging techniques to map the brains of 764 people. The subjects fell into three groups -- people in their 20s, and older people with either early-stage dementia, or Alzheimer's disease. When they compared images, they found that parts of the brain involved in musing, daydreaming or recalling pleasant memories in young people were where evidence of Alzheimer's disease appears.
The hallmarks of Alzheimer's, which affects 4.5 million Americans, are brain lesions called plaques and tangles, formed from different proteins, that are associated with nerve cells not communicating with each other and eventually dying. The result is a progressive deterioration of memory, learning and language.
The part of the brain involved in daydreaming is always active, even if the mind is at rest, said William Klunk, coauthor of the study and associate professor of psychiatry at the University of Pittsburgh. ''It's like an engine on idle,'' he said. ''It never shuts down. That activity might fuel the sequence of events that could lead to Alzheimer's.'' He said the connection is a ''problem.'' ''The answer is not shutting down our brains,'' Klunk said. ''It means it's very important to identify changes in the brain at early stages of illness, so that as newer interventions come along, we can start them at a time when it makes a difference.''
Until very recently, the disease was diagnosed with certainty only after an examination of brain tissue in an autopsy. But brain imaging technology developed by Klunk can detect the identifying plaques and tangles. The imaging techniques exist in research settings but are not yet a routine clinical tool. Buckner said even though his research correlates brain activity with Alzheimer's, ''there's a lot of evidence that suggests engaged cognition is a good thing. That's the advice I'd give my family.''
Neil Buckholtz, chief of the dementias of aging branch at the National Institute on Aging, which funded the study, said the data are interesting even if the conclusion is speculative. ''A critical question of Alzheimer's disease is why certain parts of the brain have diseased nerve cells and other areas of the brain seem fine. This paper speaks to that question.'' It remains to be seen whether there's a ''real relationship'' between the daydreaming part of the brain and Alzheimer's, he said.
On the Net: The Journal of Neuroscience: http://www.jneurosci.org/
Autistic Boy Dies After Unproven Treatment
Associated Press, 8/25/2005
PITTSBURGH -- An autistic boy died after receiving an unproven treatment that some people believe may cure the neurological and developmental disorder. Officials said they do not know for sure what killed Abubakar Tariq Nadama, 5, who died Tuesday after suffering a heart attack following his third treatment of chelation therapy at a suburban medical clinic. The staff at his doctor's office performed CPR on the boy, but he was later pronounced dead in a hospital. More tests would be needed to determine the cause of death, said Deputy Coroner Larry Barr.
Chelation (pronounced key-LAY-tion) is often used in patients with sickle cell anemia, lead poisoning or other maladies. Its use dates to the 1940s. The boy was undergoing the therapy at the Advanced Integrative Medicine Center in Portersville, about 35 miles northwest of Pittsburgh. Neither the boy's doctor, Roy E. Kerry, nor a representative from the center returned a call for comment Thursday. State police also were investigating.
Some people believe autism can be linked to a mercury-containing preservative once commonly used in childhood vaccines. Chelation therapy has been advocated as a remedy because it causes heavy metals to leave the body through urine. During the treatment, chemicals are administered under the skin or orally. The chemicals bind to heavy metals in the body, and patients excrete the chemicals through urine. One of the most common uses for chelation is lead poisoning, in which a synthetic chemical called EDTA is given to patients. It's unclear exactly how many people undergo the treatment. ''There are thousands of patients getting chelation at home at night in many parts of the world. And it's generally considered quite safe,'' said Dr. Lakshmanan Krishnamurti, a pediatric hematologist and director of the Sickle Cell Program at Children's Hospital of Pittsburgh.
The Food and Drug Administration has approved chelation only for acute heavy-metal poisoning that is confirmed by blood tests. Critics call the treatment risky and say there isn't enough evidence to link autism to mercury or lead toxicity. ''If I were a parent considering it, I would probably stop considering it. There is no clear evidence that you can make kids better with this,'' said Dr. Gervasio A. Lamas, a cardiologist at the Mount Sinai Medical Center-Miami Heart Institute. Lamas said the therapy comes with risks, including possible kidney damage and in some cases heart problems. The boy's mother, Marwa Nadama, said she did not blame the therapy, but was waiting for results of an autopsy.
