Chapter 16.

Psychopathology: Biological Basis of

Behavior Disorders
Links 1 - 20 of 725
Mothering Malnutrition: Moms' depression weighs on infants in Pakistan

Bruce Bower In southern Asia, where an estimated 75 million children

qualify as malnourished, lack of food may only be part of the problem. A
prospective study in rural Pakistan finds that mothers who became
depressed shortly before or after giving birth had babies far more likely
to experience stunted growth and bouts of diarrhea than were babies
with psychologically healthy mothers. Maternal depression critically
contributes to high rates of malnutrition and failure to thrive among
infants in this part of the world, conclude psychologist Atif Rahman of
the University of Manchester in England and his colleagues. Most people
living in southern Asia now have access to adequate food supplies, the
researchers note. In the new study, maternal depression exhibited a
stronger link to poor infant health during the first year after birth than
did other factors associated with slowed physical growth, including low
birth weight and having poor, uneducated parents. This finding raises
particular concern, according to the scientists, because several other
reports indicate that the depression rate of 10 to 15 percent among
expectant and new mothers in Western nations nearly doubles in
southern Asia. Copyright ©2004 Science Service.
Keyword: Depression; Development of the Brain
Posted: 09.18.2004

Panic Disorder

With cars blurring past to her left and right, Judy Niosi pried her fingers
around the steering wheel as she drove along a major highway,
struggling to come to grips with what she thought was a heart attack. "I
was feeling was that my heart started pounding—forcefully—to the point
where I thought my chest was going to explode," recalls the 37-year-old
graphic artist. "My hands became sweaty and I had the constant
thoughts that I was going to die." Niosi gulped down air, talked to herself
in a soothing tone and somehow rumbled up her driveway a short while
later. By then, her symptoms had disappeared. "I immediately got on
the Internet looking for things, you know, heart attack symptoms to
make sure that I wasn't having a heart attack," she says. "And I came
across panic attacks and then I realized it must've been a panic attack."
Her physician confirmed her suspicions. Doctors have long suspected
that panic attacks like Niosi's—characterized by repeated bouts of
intense fear that seem to come out of nowhere—could be hereditary and
may result from the way our brains are wired. Piling up is new evidence
that this may be the case. Psychiatrist Alexander Neumeister, an
assistant professor at Yale University, reported in the Journal of
Neuroscience that key brain receptors that receive chemical signals from
other cells are deficient in those who suffer from panic attacks. The
receptors help move the brain chemical serotonin—it regulates emotion
—around the brain. © ScienCentral, 2000- 2004.
Keyword: Emotions
Posted: 09.17.2004

Panel Urges Child Antidepressants Warning

By LAURAN NEERGAARD WASHINGTON -- All drugs used to treat

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 depressed children should carry a "black box" warning of the
antidepressants' link to increased suicidal thoughts and actions, says a
panel of federal advisers. The warning, among the strongest in the Food
and Drug Administration's arsenal, should reach doctors no matter how
they get drug information and would extend to drug advertising directed
at patients. That's the majority opinion of federal advisers, who heard
testimony Monday about antidepressants' powers and perils from
doctors, researchers and relatives of patients who killed themselves after
taking such medication. The panel spent the bulk of Tuesday deliberating
before issuing its recommendation. The black box option is more strident
than the bold-letter warnings the same federal advisers suggested be
added to antidepressant labels this March. Antidepressant prescription
rates to children were unchanged by the earlier warning. Unlike the
earlier red flag, advisers said this new warning should make clear that
antidepressants have been linked to two to three more children per 100
having heightened suicidal thoughts and behaviors. Copyright © 2004,
The Associated Press
Keyword: Depression; Development of the Brain
Posted: 09.16.2004

