Dr. Jeff's and Dr. Tanya's Blog: January 3, 2010

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January 3, 2010 - January 9, 2010

What are the Common Mental Disorders Among American Youth?

Only about half of American children and teenagers who have certain mental disorders receive professional services, according to a nationally representative survey funded in part by the National Institute of Mental Health (NIMH). The survey also provides a comprehensive look at the prevalence of common mental disorders.

The results are part of the National Health and Nutrition Examination Survey (NHANES), a collaboration between NIMH and the National Center for Health Statistics of the Centers for Disease Control and Prevention. The survey conducted from 2001 to 2004 had 3,042 participants. These most recent results include data from children and adolescents ages 8 to 15, and were published online ahead of print December 14, 2009, in the journal Pediatrics.

"Data on the prevalence of mental disorders among U.S. youth have been varied, making it difficult to truly understand how many children and teens are affected," said NIMH Director Thomas R. Insel, M.D. "These data from the NHANES survey can serve as an important baseline as we follow trends of mental disorders in children."

In the study, the young people were interviewed directly. Parents or caregivers also provided information about their children's mental health. The researchers tracked six mental disorders—generalized anxiety disorder (GAD), panic disorder, eating disorders (anorexia and bulimia), depression, attention deficit hyperactivity disorder (ADHD) and conduct disorder. The participants were also asked about what treatment, if any, they were receiving.

Overall, 13 percent of respondents met criteria for having at least one of the six mental disorders within the last year. About 1.8 percent of the respondents had more than one disorder, usually a combination of ADHD and conduct disorder. Among the specific disorders,

8.6 percent had ADHD, with males more likely than females to have the disorder;
3.7 percent had depression, with females more likely than males to have the disorder;
2.1 percent had conduct disorder;
0.7 percent had an anxiety disorder (GAD or panic disorder);
0.1 percent had an eating disorder (anorexia or bulimia).

"With the exception of ADHD, the prevalence rates reported here are generally lower than those reported in other published findings of mental disorders in children, but they are comparable to other studies that employed similar methods and criteria," said lead author Kathleen Merikangas, Ph.D., of NIMH.

Those of a lower socioeconomic status were more likely to report any disorder, particularly ADHD, while those of a higher socioeconomic status were more likely to report having an anxiety disorder. Mexican-Americans had significantly higher rates of mood disorders than whites or African-Americans, but overall, few ethnic differences in rates of disorders emerged.

Merikangas and colleagues also found that overall, 55 percent of those with a disorder had consulted with a mental health professional, confirming the trend of an increase in service use for childhood mental disorders, especially ADHD. However, only 32 percent of youth with an anxiety disorder sought treatment, a finding consistent with other studies. Moreover, African-Americans and Mexican-Americans were significantly less likely to seek treatment than whites, reiterating the need to identify and remove barriers to treatment for minority youth, noted the researchers.

"Until now, there has been a dearth of reliable data on the magnitude, course and treatment patterns of mental disorders among U.S. youth," said Dr. Merikangas. "When combined with data from other nationally representative surveys, the data will provide a valuable basis for making decisions about health care for American youth," she concluded.

Source: National Institute of Mental Health

Additional Sources of Information:

Check out The Parent's Guide to Understanding Adolescent Depression authored by Dr. Jeff and Dr. Tanya and now available in a great informational website hosted by Squidoo.com. Below is a sneak preview of the website's Table of Contents:

Great Youtube Videos on Tips on How To Maintain Your Mental Health and Adolescent Depression:

Great Informational Websites Created by Dr. Speller and Dr. Korkosz:

Sources: See blogposts in Psychiatric Disorders: General and Psychiatric Disorders: Depression, Youtube

Additional Resources:

For related articles on the Web, click on: “Sphere: Related Content” located at the bottom of this blog post.
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Dr. Jeffrey Speller

Dr. Tanya Korkosz

Psychopharmacology Associates of New England

www.psychopharmassociates.com

Posted by Dr. Jeff and Dr. Tanya on January 06, 2010 at 06:15 AM in Psychiatry: Adolescents and Young Adults | Permalink | Comments (0)

Do Substance Abusing Depressed Teens Respond Poorly to Depression Treatment?

