Adolescents with major depression who received cognitive behavioral therapy (CBT) after responding to an antidepressant were less likely to experience a relapse or recurrence of symptoms compared to teens who did not receive CBT, according to a small, NIMH-funded pilot study published in the December 2008 issue of the Journal of the American Academy of Child and Adolescent Psychiatry.
Studies have found that adults with depression who have responded to medication treatment are less likely to have a relapse if they receive CBT during the follow-up treatment phase, according to researchers Betsy Kennard, Psy.D., of the University of Texas Southwestern Medical Center, and colleagues. Scientists theorize that initial antidepressant treatment may help improve symptoms enough so that a patient becomes more receptive to CBT or other psychosocial component. Kennard and colleagues aimed to determine if a similar sequential treatment strategy would be effective with depressed adolescents.
In this pilot study, 46 depressed youths ages 11 to 18 who had responded to 12 weeks of treatment with the antidepressant fluoxetine (Prozac) were randomly assigned to either six months of continued medication management (MM), or to medication management plus cognitive behavioral therapy (MM+CBT) designed to prevent relapse.
Kennard and colleagues found that the youths who received only MM were significantly more likely to relapse than the youths who received MM+CBT. The researchers estimated that 37 percent of those in the MM group were likely to relapse, while 15 percent of those in the MM+CBT group were likely to relapse. Patients getting MM+CBT also reported higher rates of satisfaction compared to those getting MM only.
This pilot study demonstrates that, as in adult studies, introducing CBT in follow-up treatment after a patient responds to antidepressant treatment may be a promising strategy in preventing relapse among depressed adolescents.
The researchers currently are conducting a larger trial of MM+CBT to further evaluate the effectiveness of this treatment strategy in youths with depression.
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Saturday, December 6, 2008
Tobacco smoke linked to behavioral problems in boys with asthma
Boys with asthma who are exposed to environmental tobacco smoke have higher degrees of hyperactivity, aggression, depression and other behavioral problems, according to researchers. The researchers said behavioral problems increase along with higher exposure levels, but they added even low levels of tobacco smoke may be detrimental to behavior. ... > read full article
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Wednesday, December 3, 2008
How stress affects memory
Researchers using functional MRI (fMRI) have determined that the circuitry in the area of the brain responsible for suppressing memory is dysfunctional in patients suffering from stress-related psychiatric disorders. Results of the study will be presented December 3 at the annual meeting of the Radiological Society of North America (RSNA).
"For patients with major depression and other stress-related disorders, traumatic memories are a source of anxiety," said Nivedita Agarwal, M.D., radiology resident at the University of Udine in Italy, where the study is being conducted, and research fellow at the Brain Imaging Center of McLean Hospital, Department of Psychiatry at Harvard Medical School in Boston. "Because traumatic memories are not adequately suppressed by the brain, they continue to interfere with the patient's life."
Dr. Agarwal and colleagues used brain fMRI to explore alterations in the neural circuitry that links the prefrontal cortex to the hippocampus, while study participants performed a memory task. Participants included 11 patients with major depression, 13 with generalized anxiety disorder, nine with panic attack disorders, five with borderline personality disorder and 21 healthy individuals. All patients reported suffering varying degrees of stressful traumatic events, such as sexual or physical abuse, difficult relationships or "mobbing" – a type of bullying or harassment – at some point in their lives.
After reviewing a list of neutral word pairs, each participant underwent fMRI. During imaging, they were presented with one of the words and asked to either recall or to suppress the memory of its associated word.
The fMRI images revealed that the prefrontal cortex, which controls the suppression and retrieval of memories processed by the hippocampus, showed abnormal activation in the patients with stress-related disorders compared to the healthy controls. During the memory suppression phase of the test, patients with stress-related disorders showed greater activation in the hippocampus, suggesting that insufficient activation of the prefrontal cortex could be the basis for inadequate suppression of unwanted traumatic memories stored in the hippocampus.
"These data suggest that the mechanism for memory suppression is dysfunctional in patients with stress-related disorders primarily because of an alteration of the prefrontal cortex," Dr. Agarwal said. "These patients often complain of poor memory, which might in part be attributed to this altered circuitry," she added.
According to Dr. Agarwal, fMRI is an important tool in understanding the neurobiological basis of psychiatric disorders and in identifying imaging markers to psychiatric disease, helping clinicians target specific parts of the brain for treatment.
The study's principal investigator is Paolo Brambilla, M.D., Ph.D. Co-authors are Monica Baiano, M.D., Ph.D., Massimo Bazzocchi, M.D., Giuseppe Como, M.D., and Marta Maieron, Ph.D.