FDA considers antidepressant risks for kids

Erika Check Advisers to the US Food and Drug Administration (FDA)

have told the agency to issue a sweeping new warning about the risks of
all antidepressants in children. The warning would state that such
medicines cause some children to try to commit suicide. This is a step up
from warning labels adopted by the FDA in March, which say that
antidepressant drugs are associated with a risk of suicide in children, but
do not necessarily cause it. The warning would appear on all
antidepressants on the market, as well as those approved in the future.
The committee said antidepressants should also be sold with a guide
that tells parents to monitor children on the drugs for suicidal
tendencies. The advisers came to their conclusions last night after a two-
day hearing, in which they examined data from 24 clinical trials, as well
as hearing passionate testimony from patients, parents and doctors who
work with depressed children. The FDA convened the hearing on 13
September to ask its advisory committee how to interpret the clinical
trials, which examined the effect in children and teenagers of nine
antidepressant medications on five types of mental illness. The FDA
usually adopts its advisory committee's recommendations, but will
discuss them internally before announcing a decision, says Robert
Temple director of the Office of Drug Safety in the agency's drug
evaluation centre. ©2004 Nature Publishing Group
Keyword: Depression; Development of the Brain
Posted: 09.16.2004

Prozac raises child suicide risk

Children who take the anti-depressant Prozac are at greater risk of

attempting suicide, say US experts. The drug is currently the only anti-
depressant which doctors can prescribe to under-18s in the UK. Other
similar drugs are considered too dangerous because previous studies
have linked them to an increase in suicidal tendencies. However, an
analysis by the US Food and Drug Administration has found that Prozac
too may pose a risk. The analysis was overseen by Dr Robert Temple,
director of the FDA office of drug evaluation, who gave evidence on
Tuesday at a hearing to determine whether tougher warning labels were

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 needed for anti-depressants. He said: "I think we now all believe there is
an increase in suicidal thinking and action that is consistent across all
the drugs." The FDA decided that all antidepressant drugs should carry
the strongest possible warnings that they could cause children to harm
themselves. In future, the drugs will have to black boxes spelling out the
potential risks. On average, the analysis, carried out by experts at
Columbia University, New York, found anti-depressants taken by children
will cause an extra 2% to 3% to have increased suicidal thoughts.
(C)BBC
Keyword: Depression; Development of the Brain
Posted: 09.15.2004

New Warnings Sought on Antidepressants

By GARDINER HARRIS When the Food and Drug Administration opens an

advisory committee hearing tomorrow into the safety of antidepressants,
several committee members will push for tougher warnings saying that a
child or teenager given the drugs can become suicidal in the first weeks
of therapy, they said in interviews. "I want the warning strengthened,"
said Dr. Richard Gorman, a member of the committee and a pediatrician
from Ellicott City, Md. "I would also like the pharmaceutical companies to
send out letters to doctors saying that, in kids, this stuff doesn't work."
Dr. James McGough, another committee member and a professor of
clinical psychiatry at the University of California, Los Angeles, also said
he wanted stronger warnings. For more than a year, agency officials
have struggled to find the appropriate balance between warning patients
about the possible suicide risk of antidepressants and reassuring those
patients that drug therapy can be an effective and safe remedy.
Copyright 2004 The New York Times Company
Keyword: Depression; Development of the Brain
Posted: 09.13.2004

Gene May Link Alcoholism and Depression

By CHERYL WITTENAUER, Associated Press Writer ST. LOUIS -- Scientists

say they've identified a gene that appears to be linked to both
alcoholism and depression, a finding that may one day help identify
those at higher risk for the diseases and guide new treatments. Previous
studies of twins and adopted siblings have suggested there likely are
genes in common underlying alcoholism and depression, and that the
two disorders seem to run in families. But the lead researcher of the new
study says this is the first report of a specific gene that seems to
increase risk for both disorders. "Clinicians have observed a connection
between these two disorders for years, so we are excited to have found
what could be a molecular underpinning for that association," said Alison
Goate, the Washington University School of Medicine researcher who led
the study. Follow-up research might help reveal the underlying biology
that makes some people susceptible to alcoholism, others to depression,
some to both diseases, and others to neither. Goate says a variation or
alteration of the CHRM2 gene influences those four separate conditions.
The study is published in the September issue of the journal Human
Molecular Genetics. Copyright © 2004, The Associated Press
Keyword: Drug Abuse; Depression
Posted: 09.09.2004

Prescribing Antidepressants for Depression in Bipolar Disorder--Point/Counterpoint