Depressed teens who report low levels of impairment related to drug or alcohol use tended to respond better to depression treatment than depressed teens with higher levels substance-related impairment, according to an analysis of data from the NIMH-funded Treatment of SSRI-Resistant Depression in Adolescents (TORDIA) study. However, it is unclear whether less substance-related impairment allowed for better response to depression treatment, or if better treatment response led to less substance-related impairment. The study was published in the December 2009 issue of the Journal of the American Academy of Child and Adolescent Psychiatry.

Background

Substance use is more common among teens with depression than among those without depression. Researchers have also found that depression can inhibit teens' response to treatment of substance abuse, and substance abuse is associated with a poorer response to treatment of depression. Still, few trials have examined how coexisting depression and substance use among teens may affect treatment outcomes for both.

In the TORDIA study, 334 teens who did not respond to a type of antidepressant called a selective serotonin reuptake inhibitor (SSRI) before the trial were randomly assigned to one of four treatments for 12 weeks:

Switch to another SSRI
Switch to venlafaxine (Effexor), a different type of antidepressant
Switch to another SSRI and add cognitive behavioral therapy (CBT), a type of psychotherapy
Switch to venlafaxine and add CBT

Results of the trial were previously reported in February 2008. They showed that teens who received combination therapy, with either type of antidepressant, were more likely to improve than those on medication alone.

In this new analysis, Benjamin Goldstein, M.D., of the University of Toronto, and colleagues examined TORDIA data to determine the relationship, if any, between substance use, major depression and response to depression treatment. Substance use was defined as using alcohol or drugs without meeting criteria for having a full-blown substance abuse disorder. Teens who were diagnosed with a substance abuse disorder were excluded from the TORDIA study.

Results of the Study

Substance use was fairly common among TORDIA participants. At baseline, about 28 percent reported experimenting with drugs or alcohol. Those who showed more substance -related impairment were older, felt more hopeless, had greater family conflict, developed depression at an earlier age, were more likely to have a history of physical or sexual abuse, and were more likely to have coexisting oppositional defiant disorder (ODD) or conduct disorder (CD). Substance-related impairment included certain attitudes and behaviors such as craving the substance, feeling hooked on it, accidentally hurting oneself or others while using it, and other similar effects.

Participants with low levels of substance use and substance-related impairment throughout the study tended to respond better to depression treatment than those who showed persistently high or increasing levels of substance-related impairment. There were no significant differences in rates of substance use and impairment among the treatment groups.

Significance

This study is one of the first to examine the association between substance use and depression treatment among depressed teens. The findings are consistent with other studies that found depression severity to be associated with a history of physical or sexual abuse, coexisting ODD or CD, and substance-related impairment. However, the direction of the association is uncertain. The data could not determine whether low substance-related impairment facilitates improvement in depression symptoms, or whether improvement in depressed mood leads to a decrease in substance-related impairment.

What's Next

The authors caution that the study does not provide definitive conclusions about depression treatment and substance use. However, they do suggest that clinicians treating teens for depression screen for signs of substance use and address those issues as well, even if the teen does not meet criteria for a full-blown substance abuse disorder.

Reference

Goldstein BI, Shamseddeen W, Spirito A, Emslie G, Clarke G, Wagner KD, Asarnow JR, Vitiello B, Ryan N, Birmaher B, Mayes T, Onorato M, Zelazny J, Brent D. Substance use and the treatment of resistant depression in adolescents. Journal of the American Academy of Child and Adolescent Psychiatry. 2009 Dec. 48(12):1182-1192.

Source: National Institute of Mental Health

Additional Sources of Information:

Great Youtube Videos on Tips on How To Maintain Your Mental Health and Adolescent Depression:

Great Informational Websites Created by Dr. Speller and Dr. Korkosz:

Sources: See blogposts in Psychiatric Disorders: General and Psychiatric Disorders: Depression, Youtube

Additional Resources:

For related articles on the Web, click on: “Sphere: Related Content” located at the bottom of this blog post.
For related books or blog posts with related content in Dr. Jeff’s and Dr. Tanya’s Blog type in the keywords into “Google Search” located in the sidebar.
For more books with related content, type in the keywords into “Amazon Search” on the Amazon banner located in the side bar.

