Sept. #1 '05
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By-Pass Heart Surgery Increases Risk of Alzheimer's: In a 5-year follow-up study, 5,216 people who underwent coronary artery bypass graft surgery (CABG) were compared to 3,954 people who had a percutaneous transluminal coronary angioplasty (PTCA). Over 5 years, 78 who had bypass surgery and 41 who had angioplasty developed Alzheimer's disease. The coronary bypass patients had a 70 percent increased risk of developing Alzheimer's disease. Show some heart surgery patients experience memory problems immediately following the procedure. However, at a one-year follow-up most patients regain cognitive function. Heart bypass surgery represents a traumatic insult to the brain, particularly by reducing oxygen supply to the brain and increasing the stress response. Assessment of the Emergence of Alzheimer's Disease Following Coronary Artery Bypass Graft Surgery or Percutaneous Transluminal Coronary Angioplasty. Todd A. Lee, et al. Boston University. Journal of Alzheimer's Disease 9/2005:7(4). v

Dyspnea: Acupuncture Didn't Help Difficulty Breathing in Cancer: In a DB PC study of dyspnea in 47 patients with lung or breast cancer, dyspnea scores were slightly higher for patients receiving a single session of true versus placebo acupuncture, for both the period immediately following acupuncture treatment and for the daily one week follow-up. Acupuncture for dyspnea in advanced cancer: a randomized, placebo-controlled pilot trial [ISRCTN89462491]. Vickers AJ, et al.  BMC Palliat Care. 2005 Aug 18;4(1):5. Ed: Acupunture has done poorly in studies for many different types of problems. For more, see Acupunture

Acupuncture No Better than Sham in Excellent Study of Fibromyalgia: In a 12-week with 6-month follow-up DB PC study of 100 adults with fibromyalgia, patients received twice-weekly treatment of either an acupuncture program that was specifically designed to treat fibromyalgia, or 1 of 3 sham acupuncture treatments: acupuncture for an unrelated condition, needle insertion at nonacupoint locations, or noninsertive simulated acupuncture. The mean subjective pain rating among patients who received acupuncture for fibromyalgia did not differ from that in the pooled sham acupuncture group (mean between-group difference, 0.5 cm [95% CI, -0.3 cm to 1.2 cm]). Participant blinding was adequate throughout the trial. A randomized clinical trial of acupuncture compared with sham acupuncture in fibromyalgia. Assefi NP, et al. University of Washington, Seattle. Ann Intern Med. 2005 Jul 5;143(1):10-9. For more, see Fibromyalgia and Acupuncture.

Suicides Peak on Mondays: Office for National Statistics found 16% of male suicides and 17% of female suicides occured on Mondays, compared to 13% on the weekend days in a study of 34,935 suicides in the United Kingdom from 1993-2002. Researchers said the trend was not solely a result of returning to work as it was replicated for retired people.  BBC News 8/26/05. For more, see Suicide.

Corruption On-Going and Proven in the FDA: After accusations that some government scientists used their official positions for private gain, the National Institutes of Health announced rules on August 25th that ban FDA scientists from consulting for drug companies. The rules were issued after disclosures that FDA scientists had leveraged their positions to land lucrative consulting contracts that seemed to conflict or at least overlap with their official duties. Those contracts caused some critics to worry that research by the agency could be tainted. An investigation by the FDA concluded that 44 of its 1,200 senior scientists appeared to have violated rules governing consulting and that nine might have violated criminal laws. The conflicts were first reported by the Los Angeles Times. Sidney Wolfe, director of the health research group at Public Citizen, the consumer advocacy group, noted that the new rules still let employees deliver medical education lectures paid by drug companies. Although no strings are supposed to be attached to the financing, Wolfe noted that scientists who disagreed with the positions of the drug industry were rarely invited to give such lectures. Gardiner Harris, New York Times, Washington 8/26/05. Ed: Since the FDA only investigated after the FDA was caught allowing the corruption, you wonder what other corrupt schemes are still going on. Of course, the revolving door is still legal and very powerful. Many high ranking FDA officials come from the drug industry, stay with the FDA a few years, and then take much higher paying jobs with the drug industry shortly after leaving the FDA.  This strongly influences work at the FDA, since many hope to land these lucrative positions. For more, see Corruption in Medical Care.