Psychiatric Times August 2004 Vol. XXI Issue 9 It Is Reasonable To Try

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 and Treat Depression in BD Primarily With Antidepressants by Lori
Altshuler, M.D. Bipolar disorder (BD) affects approximately 1% of the
population and is associated with a high morbidity and mortality
(Goodwin and Jamison, 1990). Bipolar disorder is recurrent in almost all
cases, and most patients will spend more time in the depressed than the
manic phase of their illness over their lifetime. This is true for patients
with bipolar I disorder (BD-I) as well as bipolar II disorder (BD-II)
(Goodwin and Jamison, 1990; Judd et al., 2002). Suicide attempts and
completed suicides are high in this population (Goodwin and Jamison,
1990). Most Patients With BD Do Not Need, or Would Not Benefit From,
Antidepressants by S. Nassir Ghaemi, M.D. Voltaire is reputed to have
held his contemporary medical colleagues in low regard, saying:
"Doctors pour drugs of which they know little, to cure diseases of which
they know less, into human beings of whom they know nothing." There
is, no doubt, a herd mentality, codified in the "standard-of-care" legal
criterion, that physicians share with all of mankind. Progress in medicine
depends, however, on the ability to critically examine one's assumptions
and a willingness to apply standards of evidence that share at least
some aspects of scientific method. © 2004 Psychiatric Times
Keyword: Schizophrenia; Depression
Posted: 09.09.2004

Applications of Transcranial Magnetic Stimulation to Therapy in Psychiatry

by Antonio Mantovani, M.D., Ph.D., and Sarah H. Lisanby, M.D.

Psychiatric Times August 2004 Vol. XXI Issue 9 Transcranial magnetic
stimulation (TMS) is a non-invasive means of stimulating focal regions of
the brain using magnetic fields. Since its introduction in 1985, TMS has
been used to study localization of brain functions, connectivity of brain
regions and pathophysiology of neuropsychiatric disorders. The potential
uses of TMS to treat psychiatric disorders are under active study. This
article reviews the state of knowledge about the therapeutic potential of
TMS in psychiatry. Transcranial magnetic stimulation is an investigational
medical procedure performed by placing an electromagnetic coil on the
scalp (Figure). High-intensity current is rapidly turned on and off in the
coil through the discharge of a capacitor. This produces a time-varying
magnetic field that lasts for about 100 to 200 microseconds. The
magnetic field strength is about 1.5 to 2 tesla (about the same intensity
as the static magnetic field used in clinical magnetic resonance imaging)
at the surface of the coil, but the strength of the magnetic field drops off
exponentially with distance from the coil. The proximity of the brain to
the time-varying magnetic field results in current flow in neural tissue
and in membrane depolarization. Transcranial magnetic stimulation is
experimental; it is not approved by the U.S. Food and Drug
Administration for the treatment of any disorder. A striking effect of TMS
occurs when one places the coil on the scalp over the primary motor
cortex. A single TMS pulse of sufficient intensity causes involuntary
movement in the muscle represented by that region of cortex. © 2004
Psychiatric Times.
Keyword: Depression
Posted: 09.09.2004

Indicting the Drug Industry's Practices

By JANET MASLIN Dr. Marcia Angell is a former editor in chief of The New
England Journal of Medicine and spent two decades on the staff of that
publication. If much of that time was devoted to reviewing papers on

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 pharmacological research, it must have been spent in a state of near-
apoplexy. Her new book, 'THE TRUTH ABOUT THE DRUG COMPANIES', is
a scorching indictment of drug companies and their research and
business practices. "Despite all its excesses, this is an important industry
that should be saved - mainly from itself," she writes. This turns out to
be one of her book's more forgiving pronouncements, since the rest of it
is devoted to assertions of shady, misleading corporate behavior. If she
is accurate in her assumptions about big drug companies' feistiness and
tenacity, Dr. Angell is likely to be on the receiving end of angry rebuttals.
She is sometimes vague enough to leave room for such attacks. ("I have
heard that morale in some parts of the F.D.A. is extremely low, and I can
certainly understand why it might be.") But over all, Dr. Angell's case is
tough, persuasive and troubling. Arguing that in 1980 drug
manufacturing changed from a good business into "a stupendous one,"
thanks to changes in government regulations. She adds, "Of the many
events that contributed to their sudden great and good fortune, none
had to do with the quality of the drugs the companies were selling."
Copyright 2004 The New York Times Company
Keyword: Miscellaneous; Depression
Posted: 09.07.2004