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"For patients with major depression and other stress-related disorders, traumatic memories are a source of anxiety," said Nivedita Agarwal, M.D., radiology resident at the University of Udine in Italy, where the study is being conducted, and research fellow at the Brain Imaging Center of McLean Hospital, Department of Psychiatry at Harvard Medical School in Boston. "Because traumatic memories are not adequately suppressed by the brain, they continue to interfere with the patient's life."
Dr. Agarwal and colleagues used brain fMRI to explore alterations in the neural circuitry that links the prefrontal cortex to the hippocampus, while study participants performed a memory task. Participants included 11 patients with major depression, 13 with generalized anxiety disorder, nine with panic attack disorders, five with borderline personality disorder and 21 healthy individuals. All patients reported suffering varying degrees of stressful traumatic events, such as sexual or physical abuse, difficult relationships or "mobbing" – a type of bullying or harassment – at some point in their lives.
After reviewing a list of neutral word pairs, each participant underwent fMRI. During imaging, they were presented with one of the words and asked to either recall or to suppress the memory of its associated word.
The fMRI images revealed that the prefrontal cortex, which controls the suppression and retrieval of memories processed by the hippocampus, showed abnormal activation in the patients with stress-related disorders compared to the healthy controls. During the memory suppression phase of the test, patients with stress-related disorders showed greater activation in the hippocampus, suggesting that insufficient activation of the prefrontal cortex could be the basis for inadequate suppression of unwanted traumatic memories stored in the hippocampus.
"These data suggest that the mechanism for memory suppression is dysfunctional in patients with stress-related disorders primarily because of an alteration of the prefrontal cortex," Dr. Agarwal said. "These patients often complain of poor memory, which might in part be attributed to this altered circuitry," she added.
According to Dr. Agarwal, fMRI is an important tool in understanding the neurobiological basis of psychiatric disorders and in identifying imaging markers to psychiatric disease, helping clinicians target specific parts of the brain for treatment.
The study's principal investigator is Paolo Brambilla, M.D., Ph.D. Co-authors are Monica Baiano, M.D., Ph.D., Massimo Bazzocchi, M.D., Giuseppe Como, M.D., and Marta Maieron, Ph.D.
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Tuesday, December 2, 2008
Depression and abdominal fat linked
Older adults with symptoms of depression appear more likely to gain abdominal fat, but not overall fat, over a five-year period, according to a report in the December issue of Archives of General Psychiatry.
About 10 percent to 15 percent of older adults have symptoms of depression, according to background information in the article. "Depression has been associated with the onset of diabetes, cardiovascular disease and cardiac mortality [death]," the authors write. "To better prevent occurrence of these major disabling and life-threatening diseases, more insight into underlying mechanisms relating depression to these disorders is needed."
Nicole Vogelzangs, M.Sc., of VU University Medical Center, Amsterdam, the Netherlands, and colleagues studied 2,088 adults age 70 to 79 years. Participants were screened for depression at the beginning of the study and their overall and abdominal obesity was recorded then and again after five years. Measures of overall obesity included body mass index and body fat percentage, while abdominal obesity was assessed using waist circumference, sagittal diameter (distance between the back and the highest point of the abdomen) and visceral fat (fat between the internal organs) measured by computed tomography.
At the beginning of the study, 4 percent of participants had depression. After adjusting for sociodemographic and other characteristics associated with weight changes, depression was associated with an increase in sagittal diameter and visceral fat over five years. "Such an association was not found for an increase in overall obesity and also appeared to be independent of changes in overall obesity, suggesting that depressive symptoms are rather specifically associated with fat gain in the visceral region," the authors write.
There are several mechanisms by which depression might increase abdominal fat, they note. Chronic stress and depression may activate certain brain areas and lead to increased levels of the hormone cortisol, which promotes the accumulation of visceral fat. Individuals with depression may have unhealthier lifestyles, including a poor diet, that could interact with other physiological factors to produce an increase in abdominal obesity.
"Our longitudinal results suggest that clinically relevant depressive symptoms give rise to an increase in abdominal obesity, in particular visceral fat, which seems to be stronger than and independent of overall obesity," the authors conclude. "This could also help explain why depression is often followed by diabetes or cardiovascular disease. Future research should further disentangle these mechanisms because this will yield important information for prevention or treatment of depression-related health consequences."
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About 10 percent to 15 percent of older adults have symptoms of depression, according to background information in the article. "Depression has been associated with the onset of diabetes, cardiovascular disease and cardiac mortality [death]," the authors write. "To better prevent occurrence of these major disabling and life-threatening diseases, more insight into underlying mechanisms relating depression to these disorders is needed."