Homeopathy Doesn't Work: Homeopathy is a strange theory from the 1700s that the weaker the solution of an antidote/toxin, the more powerful the effect. In a study comparing the findings from 110 homeopathy trials to 110 conventional medical trials, researchers concluded, "There was weak evidence for a specific effect of homeopathic remedies, but strong evidence for specific effects of conventional interventions. This finding is compatible with the notion that the clinical effects of homeopathy are placebo effects.  The researchers urged medical doctors to tell their patients that they were wasting their time taking homeopathic medicines. Matthias Egger et al. Switzerland. University of Berne. Lancet 8/26/05. Ed: The dilutions in homeopathy are repeated so many times that it is unlikely that even one molecule of the original treatment still exists in the diluting water. Homeopaths claim that in some way the water is imprinted with a beneficial effect. v

Silver Nitrate Quickly Reduces Pain in Canker Sores Without Slowing Healing: Silver nitrate sticks have been used for a long time to provide pain relief for the duration of an aphthous ulceration, with only one application. Silver nitrate causes chemical cauterization and increases the depth of injury. In a 1-week DB PC study of 97 patients with painful minor oral aphthous ulceration, the ulcer was gently painted with a silver nitrate stick until it turned white. In the placebo group, the ulcer was gently painted with a placebo stick. In 70% treated with silver nitrate vs. 11% with placebo, there was a reduction in severity of pain 1 day after the procedure (P < 0.001). On the seventh day, the ulcers were completely re-epithelialized in 83% of the treatment group vs. 89% for the placebo group. The difference was not statistically significant (P = 0.39). Silver nitrate cautery in aphthous stomatitis: a randomized controlled trial. Alidaee MR, et al. Tehran University, Iran. Br J Dermatol. 2005 Sep;153(3):521-5. For more, see Canker Sores.

Vitamin C 500 mg Helped Prevent But Not Treat Common Cold: In a 5-year DB PC study of 305 Japanese adults with atrophic gastritis, the number of common colds (per 1000 person-months) was 21.3 for vitamin C 50 mg/d vs. 17.1 for vitamin C 500 mg/d. After adjustment for several factors, the relative risks was 0.34 for the high-dose group. No apparent reduction was seen for the severity and duration of the common cold. Effect of vitamin C on common cold: randomized controlled trial. Sasazuki S, et al. National Cancer Center, Tokyo, Japan. European Journal of Clinical Nutrition 24 August 2005. For more, see the Common Cold.

Adenosine A2A Receptor Gene Polymorphisms May Increase Anxiety Risk: Amphetamine is thought to produce its stimulant effects mainly via the dopamine system, but its effects may also be influenced by other systems. Dopamine D(1) and D(2) receptors exist as heterodimers with adenosine A(1) and A(2A) receptors, which modulate their responsiveness. In a study of one adenosine A(1) and three adenosine A(2A) receptor gene polymorphisms for the interindividual variability in amphetamine response in 99 healthy volunteers who received placebo or d-amphetamine (10 or 20 mg), the 1976C/T and 2592C/T(ins) polymorphisms of the adenosine receptor gene were associated with increases in anxiety at both doses. This is consistent with recent observations indicating a role for adenosine A(2A) receptor gene polymorphisms in anxiety. Interindividual variation in anxiety response to amphetamine: Possible role for adenosine A(2A) receptor gene variants. Hohoff C, et al. University of Muenster, Germany. Am J Med Genet B Neuropsychiatr Genet. 2005 Aug 23. For more, see Anxiety.

Clonidine Helped Reduce Sympathetic Overactiving and Disease: In an 8-week DB PC study of 23 patients with UC and 20 controls, researchers documented an overall increase of sympathetic activity characterized active UC. Normalization of the autonomic profile by clonidine was accompanied by an improvement of the disease. Sympathetic Overactivity in Active Ulcerative Colitis: Effects of Clonidine. Furlan R, et al. University of Milan, Italy. Am J Physiol Regul Integr Comp Physiol. 2005 Aug 25. For more, see Ulcerative Colitis.