On the Net:
Children's Hospital of Pittsburgh Autism Center: http://www.chp.edu/clinical/03a--autism.php
Parents of Autistic Children: http://www.poac.net/
OxyContin Doctor Loses Medical License
Associated Press, 8/26/2005
BOSTON -- A doctor facing criminal drug charges lost his medical license after a state board concluded he was a public threat because he wrote so many OxyContin prescriptions. Prescriptions written by Cape Cod Dr. Michael R. Brown accounted for nearly a third of the 923,000 OxyContin tablets that pharmacies in the state sold last year, a board investigator found.
''Clearly, this pattern is such an extreme deviation from his peers that it raised grave concerns for the board,'' Nancy Achin Audesse, executive director of the Board of Registration, said after the hearing Thursday. She said Brown had been required in 2001 to take courses in pain management, but his pattern of prescribing painkillers continued. ''It appears to be willful,'' Audesse said. In the emergency license suspension, the board declared Brown ''an immediate and serious threat to the public safety and welfare.'' The suspension remains in effect indefinitely, but the doctor can appeal.
On Tuesday, Brown, 52, pleaded innocent to 13 counts of illegal drug possession within intent to distribute. Sandwich police accused the doctor of buying back painkillers he had prescribed to a patient. Brown's attorney Russell Redgate said the drug charges appeared to be based on small amounts of drugs that doctor routinely carry. However, Redgate said, ''there are so many allegations, I don't want to go out on a limb and say there's nothing to any of them.''
OxyContin was approved by the federal Food and Drug Administration to treat chronic pain sufferers such as cancer patients, but abusers can alter the tablets to get a quick, heroin-like high.
About 1,000 Lawsuits Filed Against Manufacturer of OxyContin
Pat Milton, Associated Press- 9/26/2005
NEW YORK --About 1,000 people filed separate lawsuits on Staten Island against the manufacturer of the painkiller OxyContin on Friday, claiming they were victims of accidental addiction. The plaintiffs are seeking damages from the Stamford, Conn.-based Purdue Pharma LP, claiming the company dishonestly marketed the pain pill by failing to tell doctors, pharmacists and patients about the morphine-like drug's addictive qualities, according to an attorney in the case, Tor Hoerman. A Staten Island judge recently declined to certify a class-action suit, saying the cases involve different issues and alleged injuries. Instead, a coordinating judge in state Supreme Court was assigned to preside over each case.
Fourteen cartons containing the lawsuits were dropped off at the courthouse by the attorneys on Friday. It took some six hours for four court employees to process the materials and assign index numbers to each lawsuit. "It's been a very busy day but we are here to serve the court," said First Deputy County Clerk Mario DiRe. Similar lawsuits against Purdue Pharma have been filed elsewhere in the country and others are pending, according to Hoerman. "We hope we can finally let a jury hear this case to bring justice for these victims," he said. "We feel there is misconduct here."
Timothy Bannon, a Purdue Pharma spokesman, said the company will vigorously defend each of the cases and fully expects to prevail. "Over the last four years, Purdue Pharma has never lost an OxyContin personal injury lawsuit," Bannon said in a statement. "On the contrary, 365 personal injury lawsuits involving well over 1,000 plaintiffs, including many cases brought by these same personal injury lawyers, have ended in Purdue's favor. We expect these new cases will be no different." Those cases have either been dismissed by the court or withdrawn by the plaintiffs. No case has resulted in a verdict against Purdue, although in November 2004 the manufacturer reached an out-of-court settlement with the West Virginia state attorney general's office, which had filed a lawsuit in 2001.
OxyContin, which won federal approval in 1995, is prescribed for terminal cancer patients and others with chronic pain but became a target for abusers who figured out how to use it for a quick, heroin-like high. Purdue Pharma has said it is not responsible for problems caused by OxyContin abuse because the drug is safe and effective when used as intended.
SOS Offers a Secular Alternative to AA
Patricia Ward Biederman, Los Angeles Times- 8/27/2005
Eighteen years ago, Larry B. was newly sober when he got up at an Alcoholics Anonymous meeting and said he was troubled by the 12-step program's emphasis on God. Shortly afterward, someone slipped the San Fernando Valley man a note: "Have you tried SOS?" Larry took the stranger's advice and sought out SOS, now called Save Our Selves or Secular Organizations for Sobriety. When Larry discovered it in the late 1980s, SOS was one of the few support groups for those trying to overcome addiction without the steps or references to the higher power that are central to the AA tradition. Because he is a nonbeliever, Larry was relieved that SOS didn't expect him to turn his will and life "over to the care of God as we understand Him," as described in the third of AA's 12 steps. In contrast, Larry, now in his late 50s, said SOS offered "the type of sobriety I could wear right off the rack, with no alterations in my lifestyle except not drinking."
