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Antipsychotics Best for Controlling Mania: Study

2011-10-18T17:31:00.001-07:00

The manic episodes experienced by those with bipolar disorder are better controlled by antipsychotic drugs than mood stabilizers, a new, large study suggests.

Researchers from Italy and the United Kingdom also found that three antipsychotics — first-generation haloperidol (Haldol) along with later formulations of risperidone (Risperdal) and olanzapine (Zyprexa) — outperformed 11 other drugs. The scientists analyzed results from 68 randomized, controlled trials with more than 16,000 participants over a 30-year period.

Mania typically alternates with depression in those with bipolar disorder, which tends to run in families and begin between the ages of 15 and 25, according to the U.S. National Institutes of Health. Acute manic episodes — characterized by hyperactivity, racing thoughts and reckless behavior — are not experienced by all bipolar patients, but severe symptoms often require hospitalization, health officials said.

Broadly defined as an “excessively raised mood,” mania affects about 1 percent of the population, according to the study authors.

“The most important point is that this is a study about acute treatment of manic episodes, not long-term management or prevention,” said Dr. Gregory Simon, a psychiatrist and mental health researcher at Group Health Cooperative in Seattle, who was not involved in the study. “The idea that antipsychotic treatments are good for manic episodes is well-known, but the finding that one of the older ones is better is newsworthy here.”

Antipsychotics and other drugs commonly used to treat mania are known to have many significant side effects, which can sometimes disrupt treatment. Study co-author Dr. Andrea Cipriani, a lecturer in psychiatry at the University of Verona in Italy, said haloperidol and risperidone are more likely than olanzapine to cause movement problems such as tremors and rigidity, while olanzapine is linked to higher rates of weight gain, metabolic syndrome and diabetes. Some antipsychotic medications may cause irregular heartbeat as well.

Cipriani said the new research was the first of its type to compare anti-manic drugs — including antipsychotics, anticonvulsants and lithium — and rank them according to their effectiveness and ability to be tolerated. She and her colleagues completed a similar study on antidepressants several years ago.

In head-to-head comparisons among drugs, the study authors found that haloperidol was more effective than aripiprazole, asenapine, carbamazepine, valproate, gabapentin, lamotrigine, lithium, quetiapine, topiramate and ziprasidone. Risperidone, olanzapine and quetiapine were most likely to be tolerated by patients and outperformed lithium, lamotrigine, topiramate and gabapentin.

The new research, which was not funded by the pharmaceutical industry, appears in the Aug. 17 online edition of The Lancet.

“Psychiatrists now have an evidence-based hierarchy when they are to prescribe an anti-manic agent for acute mania,” Cipriani said. “These findings are in line with what psychiatrists usually prescribe in their daily practice. There are new treatments that have been recently marketed for acute mania, but this study shows that clinicians should be aware these new compounds are not better — and may be worse — than older ones, and these [new] drugs are much more expensive.”

Long-term management of bipolar disorder usually requires a combination of medications, Cipriani and Simon said, and antipsychotics typically are used for extreme manic episodes for only several weeks at a
time.

In a commentary accompanying the study, Australian researchers Dr. Michael Berk, chair of psychiatry at the Deakin University School of Medicine, and Gin S. Malhi, with the department of psychiatry at Royal North Shore Hospital in Sydney, said it’s useful to know that haloperidol seems to be a top-line treatment for the treatment of acute mania.

But, they added, haloperidol “lacks maintenance efficacy for depression — the predominant clinical state [of patients with bipolar disorder] — and indeed carries an inherent risk of incident depression.”

Genetic Links Seen Between Bipolar Illness and Schizophrenia

2011-10-18T17:30:00.001-07:00

There is a genetic link between schizophrenia and bipolar disorder, two common and often disabling brain disorders, a new study indicates.

Researchers identified 11 genetic regions, including six that had never been discovered before, which play a role in people’s risk for these mental illnesses. The findings, they say, provide new insight into the causes of both conditions.

“Schizophrenia and bipolar disorder are debilitating illnesses affecting millions of people around the world, and existing therapies for these people are ineffective as long-term options,” the bipolar study’s lead author Dr. Pamela Sklar, chief of the division of psychiatric genomics in the department of psychiatry and a professor of psychiatry at Mount Sinai School of Medicine, said in a news release. “We have been hard at work trying to determine genetic risk for these diseases so that we can intervene earlier and develop new therapies with which to treat them. Through this research, we are an important step closer to making that possible.”