Polypharmany Common in Schizophrenia Treatment Although Not Recommended: In a 1-year follow-up study of 796 adults with schizophrenia-spectrum disorders, only 35.7% of the patients were treated predominately with monotherapy (>300 days). Most patients (57.7%) had at least one prolonged period of antipsychotic polypharmacy (>60 consecutive days). Patients averaged 195.5 days on monotherapy, 155.7 days on polypharmacy, and 13.9 days without antipsychotic therapy. Olanzapine-initiated patients were significantly more likely to be on monotherapy with the initiating antipsychotic during the 1-year post initiation compared to risperidone (p = .043) or quetiapine (p = .002). The number of monotherapy days was significantly greater for olanzapine than quetiapine (p < .001), but not for olanzapine versus risperidone, or for risperidone versus quetiapine-initiated patients. Antipsychotic monotherapy and polypharmacy in the naturalistic treatment of schizophrenia with atypical antipsychotics. Douglas Faries et al. Eli Lilly. BMC Psychiatry 2005:5:26. Free access: http://www.biomedcentral.com/1471-244X/5/26 For more, see Medications for Schizophrenia.


Antidepressants Less Effective in the Elderly: Of 68 DB PC studies of antidepressant medication for major depressive disorder, 6 were of elderly patients. In comparison to studies of younger adults, the proportion of patients responding to placebo in studies of older individuals was slightly higher, and the proportion of patients responding to active medication was lower, leading to a significantly reduced effect size. Placebo control groups in trials of major depressive disorder among older patients. Walsh BT, et al. Columbia University. . J Clin Psychopharmacol. 2005 Aug;25(4 Suppl 1):S29-33.

Antidepressants May Protect Against Gray Matter Loss in Geriatric Depression: In an MRI study of 41 elderly patients with major depressive disorder (32 women; 11 antidepressant exposure and 30 drug-naive; mean age 70.5 years) and 41 controls (20 women; mean age 72.2 years), in multivariate analysis, the depressed group had smaller corrected orbitofrontal cortex (OFC) total and gray matter volumes compared to the controls (p < .01). However, depressed patients with prior antidepressant exposure had larger OFC gray matter volumes compared to drug-naive depressed patients, but smaller than those in normal controls (p = .005). Antidepressant exposure may protect against decrement in frontal gray matter volumes in geriatric depression. Lavretsky H, et al. University of California, Los Angeles. J Clin Psychiatry. 2005 Aug;66(8):964-7

Anxiety with Geriatric Depression Worse Prognosis: In elderly with Major Depressive Disorder (MDD), coexisting Generalized Anxiety Disorder (GAD) or Panic Disorder (PD) is associated with more severe symptoms and poorer short-term treatment outcomes. In a 4-year follow-up study of 79 elderly with major depressive disorder who had responded to initial treatment, the co-morbid anxious group showed a greater decline in memory, but not in other cognitive measures or measures of functional status. Depression recurrence was similar in the anxious and non-anxious groups. Among those in the anxious group, a later age of onset (> 55) of the anxiety disorder was associated with worse overall cognition at baseline, but a similar rate of decline in cognition over time, compared with early-onset anxiety disorder. Comorbid anxiety disorder in late life depression: association with memory decline over four years. Deluca AK, et al. University of Pittsburgh. Int J Geriatr Psychiatry. 2005 Aug 22;20(9):848-854. For more, see Geriatric Depression.

Topiramate (Topamax) May Have Helped Depression: In a 10-week DB PC study of 64 women with moderate Major Depression, those treated with topiramate had greater decreases on the Hamilton Depression Rating Scale (P=0.02), and the State-Trait Anger Expression Inventory (P<0.001), along with 9 pounds of added weight loss (P<0.001). Topiramate in treatment of depressive and anger symptoms in female depressive patients: A randomized, double-blind, placebo-controlled study. Nickel C, et al. Simbach/Inn, Germany. J Affect Disord. 2005 Aug;87(2-3):243-52. Ed: This is a small study, and topiramate has a high rate of side-effects and is very expensive. This study was very likely funded by the manufacturer.  I wouldn't start using Topamax for depression based on this one study. For more, see Seizure Medications for Depression.