911 PTSD Therapy

We know them as heroes, but many of the first-responders who survived

9-11 felt far from heroic. Instead they were shattered by post-traumatic
stress. As this ScienCentral News video reports, some software
engineers scrambled to help. Stephen King, a retired New York City fire
fighter, got out of the World Trade Center alive on September 11th,
2001. But the trauma didn't end that day. "It overtook every aspect of
my life," says King. "I couldn't enjoy anything, I couldn't get basic
necessities like sleep…I was like a walking zombie, literally. All the things
that always kept me occupied and busy just nothing seemed to matter
anymore." King reached out for help and found out he was suffering
from post-traumatic stress disorder or PTSD. Psychiatrist JoAnn Difede,
director of the Program for Anxiety and Traumatic Stress Studies and a
psychiatry professor at Weill Medical College of Cornell University, began
working with King using the first-line, or first choice treatment for PTSD,
called imaginal exposure therapy. "We ask the patient to imagine the
event as if it were occurring again in their own imagination," she
explains. "You want the person to relive the experience and process the
memories. If they can't access their memories then they really can't
process it and get better." That's what happened to King. He felt he
made some initial progress, then "hit a plateau." © ScienCentral, 2000-
2004.
Keyword: Stress
Posted: 09.07.2004

Mouse study shows NPAS3 and NPAS1 genes may be linked to psychosis

DALLAS – Mice with specific genetic mutations exhibit behavior similar to

human psychosis, report UT Southwestern Medical Center at Dallas
researchers, providing further support to the notion of a genetic link to
schizophrenia. The researchers genetically engineered mice with a
mutation in the gene NPAS3, a mutation in the gene NPAS1 or a
mutation in both genes. Both genes encode proteins that switch other
genes on and off in brain cells. "These mice display certain deficits that
are potentially consistent with schizophrenia," said Dr. Steven McKnight,

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 chairman of biochemistry at UT Southwestern and senior author of the
study that will appear in an upcoming issue of the Proceedings of the
National Academy of Sciences and is to be posted online this week. "It's
too early to tell whether the abnormal behavior we observed in these
mutated mice can be directly connected with human disease. On the
other hand, we find it intriguing that members of a Canadian family
carrying a mutation in the human NPAS3 gene have been reported to
suffer from schizophrenia." Normal mice in a pen will climb over each
other and interact, but the mice with the genetic mutations fail to
socialize in this way. Instead, the mutants dart about wildly, avoiding
interaction with their normal siblings.
Keyword: Schizophrenia; Genes & Behavior
Posted: 08.31.2004

Brain may produce its own antipsychotic drug

A cannabis-like substance produced by the brain may dampen delusional

or psychotic experiences, rather than trigger them. Heavy cannabis use
has been linked to psychosis in the past, leading researchers to look for
a connection between the brain's natural cannabinoid system and
schizophrenia. Sure enough, when Markus Leweke of the University of
Cologne, Germany, and Andrea Giuffrida and Danielle Piomelli of the
University of California, Irvine, looked at levels of the natural cannabis-
like substance anandamide, they were higher in people with
schizophrenia than in healthy controls. The team measured levels of
anandamide in the cerebrospinal fluid (CSF) of 47 people suffering their
first bout of schizophrenia, but who had not yet taken any drugs for it,
and 26 people who had symptoms of psychosis and have a high risk of
schizophrenia. Compared with 84 healthy volunteers, levels were six
times as high in people with symptoms of psychosis and eight times as
high in those with schizophrenia. "This is a massive increase in
anandamide levels," Leweke told the National Cannabis and Mental
Illness Conference in Melbourne, Australia, last week. And that is just in
the CSF. Levels could be a hundred times higher in the synapses, where
nerve signalling is taking place, he says. © Copyright Reed Business
Information Ltd.
Keyword: Schizophrenia; Drug Abuse
Posted: 08.30.2004

Bitter Medicine

Two books on the (big) business of the pharmaceutical industry.