SOS will celebrate its 20th anniversary today with an international conference at the Center for Inquiry-West, 4773 Hollywood Blvd., Hollywood, home of the secular humanist organization and headquarters of SOS. SOS founder Jim Christopher, 63, said the group differs from faith-based recovery programs in putting the individual in charge of overcoming his or her addictions. "My sobriety is based not on the existence of SOS or any other entity or higher power but on the recognition that I can't drink or use and get away with it," he said. Christopher, who once downed a fifth of vodka a day, said he has not had a drink since April 24, 1978. He said he did not go into a treatment program but found his own way to be sober. He tried AA, the largest and most influential support group for recovering alcoholics, but was alienated by what he saw as its religious philosophy.
Founded in North Hollywood in 1985, SOS has more than 100,000 members in the United States and abroad. Many, but not all, of its members are atheists, secular humanists or other non-Christians. It is the largest secular sobriety group in the world, Christopher said. An SOS meeting differs from a typical AA meeting. Instead of using the standard AA introduction, "Hi, I'm Jim, and I'm an alcoholic," Christopher usually opens meetings by saying, "Hi, I'm Jim, and I'm a sober alcoholic" because "that's accurate," he said. Others prefer something purely social, like "I'm Judy, and I'm happy to be here tonight." People at SOS meetings rarely tell horror stories about how badly they behaved while drunk or high on drugs, Christopher said. At the 12-step meetings he attended, he came to dread the recital of "war stories" as a perverse form of one-upmanship. And SOS has neither prayers nor a spiritual agenda, he said. The only purpose is to stay sober. "It's great not to steal hubcaps and to be the best person you can be, but you can be a jerk and stay sober," Christopher said. "It's a separate issue…. As one Catholic lady in SOS said, she wanted separation of church and recovery. 'I already have a religion. I don't need another.' I've heard that too."
Christopher is careful not to bad-mouth AA: "We're not saying we're better than AA or 'Down with AA,' but we are saying there's a need for alternatives and options." But he does regard AA as "a religion in denial" and rolls his eyes at "the bumper sticker language" of such slogans as "Let go. Let God." AA, however, says belief in God is not a requirement for participation. Julio, who like other AA members does not give his last name, is on the staff of AA's general service office for the United States and Canada, in New York City. He said: "The only requirement is the desire to stop drinking. There are many atheists and agnostics who are members of AA and find a way to stay sober and find their own spiritual path. It is a personal program. It's basically a very inclusive program. That's why we only have one requirement: a desire to stop drinking." According to its official website, AA is not allied with any sect or denomination and "does not wish to engage in any controversy."
Also expected to attend today's conference in Hollywood are members of Women for Sobriety, one of the oldest alternative sobriety groups and the first designed specifically for women, in 1976. AA's first step, acknowledging powerlessness over alcohol, was a stumbling block for sociologist Jean Kirkpatrick, founder of the women's group. Arcadia resident Michaelyn Fidone, regional moderator for Women for Sobriety, said: "Women are basically born into the world as second-class citizens, and we don't need to experience any more powerlessness than we already have." In this spirit, she introduces herself at meetings by saying, "I'm Michaelyn, and I'm a competent woman."
Like SOS, Women for Sobriety holds that "sobriety is a separate issue" from religion or spirituality, Fidone said. SOS is open to people trying to overcome any addiction — to alcohol, drugs, gambling and sex — as well as those with eating disorders, Christopher said. Friends and family are also welcome. At meetings, members often share their hard-won discoveries of what helps sobriety and what threatens it. As part of Larry B.'s recovery, he developed a "tool kit" described in a popular SOS pamphlet. His tips range from avoiding bars to observing people who are drunk and asking yourself, "Is that a wonderful life?" SOS offers "a way, not the way," Christopher said.
Barry Solof, a member of the SOS International Advisory Board, is a physician and a fellow of the American Society of Addiction Medicine who heads the local service area for Kaiser Permanente's addiction medicine department. Emphasizing that he was speaking as an individual, not for Kaiser Permanente, Solof said: "The fact is, no matter how they skirt the issue … there's a heavy emphasis on spirituality in AA," and "many people are not comfortable with that." AA and groups based on it are usually the only ones recommended to people in recovery, according to studies. But when Solof counsels patients dealing with addiction, he tries to match the person with a support program. If he sees a cross around a person's neck, he doesn't hesitate to recommend AA. But he also tells patients about secular alternatives, he said.