Manic Switches on Anti-Depressants Exaggerated? Very Rare with Duloxetine: Bipolar disorder is often undetected, with the most common misdiagnosis being unipolar depression. Studies have suggested that treatment of bipolar and unipolar depression with heterocyclic TCAs may increase the risk of switch rate to mania. In a retrospective analysis of data from eight PC DB studies of duloxetine in patients with non-bipolar major depression, one case of mania occurred in the placebo group (0.1%), and two cases of hypomania were observed in the duloxetine-treated group (0.2%). Among hypomanic-like symptoms, only insomnia was significantly higher in the duloxetine group than in the placebo group (p<0.05). Is treatment-associated hypomania rare with duloxetine: secondary analysis of controlled trials in non-bipolar depression. Dunner DL, et al. University of Washington, Seattle. . J Affect Disord. 2005 Jul;87(1):115-9. Ed: Duloxetine is still covered by patent, so its manufacturer is out there defending it.  The manufacturers of mood stabilizers and atypical anti-psychotics and their favorite academic psychiatrists are leading the charge attacking anti-depressant for Bipolar depression. For more, see Bipolar Depression.

Shyness Usually Outgrown: In the US National Comorbidity, Survey  of 5877 adults, 26% of women and 19% of men described themselves as 'very shy' when they were growing up. Of these shy individuals, 53% of women and 40% of men met criteria for a lifetime diagnosis of one or more anxiety or mood disorders [this is about twice as high as the national average suggesting that the shyness is the cause for only half in the disorders]. Shyness in childhood was linked to the complex subtype of social phobia in adulthood with lesser links to posttraumatic stress disorder in women and for major depressive disorder in men. Excessive shyness does not appear to be strongly associated with other anxiety and mood disorders when related psychosocial and developmental dimensions are statistically controlled. Finally, many individuals who report excessive childhood shyness do not meet criteria for any anxiety or mood disorder. Also, 50% of individuals with a lifetime history of complex social phobia did not view themselves as very shy when growing up. Psychiatric correlates of childhood shyness in a nationally representative sample. Cox BJ, et al. University of Manitoba. . Behav Res Ther. 2005 Aug;43(8):1019-27. v

Anti-Depressants: If the First or Second Don't Work, Keep Trying: In a study of 171 out-patients with major depression and initially treated with fluoxetine for 6 to 12 weeks, if unimproved, patients received a second or third trial of different anti-depressants in an attempt to achieve remission of the depression, i.e., a score of 7 or less on the 17-item Hamilton Rating Scale for Depression. In an intent-to-treat analysis, 66% (113/171) of patients who were treated with second-generation antidepressants and 65% (275/420) of patients who were treated with first-generation antidepressants (tricyclics or MAO inhibitors) eventually achieved remission. Remission rates in the effectiveness study are approximately 20% higher than the rates usually cited in research studies. The usual procedure when comparing treatments is to assess outcome after a single anti-depressant trial. The cumulative high remission rates here suggest antidepressants are effective and should encourage more patients to keep seeking treatment and physicians to develop techniques to improve patient adherence. Remission rates with 3 consecutive antidepressant trials: effectiveness for depressed outpatients. Quitkin FM, et al.  Columbia University. J Clin Psychiatry. 2005 Jun;66(6):670-6. v

Depression May Cause Early Hardening of the Arteries: Depression is known to cause heart disease. In a study of 210 women, some oronary calcification was found in 49% and aorta calcification in 54%. The 53 women with a history of recurrent major depression were more than twice as likely to have any coronary calcification or calcification in the high category compared with women with a history of a single episode of depression or no depression: odds ratios (ORs) of 2.71 for high coronary calcification, and 3.39 for high aortic calcification. Coronary and aortic calcification in women with a history of major depression. Agatisa PK, et al. University of Pittsburgh. Arch Intern Med. 2005 Jun 13;165(11):1229-36. For more, see Harm of Depression.