Reviewed By Shannon Brownlee Every author should be so lucky. While
Jerome Kassirer and Marcia Angell were holed up in their offices, typing
away, Congress launched an investigation into financial entanglements
between industry and the National Institutes of Health. Then Pfizer was
hit with nearly half a billion dollars in fines for paying doctors to hype its
anti-seizure drug Neurontin for unapproved—and largely unproven—
uses. Now, New York state attorney general Eliot Spitzer has accused
another drug giant, GlaxoSmithKline, of burying evidence that the
antidepressant Paxil can trigger suicide. It's great news for Angell's and
Kassirer's book sales, bad news for the rest of us. These stories about
the unholy alliance between the pharmaceutical industry, researchers,
and doctors may have seemed, to the casual observer, like nothing more
than isolated blips. Sad to say—as these surprisingly bare-knuckled
books by the last two editors-in-chief at the New England Journal of
Medicine make clear—such accounts provide a mere glimpse of the

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 corruption of medical science. In the last two decades, the drug and
biotech industries have gained unprecedented leverage over what
doctors and patients know—and don't know—about the $200 billion
worth of prescription pharmaceuticals consumed by Americans each
year. Industry has gained that leverage by funding and, increasingly,
controlling medical research. It has also used its deep pockets to
effectively buy the loyalty of physicians in private practice and to sway
the opinion of thought-leaders in academia. Grasp the full scope of
industry influence over medical science and practice, and it's enough to
make anybody think twice before filling a prescription. © 2004 The
Foundation for National Progress
Keyword: Depression
Posted: 08.27.2004

Glaxo Agrees to Post Results of Drug Trials on Web Site

By GARDINER HARRIS In a settlement that the New York attorney

general said would transform the drug industry, GlaxoSmithKline agreed
yesterday to post on its Web site the results of all clinical trials involving
its drugs. "This settlement is transformational in that it will provide
doctors and patients access to the clinical testing data necessary to
make informed judgments," the attorney general, Eliot Spitzer, said.
While the case involves only GlaxoSmithKline, the British drug maker, Mr.
Spitzer predicted that other companies would follow its lead by posting
the results of their studies online. Eli Lilly, for example, has said it would
create a Web site on which it would list the results of clinical tests of
approved drugs. Other companies, including Johnson & Johnson and
Merck, have said they support the concept of a public database that
would list trial results. Mr. Spitzer filed suit in June against
GlaxoSmithKline, contending that it committed fraud by publicizing the
results of only one of five trials studying the effect of its antidepressant,
Paxil, in children. That single study showed mixed results. The others not
only failed to show any benefit for the drug in children but demonstrated
that children taking Paxil were more likely to become suicidal than those
taking a placebo. Copyright 2004 The New York Times Company
Keyword: Depression; Development of the Brain
Posted: 08.27.2004

Patient with mad-cow-like brain ailment dies

By Sandi Doughton, Seattle Times staff reporter The woman treated at

Harborview Medical Center this summer for a mysterious brain ailment
related to mad-cow disease has died. An autopsy was performed, and
should help national experts in their quest to identify the disease, said
epidemiologist Dr. Jo Hofmann, of the Washington Department of Health.
"There will be brain tissue obtained from multiple parts of the brain, that
will definitely provide more information," Hofmann said. The tissue will
be sent to the National Prion Disease Pathology Surveillance Center at
Case Western Reserve University in Cleveland. The woman, who
Hofmann said was under the age of 60, was not a resident of
Washington and did not die here. The woman has not been identified to
protect her family's privacy. She was treated at Harborview, where
doctors performed a brain biopsy, collecting a tiny sample of brain tissue
they hoped would help them diagnose the baffling illness, characterized
by dementia.
Keyword: Prions