Sociologist Randolph Atkins Jr. is analyzing data from a national survey he conducted for the National Institute on Drug Abuse on attitudes of 1,067 people in recovery support groups, including SOS. Atkins, who is scheduled to speak at the conference, said the goal is to develop an assessment tool to help counselors match people in recovery with appropriate support. In spite of the continuing prominence of AA, he said, there is growing recognition in addiction treatment that "one size does not fit all. Different people need different things."
Education Could Be Key to Stop Bedwetting
Associated Press, 8/29/2005
WASHINGTON -- To help a 7-year-old overcome bedwetting, Dr. Howard Bennett reaches for red water balloons and a superhero named Bladderman. Bedwetting is a problem for more than 5 million U.S. children age 6 or older. Alarms and medicines are available, but understanding how their bodies work for many kids is key to staying dry -- instruction that's a challenge to work into the typical rushed visit to the pediatrician.
Enter Bladderman, Bennett's creation and hero of the first book published by the American Academy of Pediatrics that's aimed directly at children, not just their parents. The goal: To demystify bedwetting so that children understand accidents aren't their fault -- it's not a matter of willpower but of biology -- and to outline research-backed steps they can take to help stay dry. Bedwetting ''is common. You can ask for help,'' says Bennett, author of ''Waking Up Dry'' and a Washington pediatrician who specializes in treating what doctors call nocturnal enuresis.
Bedwetting is hard on youngsters' self-esteem. They may decline sleepovers or dread camp, or devise elaborate schemes, such as doing their own laundry, to hide the problem. Bennett even had a 9-year-old patient whose younger brother discovered his bedwetting and used it as blackmail.
Children usually get nighttime bladder control between ages 3 and 5. The brain and bladder must learn to work together: First, the bladder signals the brain that it's filling. The brain then either signals back for the bladder to relax and hold more urine overnight, or signals the child to awaken.
Occasionally, medical problems such as diabetes or anatomical abnormalities, cause bedwetting. But 85 percent of the time, it happens simply because the brain-bladder maturation isn't finished. Three main reasons:
--While people's bladders are all about the same size, some sense that it's full sooner than it really is. Bennett calls this a ''small functional bladder.''
--Some kids don't produce enough of a hormone called vasopressin that signals the kidneys to make less urine at night.
--Some children are difficult to arouse at night, and sleep through the tickle sensations of a full bladder.
Boys are twice as likely as girls to experience delays in nighttime bladder control, and bedwetting tends to run in families; whatever age mom or dad became dry usually is the age their own children will.
The good news: Fifteen percent of bedwetters become dry each year without any intervention. For children who don't want to wait it out, there are ways to help. Most common are alarms that buzz or vibrate when they sense wetness. Studies show the alarms, which cost from $60 to $200, can help train children to wake up. ''But the education is crucial,'' stresses Dr. Patrick McKenna, chairman of urology at Southern Illinois University School of Medicine, citing studies that show good training in how the bladder works and how to control it can meet or exceed the devices' effect.
It requires an hour of doctor-child training, hard to squeeze into a busy pediatrician's schedule, McKenna says. So parents often are left seeking more information on their own, from such sources as the National Kidney Foundation -- which has some kid-friendly advice on its Internet site -- and the pediatrics' academy. Humor, Bennett says, eases kids' anxiety so they can learn: He regularly gets splashed as he uses water balloons to show his patients how the bladder's door, the sphincter muscle, controls urination.
Among his recommendations:
--Exercise that muscle by squeezing it several times a day.
--Limit liquid near bedtime, but drink two extra glasses of water earlier in the day to exercise your bladder. ''We think if you pay attention to your bladder in the daytime, you'll pay more attention at night,'' Bennett explains.
--Kids should chart on a calendar how often they wet. Once they're dry for 14 consecutive nights, bedwetting likely is over.
--Tell kids it takes practice to achieve bladder control, just like sports stars practice their jobs daily -- and offer small weekly rewards for the effort whether they stay dry or not, advice that mothers of two of Bennett's patients called key to maintaining children's enthusiasm.
There are bedwetting medications, including a synthetic version of vasopressin to reduce urine production. But Bennett and other specialists stress they should be a last resort; they have side effects and their effect is almost always temporary.
When pediatrician-based programs fail, urology specialists typically are called -- but even with many hard-to-treat cases, bladder training without medication can help, says McKenna, who developed computer games that help youngsters exercise their pelvic muscles.