Researchers examined the DNA of 7,481 people with bipolar disorder as well as 9,250 healthy people. In a separate study, another team of scientists evaluated the same DNA sites in more than 17,000 people with schizophrenia.

In these two studies, the researchers found several DNA sites also known as DNA variants in certain genes were linked with schizophrenia and bipolar disorder. In some cases, certain variants were associated with both disorders. They argued the findings could help scientists identify new treatments for these mental illnesses enabling them to treat them earlier on and more effectively.

“Until recently, psychiatric research has understood the genetic basis of mental illness only very poorly,” Dr. Shaun Purcell, an associate professor of psychiatry at Mount Sinai School of Medicine and co-author on the schizophrenia study, said in a news release. “Our research has helped us begin to elucidate the genetic structure of bipolar disorder and schizophrenia, and will, we hope, provide a new foundation to build upon in improving treatments and the quality of life of these patients.”

The research was published in the Sept. 18 issue of Nature Genetics.

Painful Sex After Menopause? When Hormones Aren’t an Option, Some Women Consider Surgery

2011-10-18T17:29:00.000-07:00

THURSDAY, October 6, 2011 (Health.com) — Linda Bianchini was in her mid-50s when sex with her husband became unbearably painful.

“Before I started to have discomfort, our sex life was good. I had only remarried in 2004 so, although we were middle-aged, we were still like newlyweds,” recalls Bianchini, now 57, a human resources manager at a hospital in Staten Island, N.Y. “It had been going on for at least a year, but I just did not bring it to my doctor since I thought it is just the way it is.”

But sex became so infrequent that, desperately, Bianchini finally mentioned the problem to her gynecologist, David Herzog, MD. Herzog explained that after menopause, decreased estrogen levels in the body can lead to loss of elasticity, or atrophy, around the vaginal muscles—essentially shrinking the opening and making it more difficult to have intercourse.

It’s not an uncommon problem: Dryness and pain during intercourse are two of the main causes of female sexual dysfunction, which affects more than 40% of women and is most common between ages 45 and 64, according to the 1999 U.S. National Health and Social Life Survey. (Other causes include lack of interest and inability to experience orgasm.) A 2007study found that among women ages 57 to 64, 34% avoid sex altogether, citing pain (18%), decreased lubrication (36%), and low desire (44%) as their reasons.

Being Heavier May Mean Fewer Hot Flashes for Women Over 60

2011-10-18T17:27:00.001-07:00

Older, heavier women tend to have fewer hot flashes than younger, leaner menopausal women, a small, new study suggests.

The study included 52 women who experienced hot flashes and were not taking medication for those symptoms.

The women’s body fat percentage, waist circumference and body mass index (BMI) were also measured, and a special skin monitor and electronic diary were used to track their hot flashes.

The result: the researchers found that higher fat levels, BMI and waist circumference were associated with fewer hot flashes. These associations were strongest among white women.

However, the reduction in hot flashes associated with higher fat levels wasn’t evident in women younger than 60.

One expert who was not involved in the study said the finding did make physiologic sense.

“Being heavier means more body fat that can convert androgens into estrogens,” explained Dr. Spyros Mezitis, an endocrinologist at Lenox Hill Hospital in New York City. That should mean that heavier, postmenopausal women will have more circulating estrogen than lean postmenopausal women, “which would explain the fewer hot flashes in the heavier postmenopausal women,” he said.

The study also “provides a more nuanced understanding of the relationship between body size and hot flashes, emphasizing the important role of age,” lead author Rebecca Thurston, of the University of Pittsburgh, added in a news release from the Endocrine Society.

Mezitis stressed, however, that the finding should not be seen as a “green light” for older women to pile on excess pounds.

“Being heavier means more body fat and higher insulin resistance and higher risk for metabolic syndrome,” a constellation of unhealthy risk factors that can bring on heart disease, Mezitis said. “Higher estrogens may be to a certain extent cardioprotective, but I think studies will show more [arterial] risk than benefit in heavy postmenopausal women.”

Another expert agreed. Dr. Stuart Weinerman, chief of the division of endocrinology at North Shore-LIJ Health System in New Hyde Park, N.Y., said that “weight has multiple health effects, and this would not be evidence of finding an ideal body weight for anyone.”

The findings were released online Aug. 31 in advance of publication in the October print issue of the Journal of Clinical Endocrinology & Metabolism.

Aging, Not Menopause, Raises Women’s Heart Risks, Study Finds

2011-10-18T17:26:00.000-07:00

There’s no link between menopause and increased risk of death from heart disease, says a study that challenges a long-held medical belief that the rate of cardiovascular death in women spikes after menopause.