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 Posted: 08.26.2004

Pain common side effect of depression

Physical symptoms are nearly as common as emotional ones in patients

suffering from depression, according to Indiana University School of
Medicine research published in the August issue of the Journal of General
Internal Medicine. Patients with depression frequently talk to their
physicians about symptoms such as headache, back or muscle pain,
stomach ache and dizziness instead of symptoms more commonly
associated with depression such as fatigue, lack of motivation and
moodiness, says Kurt Kroenke, M.D., professor of medicine in the
Division of General Internal Medicine and Geriatrics at IU and a research
scientist at the Regenstrief Institute, Inc. "Depression is a risk factor for
symptoms of pain," he said. "The most reports of pain – such as muscle
pain, headaches, leg pain – are two or three times more common in
people with depression." Physical symptoms also may serve as a
barometer for physicians to gauge the effectiveness of common
antidepressant treatments, he said. "Physical symptoms may not
respond to common antidepressant treatment as much as the emotional
symptoms," says Dr. Kroenke. "Even though the physical symptoms may
be related to or aggravated by the depression, they can linger longer
than the emotional symptoms."
Keyword: Depression
Posted: 08.26.2004

New Therapy on Depression Finds Phone Is Effective

By BENEDICT CAREY Debates about the safety and effectiveness of

treatments for depression miss a basic reality about the disease: most
people affected by it do not seek help at all, and those who do
commonly neglect to complete counseling or drug regimens
recommended by doctors. For at least a third of the people who try
them, treatments of any kind fall short, surveys show. But improving
success rates may be a matter of picking up the phone, according to a
report today in the Journal of the American Medical Association. In a
large-scale, 18-month study, doctors in Seattle found that they could
significantly increase recovery rates for patients taking antidepressants
by providing several 30- to 40-minute counseling sessions over the
phone. In previous studies, researchers showed that phone calls from
nurses or other clinic staff members providing emotional support could
help people trying to quit smoking, stay on medication or shake low
moods. The Seattle study is the first to test the effect of a standardized
form of counseling, cognitive behavior therapy, delivered entirely over
the phone. Copyright 2004 The New York Times Company
Keyword: Depression
Posted: 08.25.2004

Combination Treatment Most Effective in Adolescents with Depression

A clinical trial of 439 adolescents with major depression has found a

combination of medication and psychotherapy to be the most effective
treatment. Funded by the NIH’s National Institute of Mental Health
(NIMH), the study compared cognitive-behavioral therapy (CBT) with
fluoxetine, currently the only antidepressant approved by the U.S. Food
and Drug Administration for use in children and adolescents. John March,
M.D., Duke University, and colleagues, report on findings of the multi-
site trial in the August 18, 2004, Journal of the American Medical

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 Association (JAMA). The results of the first 12 weeks of the Treatment
for Adolescents with Depression Study (TADS), conducted at 13 sites
nationwide, show that 71 percent responded to the combination of
fluoxetine and CBT. The other three treatment groups, of participants
between the ages of 12 and 17, also showed improvement, with a 60.6
percent response to fluoxetine-only treatment, and 43.2 percent
response from those receiving only CBT. The response rate was 34.8
percent for a group that received a placebo. The difference in response
rates for the latter two treatment groups was not statistically significant.
The $17 million study is the first large, federally funded study using an
antidepressant medication to treat adolescents suffering with moderate
to severe depression. TADS was conducted between the spring of the
year 2000 and the summer of 2003.
Keyword: Depression; Development of the Brain
Posted: 08.21.2004

Teens with depression show most improvement when medication and therapy combined

DALLAS – – Teenagers suffering from depression improved more with a

combination of an antidepressant and cognitive-behavior therapy than
they did when treated with either separately, a multicenter study
published today in the Journal of the American Medical Association
shows. Results of a national, yearlong government-funded study in
which UT Southwestern Medical Center at Dallas researchers participated
also showed that depressed teens treated only with cognitive-behavior
therapy did little better than teens given placebos. Cognitive-behavior
therapy is a form of psychotherapy that emphasizes the role of thinking
in creating subsequent feelings and behaviors. The study, designated the
Treatment for Adolescents with Depression Study (TADS), is the first to
directly compare psychotherapy and medication treatment for teenagers,
said Dr. Graham Emslie, professor of psychiatry and director of UT
Southwestern's child and adolescent psychiatry division.