Providentia

Stress, Depression and Epilepsy

The September 2008 issue of Epilepsy and Behavior presents the results of a study examining the relationship between psychological factors (anxiety, stress, and depression) and epileptic seizures. Using a longitudinal study design with 433 subjects, data was collected concerning anxiety, depression, perceived stress, and time since last seizure using standard psychometric testing. The subjects were tested on two separate occasions to determine change over time. The researchers used statistical modeling techniques to test how psychological factors acted together in predicting frequency and length of seizures. The results indicated that stress, anxiety and depression all predicted the time since the last seizure. Depression, however, was found to be the most significant mediating factor. The researchers concluded that the role of depression in epileptic seizures emphasized the importance of depression management in addition to seizure management in the assessment and treatment of epilepsy in an adult population.

Click here for the abstract.

Off to South Africa

By the time you read this, I'll be in South Africa as part of a professional delegation of Canadian psychologists visiting counterparts there. The delegation has been organized by the People to People Citizen Ambassador program and I'm looking forward to continuing my long love affair with Africa and its people. I'll try to keep you updated as time and Internet access allows.

Click here for the itinerary.

HIV and AIDS in Older Adults

As study in the October 2008 issue of AIDS Care discusses the growing number of older Americans with HIV or AIDS. According to the National Institute of Health, cumulative estimated number of HIV/AIDS cases in the US for ages 50-54 was 56,950. Furthermore, the number of newly-infected persons 65 years and older has grown considerably in the last ten years. Unfortunately, surveys indicate that the attitudes and knowledge of older Americans concerning HIV/AIDS tends to be poorer than younger adults. This may be due to the lack of prevention programs geared towards older persons and physician discomfort levels in discussing sexuality with older patients. While it is important to attribute this longevity to the emergence of highly active antiretroviral therapy, consideration must also be made for the mental well-being of this cohort, as evidenced by the effectiveness of antiretroviral chemotherapy and the prevalence of depressive disorders unique to older populations. The unique co-morbidity of clinical depression and HIV/AIDS presents unique challenges to the physician and other healthcare providers. The NIH awarded $1.6 million to the University of Ohio Health Psychology Program in 2006 to examine how older Americans are coping with HIV/AIDS.

Click here for the abstract.

How Dangerous is Lariam?

Malaria kills millions of men, women and children each year and represents one of the greatest health threats the world has ever known. While the disease is curable if diagnosed and treated promptly, delays in receiving treatment are far from uncommon.; Health agencies recommend avoiding mosquito bites and taking effective anti-malarial medication for all visitors to regions where malaria is endemic (including most tropical areas of the world). In addition to travelers, military and foreign aid personnel deployed in high-risk regions are routinely provided with anti-malarial medication, most of which are taken orally

As as result of several high-profile cases, concerns have been raised over the health risks posed by one of the most widely-used anti-malarial medication. Lariam (generic name mefloquine) was first developed in the 1970s by the U.S. military as synthetic analogue to quinine. As the drug of choice in treating chloroquine-resistant malaria and as an oral preventive agent, Lariam remains widely prescribed despite questions over possible toxicity.

In addition to common side-effects such as diarrhea, nausea and stomach problems, more worrisome symptoms have been reported including neuropsychiatric complications. Cases of psychotic behaviour, depression, suicide, paranoia, and aggression have been reported, including incidents of domestic violence and a recent suicide involving a US serviceman that have been linked to Lariam use. While the US Food and Drug Administration has acknowledged the possibility of dangerous side effects with Lariam, they maintain that the "benefits far outweigh its risks". Other countries, including Canada, have issued health advisories concerning Lariam and Hoffman-La Roche has provided warning letters to travel doctors and pharmacists concerning potential side-effects.

These precautions are not enough for some US-based activists who have organized an information and support service to warn about Lariam's dangers. Their network has links to similar activist groups across the world.

Click here for more information

Click here for more information.

Does Suppressing Anger Affect Pain Sensitivity?

An article in the September 2008 issue of Health Psychology provides evidence linking anger inhibition or suppression and chronic pain severity. Based on ironic process theory, researchers have proposed that attempting to suppress suppress angry thoughts during when experiencing painful stimuli would increase subsequent pain intensity among chronic low back pain (CLBP) patients, due to paradoxically enhanced anger. Although previous research has indicated a link, these studies have focused on correlational data. Using an experimental model, a sample of 58 CLBP patients (N = 58) were assigned to suppression and nonsuppression conditions while performing a computer maze task with a harassing confederate. A structured pain behavior task (SPBT) followed. The subects were tested in terms of self-reported anger, estimated pain severity and observed on the experimental trials. The results showed that patients told to suppress during provocation: (a) reported greater anger following the maze task, reported greater pain intensity during the SPBT, and exhibited more pain behaviors than patients not suppressing; (b) postmaze anger levels significantly affected group differences on pain behaviors. The researchers concluded that attempts by CLBP patients to suppress anger may aggravate pain related to their clinical condition through ironically increased feelings of anger.