Dr. Jeffrey Speller

Dr. Tanya Korkosz

Psychopharmacology Associates of New England

www.psychopharmassociates.com

Posted by Dr. Jeff and Dr. Tanya on January 06, 2010 at 06:12 AM in Addictions: General, Psychiatry: Adolescents and Young Adults | Permalink | Comments (0)

Does Early Intervention for Autistic Toddlers Improves Their Chances?

Children with autism who receive a high intensity developmental behavioral intervention starting by age 18-30 months show major improvements in IQ, language, adaptive behavior, and severity of their diagnosis, according to an NIMH-funded study.

Background

Current guidelines by the American Academy of Pediatrics recommend screening children for autism spectrum disorder (ASD) by age 18 months. However, no randomized clinical trials of intensive interventions for this age group had been conducted.

To address this gap, Geraldine Dawson, Ph.D., who was at the University of Washington at the time of the study, and colleagues randomly assigned 48 children, ages 18-30 months, to one of two intervention groups:

Early Start Denver Model (ESDM), a comprehensive, developmental behavioral intervention designed for toddlers with ASD as young as 12 months old. ESDM combines aspects of applied behavioral analysis (ABA) with developmental and relationship-based approaches.
Assess and Monitor (A/M), the comparison group intervention in which parents received recommendations on ASD interventions for their children, as well as referrals to local community providers of the interventions. A/M represents typical community-based care.

Children in the ESDM group were provided 20 hours per week of therapy from study clinicians, while their parents received related training to use ESDM strategies for at least five additional hours per week during their daily activities. Parents of all study participants were also free to receive other community services they thought appropriate.

All children in the study had been diagnosed with autism or a milder form of ASD called pervasive developmental disorder not otherwise specified (PDD-NOS). They were assessed yearly for two years or until the child turned four years old, whichever was longer.

Results of the Study

By the first- year assessment, children in the ESDM group gained 15.4 IQ points on average, while children in the A/M group gained an average of 4.4 points.

Over the two-year study period, children in the ESDM group consistently improved on measures of communication skills. They also showed improvements in motor skills, daily living skills, and other adaptive behaviors.

While children in the ESDM group were significantly delayed in their adaptive behaviors compared to typically developing children, they showed similar rates of improvement. In contrast, children in the A/M group fell further and further behind over time.

By the end of the study, more children who had received ESDM received improved diagnoses than children in the A/M group—seven children initially diagnosed with autistic disorder had their diagnosis change to PDD-NOS after receiving ESDM (30 percent), compared to only one child in the A/M group (5 percent).

Significance

According to the researchers, this is the first randomized controlled trial to study a potentially useful intensive intervention for very young children with ASD.

The study's findings suggest that ESDM can help children with ASD achieve better outcomes in terms of IQ, language, and behavioral skills, and in severity of their ASD diagnosis, than if they receive community-based care. Compared to research on other, similar interventions, this study showed greater differences between groups, suggesting that ESDM, delivered at a very young age, may be more effective than other approaches. The researchers noted that parents' use of ESDM strategies at home may have been key to this intervention's effectiveness.

What's Next

The University of Washington research team has been funded through the NIH Autism Centers of Excellence (ACE) program to follow this study's participants to determine whether the effects of ESDM can be sustained over time. In addition, Dr. Sally Rogers, Ph.D., a co-author on the study and co-developer with Dr. Dawson of the ESDM model, is leading a multi-site, randomized clinical trial of ESDM, also funded through the NIH ACE program. With a larger sample size, the investigators hope to better understand factors that predict level of response to the ESDM intervention.

Reference

Dawson G, Rogers S, Munson J, Smith M, Winter J, Greenson J, Donaldson A, Varley J. Randomized, Controlled Trial of an Intervention for Toddlers With Autism: The Early Start Denver Model. Pediatrics. 2009 Nov 30. [Epub ahead of print] PubMed PMID: 19948568.

Source: National Institute of Mental Health

Great Youtube Video on Autism

Thirteen Great Books on Autism Spectrum Disorders:

Nine Resource and Support Groups for Autism Spectrum Disorders:

Great Informational Websites Created by Dr. Speller and Dr. Korkosz:

Additional Resources:

For related articles on autism spectrum disorders on the Web, click on: “Sphere: Related Content” located at the bottom of this blog post.
For related books or blog posts with related content in Dr. Jeff’s and Dr. Tanya’s Blog, go to “Psychiatric Disorders: Autism Spectrum Disorders” or type in the keyword “Autism Spectrum disorders” into “Google Search” located in the sidebar.
For more books with related content, click any hyperlinked keyword in the blog or type in the keyword, “autism spectrum disorders” into “Amazon Search” on the Amazon banner located in the side bar.