Northville Psychiatric Hospital Sold for $31.5 Million
Associated Press, 8/30/2005
LANSING, Mich. -- A real estate developer will pay $31.5 million for the site of a former psychiatric hospital in suburban Detroit, much less than the asking price two years ago, the state said Tuesday. Bloomfield Hills-based Real Estate Interests Group Inc. -- which backed out of a planned purchase earlier this year -- has agreed to buy the 414-acre property in Wayne County's Northville Township. It will close the sale by Sept. 29, according to the state Department of Management and Budget. The state planned to hold a live auction Tuesday afternoon. But it wasn't necessary after another bidder for the property, Bloomfield Hills-based Windham Development Inc., didn't conform to requirements, the DMB said. The property is appraised at $31.5 million to $41.5 million.
DMB Director Lisa Webb Sharpe said redeveloping the state's former Northville Psychiatric Hospital is important to the local community and Michigan. "No longer sitting unused, this property sale will support vital services to Michigan citizens, while fostering economic growth and generating revenue," Sharpe said in a statement. The property is attractive because it's the only substantially undeveloped site remaining in Northville, a fast-growing suburb. It's located in a prime commercial corridor.
Past efforts to sell the site have been unsuccessful, though. Twice in 2003 the department requested minimum bids of $65 million. But two bidders, including REI, walked away. REI cited concerns over the cost of environmental cleanup at the site -- which has medical waste dumps, oil wells and other contaminants. Herb Lawson, president of Windham Development, said Tuesday there were many unanswered questions about the site such as its sewer capacity, Northville Township's zoning ordinance and environmental cleanup. Windham's bid had contingencies it wanted resolved before the developer would close on a sale, Lawson said. "There was a lot of risk involved without knowing the answers," he said. "We're not land speculators."
Lawson said he was thrilled the state found a buyer, noting it was fortunate to receive any bids. The state plans to use money from the sale to help balance the budget for the fiscal year that ends Sept. 30. It was anticipating $40 million from the sale, meaning more than $8 million must come from elsewhere.
On the Net Department of Management and Budget: http://www.michigan.gov/dmb
Heroin Addicts Get Overdose Remedy
John Keilman, Chicago Tribune- 8/31/2005
Street lore holds that in case of a heroin overdose, the victim should be made to walk, placed in a cold shower or shot up with everything from salt water to milk. But on Tuesday, a Chicago health organization tried to spread the word about the remedy that works best: a drug called naloxone. It's a clear liquid that reverses the potentially fatal effects of opiate drugs. The Chicago Recovery Alliance, which has trained 5,000 people in how to use naloxone, says the instruction has saved at least 336 lives over the last four years. "As a physician, this is some of the most rewarding work I've ever done," said Dr. Sarz Maxwell, the alliance's medical director. She was leading a workshop for six outreach workers who, in turn, are supposed to pass their knowledge to heroin addicts. Once trained, drug users can get bottles of naloxone and syringes from Maxwell.
Heroin kills by depressing breathing. Naloxone reverses that effect, which for decades has made it the standard emergency room method of reviving overdose victims. The alliance, formed in 1992, operates needle exchanges--providing sterile needles in exchange for used ones--around the city and suburbs. Alliance officials believe that heroin addicts can save fellow users with naloxone. Most won't call 911 if a friend gets in trouble for fear of the police, Maxwell said. Naloxone "wakes people up enough that they can walk to the car and go to the hospital," she said. "That might be a better idea to users than inviting the cops up to your apartment where all your dope is laying out."
Dr. Richard Feldman, head of the emergency department at Advocate Illinois Masonic Medical Center in Lakeview, said he saw little downside to the training. "It's an extremely rapid-acting, effective and safe drug," he said. "I would be very supportive of the training program, because there are a lot of heroin addicts who die without ever getting to the hospital." But in the view of Dr. Andrea Barthwell, a public health consultant and former official with the White House Office of National Drug Control Policy, distributing naloxone helps support drug habits and makes addicts harder to reach. "If you engage in strategies that delay confrontation of the disease and application of curative strategies, you actually do more harm than good," she said.
But those who took the training said their main concern is to help in a moment of crisis. Ana Arias, an HIV case manager at Howard Brown Health Center in Lakeview, said that some of her clients use heroin, and that naloxone could keep them and their peers around until they're ready for help. "If you know for sure this person isn't going to stop, you're not enabling them, you're helping to save their life," she said.
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