Aging alone, not the hormonal impact of menopause, explains the increasing number of deaths among older women, according to the Johns Hopkins researchers.

The new findings could affect how heart health is assessed in premenopausal women, who were previously believed to have a low risk of death from heart attack, the authors pointed out in the study published in the Sept. 6 issue of the BMJ.

“Our data show there is no big shift toward higher fatal heart attack rates after menopause,” study leader Dhananjay Vaidya, an assistant professor of medicine at the Johns Hopkins University School of Medicine, said in a Hopkins news release.

“What w

e believe is going on is that the cells of the heart and arteries are aging like every other tissue in the body, and that is why we see more and more heart attacks every year as women age. Aging itself is an adequate explanation and the arrival of menopause with its altered hormonal impact does not seem to play a role,” Vaidya added.

In the study, the investigators analyzed death statistics for people born in England, Wales and the United States between 1916 and 1945. Among women, increases in death rates at the time of menopause were not above and beyond the steady curve associated with aging.

“Special attention should be paid to heart health in women due to their overall lifetime risk,” Vaidya concluded, “not just after the time of menopause.”

Factors Identified That May Raise Risk of Early Menopause

2011-10-18T17:24:00.001-07:00

Certain factors have been found to be associated with a raised risk of early menopause, including having a chronic inflammatory disease or having one of two genes known to be linked to breast cancer, especially among those who smoke, according to two new studies.

The stud

ies were slated for presentation Tuesday at the annual meeting of the American Society for Reproductive Medicine (ASRM) in Orlando, Fla.

In one study, researchers examined data from the University of California, San Francisco Cancer Risk Registry on 931 white women in the United States and found that BRCA1 and BRCA2 carriers started menopause at a much earlier age than those without the breast cancer genes — age 48 versus 53.

Heavy smoking (20 or more cigarettes a day) was associated with an even earlier onset of menopause in BRCA1/2 carriers, an average age of 45.5, the study revealed.

In another study, University of Pennsylvania researchers examined the medical records of more than 1.7 million U.S. women to determine whether early menopause or premature ovarian failure is more common in women with psoriasis, rheumatoid arthritis, inflammatory bowel disease or lupus.

The analysis showed that women with these inflammatory conditions are two to five times more likely than other women to reach menopause before age 45 or to lose ovarian function before age 40.

“For carriers of the BRCA1 and BRCA2 genes considering prophylactic oophorectomy [removal of their ovaries to prevent cancer] and for women facing treatment for cancer who may want to attempt fertility preservation procedures, these findings may provide a better idea of when their natural fertility might end and therefore the likelihood of success of any fertility preservation procedures they might undertake,” Dr. Roger Lobo, ASRM president, said in a society news release.

Experts note that data and conclusions presented at medical meetings should be viewed as preliminary until published in a peer-reviewed journal.

Use of Asthma Controller Meds on the Rise Among U.S. Kids

2011-10-18T17:23:00.000-07:00

The percentage of children with asthma in the United States who use a prescription “controller” medicine has nearly doubled since the late 1990s, a new federal government report finds.

The analysis of data from the Medical Expenditure Panel Survey showed that the use of controller drugs by these children increased from 29 percent in 1997-1998 to 58 percent in 2007-2008, according to the latest News and Numbers from the U.S. Agency for Healthcare Research and Quality.

Asthma controller drugs include: corticosteroids, which control inflammation and reduce the risk of airway spasms; beta-2-agonists, which make breathing easier; and leukotrienes, which help prevent asthma symptoms from occurring.

Use of inhaled corticosteroids among American children with asthma increased from 15.5 percent to 40 percent, use of leukotrienes rose from 3 percent to 34 percent, and use of beta agonists rose from 3 percent to 13 percent, according to the report.

During the same period, the use of reliever and oral corticosteroid drugs fell from 44 percent to 30 percent and from 17 percent to 9 percent, respectively, the investigators noted in an agency news release.

Average annual total spending for all asthma drugs more than quadrupled, from $527 million in 1997-1998 to $2.5 billion in 2007-2008. When broken down by category, spending for controller drugs rose from $280 million to $2.1 billion, spending for reliever drugs increased from $222 million to $352 million, and spending for oral corticosteroids fell from $25 million to $8 million, the findings revealed.

Celebrity Health

2011-10-18T17:20:00.000-07:00

Some celebrities chose to speak out about the various health conditions that are near and dear to their hearts, whether they themselves have struggled with an illness, a chronic condition, or fluctuating weight, or a family member or close friend's experience has left a mark in their lives. Debi Mazar explains what it's like to have a family member with bipolar disorder, Sheryl Crow talks breast cancer, and why those crash diets the celebs love are simply not going to help you.