Sources: See blogposts in: Psychiatric Disorders: Autism Spectrum Disorders, Youtube

Dr. Jeffrey Speller

Dr. Tanya Korkosz

Psychopharmacology Associates of New England

www.psychopharmassociates.com

Posted by Dr. Jeff and Dr. Tanya on January 06, 2010 at 06:09 AM in Psychiatric Disorders: Autism Spectrum Disorders | Permalink | Comments (0)

Does Long-term Depression Treatment Lead to Sustained Recovery for Depressed Teens?

Long-term treatment of adolescents with major depression is associated with continuous and persistent improvement of depression symptoms in most cases, according to the most recent analysis of follow-up data from the NIMH-funded Treatment of Adolescents with Depression Study (TADS). The report, along with a commentary compiling the take-home messages of the study, was published in the October 2009 issue of the American Journal of Psychiatry.

Background

The TADS team randomly assigned 439 adolescents aged 12 to 17 to one of four treatment strategies for 36 weeks—the antidepressant fluoxetine (Prozac) only, cognitive behavioral therapy (CBT) only, the combination of the two, or placebo (inactive or "sugar" pill). After the first 12 weeks, the placebo group was discontinued, while the participants assigned to the active interventions continued treatment for another six months. Overall, the combination therapy was found to be the most effective in speeding up remission. Visit the NIMH website for more information about TADS results.

After the trial ended, the teens who had been assigned to the active treatments were assessed up to four times during the following year to determine if improvements were sustained over time. TADS treatments were no longer offered, but participants were encouraged to continue to seek treatment within their communities.

Participants who had been assigned to the placebo group received open treatment during the one-year follow-up period and were not included in this follow-up assessment. About 66 percent of TADS subjects (not including those who had been in the placebo group) participated in at least one assessment during the follow-up year.

Results of the Study

By the end of the 36-week trial, 82 percent of participants had improved and 59 percent had reached full remission. During the follow-up year, most participants maintained their improvements, and the remission rate climbed to 68 percent. However, about 30 percent of the participants who were in remission at week 36 became depressed again during the following year.

In addition, while 91 percent of participants showed no evidence of suicidal thinking or behavior at the end of the trial, 6 percent developed suicidal thinking during the follow-up year, with no statistically significant differences among the treatment groups.

Significance

The longer-term treatment of TADS, regardless of treatment strategy, was associated with lasting benefits for the majority of participants. However, a significant number of those who had recovered worsened during the follow-up period, indicating a need for continuous clinical monitoring and further improvement in long-term treatment of youth with major depression.

What's Next?

The final results of TADS suggest that for most teens with depression, long-term, evidence-based treatments are effective and sustainable. But future research should concentrate on improving treatment strategies to reduce the rate of depression relapse or deterioration. The authors suggest that a randomized maintenance therapy trial would help determine how long active treatment should last to ensure the effects of treatment will endure over time.

References

TADS Team. The Treatment for Adolescents with Depression Study (TADS): Outcomes over one year of naturalistic follow-up. American Journal of Psychiatry. 2009 Oct. 166(10): 1141-1149.

March JS and Vitiello B. Take home messages from the Treatment for Adolescents with Depression Study (TADS). American Journal of Psychiatry. 2009 Oct.166(10):1118-1123.

Source: National Institute of Mental Health

Additional Sources of Information:

Great Youtube Videos on Tips on How To Maintain Your Mental Health and Adolescent Depression:

Great Informational Websites Created by Dr. Speller and Dr. Korkosz:

Sources: See blogposts in Psychiatric Disorders: General and Psychiatric Disorders: Depression, Youtube

Additional Resources:

For related articles on the Web, click on: “Sphere: Related Content” located at the bottom of this blog post.
For related books or blog posts with related content in Dr. Jeff’s and Dr. Tanya’s Blog type in the keywords into “Google Search” located in the sidebar.
For more books with related content, type in the keywords into “Amazon Search” on the Amazon banner located in the side bar.