Nicole Vogelzangs, M.Sc., of VU University Medical Center, Amsterdam, the Netherlands, and colleagues studied 2,088 adults age 70 to 79 years. Participants were screened for depression at the beginning of the study and their overall and abdominal obesity was recorded then and again after five years. Measures of overall obesity included body mass index and body fat percentage, while abdominal obesity was assessed using waist circumference, sagittal diameter (distance between the back and the highest point of the abdomen) and visceral fat (fat between the internal organs) measured by computed tomography.
At the beginning of the study, 4 percent of participants had depression. After adjusting for sociodemographic and other characteristics associated with weight changes, depression was associated with an increase in sagittal diameter and visceral fat over five years. "Such an association was not found for an increase in overall obesity and also appeared to be independent of changes in overall obesity, suggesting that depressive symptoms are rather specifically associated with fat gain in the visceral region," the authors write.
There are several mechanisms by which depression might increase abdominal fat, they note. Chronic stress and depression may activate certain brain areas and lead to increased levels of the hormone cortisol, which promotes the accumulation of visceral fat. Individuals with depression may have unhealthier lifestyles, including a poor diet, that could interact with other physiological factors to produce an increase in abdominal obesity.
"Our longitudinal results suggest that clinically relevant depressive symptoms give rise to an increase in abdominal obesity, in particular visceral fat, which seems to be stronger than and independent of overall obesity," the authors conclude. "This could also help explain why depression is often followed by diabetes or cardiovascular disease. Future research should further disentangle these mechanisms because this will yield important information for prevention or treatment of depression-related health consequences."
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Monday, December 1, 2008
The best way to teach kids
It's a question that confronts parents and teachers everywhere- what is the best method of teaching kids new skills? Is it better for children to learn gradually, starting with easy examples and slowly progressing to more challenging problems? Or is it more effective to just dive-in head first with difficult problems, and then move on to easier examples? Although conventional wisdom suggests that the best way to learn a difficult skill is to progress from easier problems to more difficult ones, research examining this issue has resulted in mixed outcomes.
University of California, Santa Barbara psychologists Brain J. Spiering and F. Gregory Ashby wanted to pinpoint the best strategies for learning new information. In their study, a group of volunteers were taught a new task in which they had to categorize items. The volunteers were trained to complete the task by one of three methods—starting with easy problems, starting with harder problems then moving on to easier examples or being shown examples in random order.
The results, published in Psychological Science, a journal of the Association for Psychological Science, showed that the effects of the different training methods depended on the type of categories that the participants were learning. When the categories could be easily described (i.e. was the line horizontal or vertical?), all three of the training procedures were equally effective. However, when the categories could not be described easily, starting with the harder problems then moving to easier ones produced the best results. The volunteers in the easy-to-hard group were able to come up with simple rules and category descriptions which worked for the easy problems, but were not applicable to more complicated problems.
As a result, these participants ended up doing poorly on the task because they were unable to think abstractly to solve the problem. On the other hand, the participants who began with harder problems very quickly stopped trying to come up ways to describe the categories and thought about the problems in a more abstract way; this strategy helped them to perform well throughout the task.
These findings have important implications for teachers and educators and suggest that materials should be presented to students in a specific order, depending on what is being taught.
Source: Association for Psychological Science
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University of California, Santa Barbara psychologists Brain J. Spiering and F. Gregory Ashby wanted to pinpoint the best strategies for learning new information. In their study, a group of volunteers were taught a new task in which they had to categorize items. The volunteers were trained to complete the task by one of three methods—starting with easy problems, starting with harder problems then moving on to easier examples or being shown examples in random order.
The results, published in Psychological Science, a journal of the Association for Psychological Science, showed that the effects of the different training methods depended on the type of categories that the participants were learning. When the categories could be easily described (i.e. was the line horizontal or vertical?), all three of the training procedures were equally effective. However, when the categories could not be described easily, starting with the harder problems then moving to easier ones produced the best results. The volunteers in the easy-to-hard group were able to come up with simple rules and category descriptions which worked for the easy problems, but were not applicable to more complicated problems.
As a result, these participants ended up doing poorly on the task because they were unable to think abstractly to solve the problem. On the other hand, the participants who began with harder problems very quickly stopped trying to come up ways to describe the categories and thought about the problems in a more abstract way; this strategy helped them to perform well throughout the task.
These findings have important implications for teachers and educators and suggest that materials should be presented to students in a specific order, depending on what is being taught.
Source: Association for Psychological Science
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