Click here for the abstract.

WHO Calling for Treatment of Mental Disorders in Developing World

A representative for the World Health Organization has announced a new program to raise awareness of the critical need for treatment programming in developing countries for people suffering from psychiatric and neurological disorders. Although an estimated 300 million people in the world suffer from mental health problems, developing countries lack essential resources to address these issues. More than 75 per cent of all mentally ill individuals in less economically prosperous countries remain untreated.

The proposed WHO program, titled the mental health Gap Action program (mhGAP) is focusing on eight conditions including schizophrenia, substance abuse, psychiatric illnesses in children, dementia, epilepsy and suicide. The goal is to provide treatment by 2015 for 20 per of individuals needing help. The program is also focusing on the stigma that surrounds mental illness which prevents sufferers from seeking treatment and which also results in discrimination and neglect. The WHO is planning to train local health professionals to integrate mental health programs into primary health care.

Critical problem areas include the nine out of ten epilepsy sufferers in Africa who are currently not receiving proper medication to control seizures as well as the growing number of HIV dementia cases that are straining available resources.

As evidence of the feasibility of the new program, the WHO has cited several initiatives that have been extremely effective. Chile has successfully incorporated treatment for depression into primary health care providing treatment for thousands of Chileans with emotional difficulties. An epilepsy treatment in China has also been successful.

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L.A. Murder-Suicide Linked to Financial Problems

Police found two suicide notes found in the upscale L.A. home where 45-year old Karthik Rajaram shot and killed his wife, three children and mother-in-law before killing himself on October 6. The two notes, one addressed to the police and the other for his family and friends, referred to Rajaram's financial problems and his decision to kill himself and his family. Their eldest son, Krishna, had been a Fulbright scholar at UCLA and had been visiting his family when the killings occurred.

Rajaram had an MBA from UCLA and formerly worked for Price Waterhouse and Sony Pictures among other businesses but had apparently been unemployed for several months. He and his family had been extremely well-off at one time with several million dollars in assets before financial reversals and his own erratic behaviour caused him to become despondent over his inability to maintain his family's affluent lifestyle.

Residents in the neighbourhood and representatives of the extended Indian community to which the Rajaram family had belonged expressed shock and grief at the deaths. While police have indicated that the killings were apparently premeditated, Rajaram's motives remain unclear. There is no evidence that he ever sought mental health counseling regarding his emotional issues.

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Dying In Isolation

News media sources in the Netherlands have provided a disturbing look at a practice that has become increasingly common in Dutch psychiatric facilities: the use of "isolation cells" to warehouse problem patients. An estimated 18,000 psychiatric patients are believed to be placed in isolation cells each year where they are kept segregated from other patients, often for months at a time. While legislation prevents patients from being kept in isolation if they are judged to pose an active danger to themselves or others, isolation cells are increasingly being used to house patients as punishment or even due to lack of staff.

In August of this year, the Dutch Health Inspectorate released a report criticizing an Amsterdam psychiatric clinic for its inadequate care and staffing shortage. In September, a 47-year old schizophrenic patient in isolation "choked to death on a piece of bread". A second patient committed suicide. Health care ombudsmen are reporting isolation-related deaths at other facilities that have not been mentioned in the media.

While the use of segregation remains a common practice in dealing with mentally ill inmates in jails and prisons, the use of isolation cells in psychiatric facilities represents a disturbing new trend. Dutch legislators are calling for minimum standards for isolation cells as well as closed-circuit cameras and regular inspections.

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The National Guard in Iraq

While National Guard (NG) troops are serving longer deployments than ever before, there is still little research examining the effects of these deployments affect compared to active military troops. In the September 2008 issue of Anxiety,Stress and Coping, a study presents the results of research into the extent of combat exposure, severity of post-deployment psychological symptoms, and general interpersonal functioning in 50 NG soldiers who served a 12-month deployment in Iraq from 2005 to 2006. The results indicate that combat exposure and post-deployment post-traumatic stress symptoms in this sample are greater than those in NG veterans of past military operations, and similar to those of full-time soldiers in current operations. Furthermore, the patterns of interrelationships between combat exposure, psychological symptoms, and interpersonal variables were similar to those detected in prior research on military troops. These results suggest that NG veterans of current military operations may require the same psychological resources as active duty veterans. Given that NG troops are less integrated into the military structure, specific outreach efforts may be needed to help NG veterans to receive such services.

Click here for the abstract.