Childhood Vaccines

2011-10-18T17:19:00.000-07:00

Vaccines or immunizations are the reason few people have seen a child with polio, German measles, or whooping cough. At the same time, concerns about vaccine side effects have led some parents to avoid vaccinating their children, resulting in outbreaks of vaccine-preventable diseases. There are currently 12 vaccines recommended for children between birth and 18 years of age.

11 Signs Cholesterol Is Harming Your Legs

2011-10-18T17:14:00.000-07:00

What is PAD?

Cholesterol can clog the heart's blood vessels, but it can also affect the legs, leading to peripheral arterial disease, or PAD.

Up to 12 million people in the U.S. have PAD, which is linked to a higher risk of heart disease, heart attack, and stroke, says David Slovut, MD, director of advanced interventional therapy at Montefiore Medical Center.

After five years, 20% of people with PAD will have had a nonfatal heart attack.

Here are 11 signs you could have PAD. The good news? It's treatable.

3 Hours of Exercise Weekly Can Cut Men’s Heart Risks

2011-10-18T16:52:00.000-07:00

WEDNESDAY, Oct. 5 (HealthDay News) — Three hours of vigorous exercise a week can reduce a man’s heart attack risk by 22 percent, a new study suggests.

The Harvard School of Public Health researchers also found that about 38 percent of that decreased risk was due to the beneficial effects of exercise on a man’s levels of “good” high-density lipoprotein (HDL) cholesterol.

The findings were published Oct. 4 the journalMedicine & Science in Sports & Exercise.

The study included 1,239 men in the Health Professionals Follow-Up Study who provided information on their weekly amount of exercise. The researchers also analyzed the men’s cholesterol levels, as well as biomarkers of inflammation and insulin sensitivity.

Between 1994 and 2004, 454 of the men suffered a nonfatal heart attack or died from coronary artery disease. Of these, 412 men were compared to a control group of 827 men without heart problems.

“As expected, traditional cardiovascular disease risk factors were more common among cases than controls,” study author Andrea Chomistek said in a journal news release. “Men who suffered a nonfatal heart attack or died from coronary heart disease had less ‘good’ cholesterol, more ‘bad’ [LDL] cholesterol and were more likely to have high blood pressure, high cholesterol and diabetes.

14 Smart Ways Seniors Can Cut Medical Costs

2011-10-18T16:05:00.000-07:00

How to save money

By Karen Pallarito

Are rising healthcare costs hammering your budget? If so, you're not alone. One in four people on Medicare laid out 30% or more of their income on healthcare in 2006, according to a recent analysis by the Henry J. Kaiser Family Foundation.

As healthcare costs continue to swell, people on Medicare likely will be required "to put even more skin in the game to pay for their health expenses," the foundation concludes.

But there are plenty of ways for the savvy senior to stretch a dollar. Here are some strategies that may lower your overall healthcare tab.

6 Surprising Libido Boosters

2011-10-18T16:04:00.001-07:00

Astonishing aphrodisiacs

You’ve heard (and tried) it all before: down a dozen oysters, watch a marathon of sultry movies, get a couples massage. Even if these usual turn-ons work for you, sooner or later they start to feel tired—which may make you less likely to respond to them, says Irwin Goldstein, MD, director of sexual medicine at Alvarado Hospital in San Diego.

Luckily, science has discovered a few more offbeat things that crank up your desire. Try one out tonight!

2011-10-18T16:02:00.000-07:00

Are You at Risk for Psoriatic Arthritis?

Psoriatic arthritis risk factors

By Amanda Gardner

Psoriatic arthritis can't be prevented or cured, but it can be treated. It's not easy to predict who will get this painful joint condition, but if you're at risk, it makes sense to watch for early symptoms such as swollen and painful fingers and toes.

Psoriatic arthritis symptomscan be mild or severe, depending on the individual, but either way, gettingtreatment sooner rather than later can help you avoid permanent joint damage.

Here are some reasons you may be at higher risk of psoriatic arthritis.

5 Simple Things That Could Cut Your Breast Cancer Risk

2011-10-18T15:58:00.000-07:00

1. Limit yourself to two or three alcoholic drinks a week

By Lorie Parch

Alcohol, consumed even in small amounts, is believed to increase the risk of breast cancer. Most doctors recommend cutting back on wine, beer, and hard liquor.

A recent study showed the link between drinking and breast cancer was especially strong in the 70% of tumors known as hormone-sensitive.