Neither Insomnia Nor Anxiety Predict Improvement in Bupropion (Wellbutrin) Study: In a retrospective analysis from an open-label, 8-week, study of 797 adult outpatients with recurrent, nonpsychotic major depressive disorder who received bupropion SR (300 mg/day), neither baseline insomnia nor baseline anxiety was related to the likelihood of a reduction in depression. Higher baseline insomnia and lower baseline anxiety were associated with an earlier improvement by about a week. Does pretreatment insomnia or anxiety predict acute response to bupropion SR? Rush AJ, et al. University of Texas Southwestern. . Ann Clin Psychiatry. 2005 Jan-Mar;17(1):1-9. Ed: Bupropion is a good anti-depressant, but there is absolutely no reason to waste money on the expensive long-acting pills to take them once a day instead of twice a day. v

6% of Americans Have Serious Mental Illness in the Past Year: In the US National Comorbidity Survey (2001-3) of 9282 adults, during the previous 12 months, rates of disorders were: anxiety, 18%; mood, 9.5%; impulse control, 9%; substance, 4%; and any disorder, 26%. Of 12-month cases, 22% were classified as serious; 37%, moderate; and 40%, mild. Although mental disorders are widespread, serious cases are concentrated among a relatively small proportion of cases with high comorbidity. Prevalence, severity, and comorbidity of 12-month DSM-IV disorders in the National Comorbidity Survey Replication. Kessler RC, et al. Harvard. . Arch Gen Psychiatry. 2005 Jun;62(6):617-27.

Depression in Child Increased If Mother Smoked Marijuana in Pregnancy: In a 10-year follow-up of 633 mother-child pairs in the Maternal Health Practices and Child Development Project and using multivariate regressions, marijuana use in the first and third trimesters predicted increased depression in the child at age 10. Other significant correlates of depressive symptoms in the children included lower maternal education, maternal tobacco use (prenatal or current), and the child's lower IQ score. Prenatal marijuana exposure: effect on child depressive symptoms at ten years of age. Gray KA, et al.  National Institute of Environmental Health Sciences. Neurotoxicol Teratol. 2005 May-Jun;27(3):439-48. Ed: Marijuana definitely causes depression and, less often, schizophrenia. For more, see Marijuana and Depression.

Cholecystectomy, Gallstone Increase Risk of Colon Cancer: Increased exposure of the colon lining to bile acids and undigested fat following cholecystectomy raises the risk of colon but not rectal cancer, which is consistent with the bile acid exposure theory. Data from 600,000 adults in the UK General Practice Research Database was analyzed. If 10,000 people who underwent the surgery, were followed for 10 years, 119 would develop colon cancer. By contrast, among subjects who did not undergo cholecystectomy, the number was lower -- 86. Simply having gallstones raised the risk of colon cancer to a similar degree as cholecystectomy, which also supports the bile acid exposure theory. Theresa Shao et al. University of Pennsylvania. Amer J Gastroenterology, August 2005. For more, see Colon Cancer.

Statins Help Survive Heart Attack: The study tracked treatment of more than 170,000 patients taken to hospitals after heart attacks. Of those who received a statin within 24 hours of the attack, there was a 54% better chance of living through the experience than those who did not. Gregg Fonarow, et al. UCLA. AFP-Los Angeles 8/29/05. For more, see Treatment.

Brain Blood Flow Factor in Dementia: Using MRIs to examine the brains of 17 elderly patients with dementia after age 75 related to Alzheimer's or Parkinson's disease, 16 seniors of the same age with optimal cognitive function and 15 healthy younger individuals, the average cerebral blood flow in the healthy young individuals was 742 milliliters (mL) per minute vs. 443 mL per minute in dementia vs. 551 mL per minute in seniors with optimal brain function. Aart Spilt, et al. Leiden University, Netherlands. Radiology 9/05. For more, see Causes of Alzheimer's.