Dr. Jeffrey Speller

Dr. Tanya Korkosz

Psychopharmacology Associates of New England

www.psychopharmassociates.com

Posted by Dr. Jeff and Dr. Tanya on January 06, 2010 at 06:05 AM in Psychiatry: Adolescents and Young Adults | Permalink | Comments (0)

Is Telephone-based Depression Treatment Effective?

Patients who receive structured, telephone-based support to manage their depression gain significant benefits with only moderate increases in health care costs compared to those who receive usual care, according to an NIMH-funded analysis published in the October 2009 issue of the Archives of General Psychiatry.

Background

Previous research found structured depression treatment programs in primary care to be effective, but the success of their dissemination likely will depend on whether benefits can be balanced with costs, according to researchers at Group Health Research Institute in Seattle led by Gregory Simon, M.D., M.P.H.

Simon and colleagues conducted a randomized controlled trial of a telephone-based depression treatment program within one health care plan. Between November 2000 and June 2004, 600 patients were randomly assigned for two years to one of three depression treatment groups:

telephone care management that included outreach calls for monitoring and support;
telephone care management plus telephone-based cognitive behavioral therapy (CBT); or
usual care, which consisted of follow-up by a primary care provider and referral to a mental health care specialist.

Previously published data showed that telephone care management plus CBT yielded the most significant and sustained improvements in depression, while the care management program alone showed modest improvements.^1,² This most recent paper examined the cost effectiveness of the program.

Results of the Study

When compared to usual care, participants who received telephone care plus CBT had 46 more depression-free days at an increased cost of $397 over usual care. Those who received just telephone care had 29 more depression-free days at an increased cost of $676 over usual care. Costs included outpatient depression treatment as well as health care plan costs for all other outpatient services. Although adding CBT to telephone care management required more upfront costs, it led to more significant and sustained improvements, and therefore, more modest costs overall.

Significance

The findings offer some guidance to insurers and health care systems that are considering ways to improve depression care. Both interventions led to increased spending over usual care, but the costs were balanced by improvements in depression symptoms, potentially allowing for improved worker productivity.

What's Next

Additional research is needed to determine to what extent depression and depression treatment affect other economic factors such as work productivity and burden on families. In addition, findings may be different among health care plans that calculate mental health care costs separately from overall health care spending.

References

Simon GE, Ludman EJ, Rutter C. Incremental benefit and cost of telephone care management and telephone psychotherapy for depression in primary care. Archives of General Psychiatry. 2009 Oct;66(10):1081-1089.

¹Simon GA, Ludman EJ, Tutty S, Operskalski B, Van Korff M. Telephone psychotherapy and telephone care management for primary care patients starting antidepressant treatment: a randomized controlled trial. Journal of the American Medical Association. 2004;292(8): 935-942.

²Ludman EJ, Simon GE, Tutty S, Von Korff M. A randomized trial of telephone psychotherapy and pharmacotherapy for depression: continuation and durability of effects. Journal of Consulting and Clinical Psychology. 2007;75(2): 257-266.

Source: National Institute of Mental Health

How to improve your understanding of depression. View this top rated video from Youtube:

Great Informational Websites Created by Dr. Speller and Dr. Korkosz:

Sources: See blogposts in Psychiatric Disorders: General, Depression

Additional Resources:

For related articles on the Web, click on: “Sphere: Related Content” located at the bottom of this blog post.
For related books or blog posts with related content in Dr. Jeff’s and Dr. Tanya’s Blog type in the keywords into “Google Search” located in the sidebar.
For more books with related content, type in the keywords into “Amazon Search” on the Amazon banner located in the side bar.

Dr. Jeffrey Speller

Dr. Tanya Korkosz

Psychopharmacology Associates of New England

www.psychopharmassociates.com

Posted by Dr. Jeff and Dr. Tanya on January 06, 2010 at 06:02 AM in Psychiatric Disorders: Depression | Permalink | Comments (0)

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January 3, 2010 - January 9, 2010

Background

Results of the Study

Significance

What's Next

Reference

Background

Results of the Study

Significance

What's Next

Reference

Background

Results of the Study

Significance

What's Next?

References

Background

Results of the Study

Significance

What's Next

References