Chamomile for Colicky Infants; Add Peppermint for Children Ingestation; Ginger for Nausea: Chamomile as one of the most widely used and safest herbs for children with abdominal discomfort. It can be given in small amounts to treat colic in infants and can be combined with peppermint, star anise or fennel for stomach aches, gas, indigestion and bloating for school-age children. Ginger has been well documented as a remedy for nausea and dyspepsia. Probiotics, such as yogurt, have been used to prevent antibiotic-associated diarrhea, newborn colic, ulcerative colitis, and a variety of forms of diarrhea. Star anise should be avoided for colicky infants. Kathi J. Kemper, et al. Wake Forest University, et al. Contemporary Pediatrics 9/05. Ed: The research on ginger and yogurt is excellent, but otherwise I think this doctor is going beyond available research. I am opposed to experimenting on patients. For more, see Chamomile.

Selenium Level Linked to Increased Longevity: In the 9-year follow-up EVA study of 1389 adults ages 60-70, 101 study participants died. Baseline plasma selenium was higher in individuals who were alive at the end of follow-up [1.10 micromol/L] than in those who died during the follow-up [1.01 micromol/L; P <10(-4)]. Mortality rates were 56% higher in individuals with low selenium [relative risk (RR) = 1.56]. After controlling for various potential confounding factors, mortality rates were 54% higher in individuals with low selenium [RR = 1.54]. Cancer-related mortality was most significant [adjusted RR = 1.79]. Selenium and Mortality in the Elderly: Results from the EVA Study. Akbaraly NT, et al. Universite Montpellier I, France. Clin Chem. 2005 Aug 25. For more, see Selenium.

SSRIs Linked to Increase in Birth Defects: SSRI use in the first three months of pregnancy is linked to a 40% increased risk of cleft palate - but the results are preliminary. Cardiac defects appeared to be 60% more likely when the women used SSRIs.  Pulse magazine. In a study of 1,054 women who took SSRIs during pregnancy, scientists also found that use of the drugs late in pregnacy was associated with a 40% increased risk of premature birth. And a second study of 377 cases of persistent pulmonary hypertension in babies found SSRI use late in pregnancy was linked a 5.5-fold increased risk. Previous studies have shown differing results, some showing no difference in birth defects in women taking antidepressants to the average population rate. Henrik Toft Sorensen, et al. International Society for Pharmacoepidemiology conference. BBC News 9/1/05. For more, see SSRI Side-effects.

Meningitis in Childhood Increases Risk of Adult Schizophrenia: In a follow-up study of 190 individuals affected by a meningitis infection the first 4 years of life during an epidemic in Sao Paulo, Brazil, between 1971 and 1974, usign 156 siblings of the meningitis patients who were not affected by meningitis at childhood as controls, there were eight (4.2%) cases of schizophrenia among meningitis victims vs. none in the controls, and 40 (21.0%) cases of life occurrence of psychotic symptoms compared to 12 (7.6%) cases in the control group (P<0.001). There were no differences between the two groups regarding other psychiatric disorders or of neurological soft signs. Childhood meningitis increases the risk for adult schizophrenia. Abrahao AL, et al. University of Sao Paulo, Brazil. World J Biol Psychiatry. 2005;6 Suppl 2:44-8.

Cytomegalovirus Associated with Deficit Schizophrenia: In a study of 88 patients with deficit schizophrenia and 235 nondeficit schizophrenia patients, serum antibodies to cytomegalovirus were twice as common in deficit schizophrenia (odds ratio = 2.01, p = .006). This association remained significant after covarying for positive psychotic symptoms and demographic features known to be associated with cytomegalovirus seropositivity and after correcting for multiple comparisons. No other human herpesvirus was significantly associated with deficit versus nondeficit categorization. Deficit Schizophrenia: Association With Serum Antibodies to Cytomegalovirus. Dickerson F, et al. Sheppard Pratt, Baltimore. Schizophr Bull. 2005 Sep 15. For more, see Risk Factors for Schizophrenia.

D-Alanine Helps Schizophrenia: D-alanine is another endogenous agonist of the NMDA-glycine site. In a 6-week DB PC study of 36 patients with schizophrenia, D-alanine (100 mg/kg/day) added to their stable antipsychotic medications caused significant reductions in their Clinical Global Impression Scale and Positive and Negative Syndrome Scale (PANSS) total scores. The Scale for the Assessment of Negative Symptoms and PANSS subscores of positive and cognitive symptoms were improved. D-alanine was well tolerated, and no significant side effect was noted. D-Alanine Added to Antipsychotics for the Treatment of Schizophrenia. Tsai GE, at al. UCLA and Kaoshiung Medical University, Taiwan. Biol Psychiatry. 2005 Sep 8. Ed: While D-alanine is not readily available, glycine, which works in the same way, is available and inexpensive. For more, see Glycine and NMDA Agonists for Schizophrenia.

Delayed Treatment of Psychosis Hurts Outcome:In a review of 26 studies involving 4490 participants, there was a significant association between the duration of untreated psychosis (DUP) and several outcomes at 6 and 12 months (including total symptoms, depression/anxiety, negative symptoms, overall functioning, positive symptoms, and social functioning). Long vs short DUP data showed an association between longer DUP and worse outcome at 6 months in terms of total symptoms, overall functioning, positive symptoms, and quality of life. Patients with a long DUP were significantly less likely to achieve remission. The observed association between DUP and outcome was not explained by premorbid adjustment.  Association between duration of untreated psychosis and outcome in cohorts of first-episode patients: a systematic review. Marshall M, et al.  University of Manchesterr. . Arch Gen Psychiatry. 2005 Sep;62(9):975-83. v

Active and Low-Dose Controlled Studies Biased; Placebo-Controlled Best: In 32 studies comprising 66 risperidone, olanzapine, quetiapine, and ziprasidone arms including 7,264 patients, researchers found that in atypical antipsychotic medication arms, the degree of improvement was nearly double in active-controlled trials than that seen with the same drugs and dosages in placebo-controlled studies. An effect of design was also observed in low dose-controlled studies vs placebo-controlled studies in ineffective and intermediate antipsychotic medication dose ranges. Therfore, caution is indicated when considering active- or low dose-controlled studies requiring comparisons with external placebo as alternatives to placebo-controlled trials for establishing efficacy of new medications for schizophrenia. Control group bias in randomized atypical antipsychotic medication trials for schizophrenia. Woods SW, et al. Yale University. Arch Gen Psychiatry. 2005 Sep;62(9):961-70. v

Chronic Pain Opiate Addicted Patients: Suboxone May Have Helped: Many patients with chronic pain have less than optimal therapeutic outcomes after prolonged treatment with opiate analgesics. In an open trial of 95 adults with chronic noncancer pain referred by local pain clinics for detoxification from long-term opiate analgesic (LTOA) therapy, all patients had failed treatment as manifest by increasing pain levels, worsening functional capacity, and, in 8%, the emergence of opiate addiction. Length of prior LTOA therapy averaged 8.8 years. After a minimum of 12 hours of abstinence from all opiate analgesics, patients were given low doses of sublingual (SL) buprenorphine or buprenorphine/naloxone. Daily SL dose of buprenorphine ranged from 4 to 16 mg (mean, 8 mg) in divided doses. Mean duration of treatment is 8.8 months. 86% experienced moderate to substantial relief of pain accompanied by both improved mood and functioning. Patient and family satisfaction was robust. Only 6 patients discontinued therapy secondary to side effects and/or exacerbation of pain. Sublingual buprenorphine is effective in the treatment of chronic pain syndrome. Malinoff HL, et al. Rush Pain Center, Chicago. Am J Ther. 2005 Sep-Oct;12(5):379-84. Ed: Open trials are notoriously unreliable due to bias.  However, I thought this one worth saving. For more, see Buprenorphine for Opiate Addiction.

Thomas E. Radecki, M.D., J.D.

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