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Academy of Psychosomatic Medicine |
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 Home > News > Media Relations > Press Releases > 2006 Archives |
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2006 PRESS RELEASES
Apathy Reduces Adherence to Diabetes Treatments Emotional state affects physical measures of adherence in diabetes such as HgbA1C. It is known that patients with diabetes who also have major depressive disorder have higher HgbA1C levels, which indicates poor adherence to diet and medications during the three months prior to the time of measurement. Other emotional symptoms may also be relevant to patients' compliance with glycemic control recommendations. Apathy is a specific symptom often present in patients with depression as well as other diagnoses such as stroke or dementia. A study presented in November at the 53rd annual meeting of the Academy of Psychosomatic Medicine in Tucson , AZ found a correlation between apathy and poor glycemic control. A research team at the University of Nebraska Medical Center in Omaha led by Prasad Padala , MD performed a cross-sectional study on patients with diabetes in a primary care general medical clinic. They enrolled 70 consecutive patients with diabetes. They did not use any DSM-IV diagnoses, such as major depressive disorder, as either inclusion or exclusion criteria. They defined apathy as loss of initiative and motivation, decreased social engagement and emotional indifference, and used the Apathy Evaluation Scale (AES) to assess clinically significant levels of apathy, defined as an AES score > 30. Poor glycemic control of diabetes was defined as HgbA1C > 7. Of the 70 patients, 63% (n=44) had clinically significant apathy vs 37% (n=26) who did not. Those with apathy were more likely to have poor glycemic control than those without apathy (77% vs 50% of each group, respectively, p<0.07). Conversely, of the 70 patients, 67% (n=47) had poor glycemic control vs. 33% (n=23) who had good control. Among those with poor control, 72% (n=34) had clinically significant apathy vs only 43% (n =10) of those with good glycemic control (p<0.02). Both comparisons were statistically significantly different suggesting a relationship between apathy and poor glucose control. The authors concluded that apathy is prevalent in patients with diabetes and that its presence has an adverse impact on glycemic control, though they did not report the prevalence of major depression as a possible reason for the apathy. While these data are suggestive that doctors could monitor for apathy as an indicator of potentially reduced adherence to diabetes treatment, Dr. Padala stated that further study on the impact of addressing apathy on adherence rates is needed.
Study Finds that Depression in Head and Neck Cancer Patients Can be Prevented Prophylactic antidepressant medications given to patients with newly diagnosed head and neck cancer may prevent the onset of depression, according to the results of a newly released study presented November 18 in Tucson at the annual meeting of the Academy of Psychosomatic Medicine. Head and neck cancer treatment is characteristically grueling, involving surgery to emotionally and cosmetically sensitive areas such as the face or neck, plus radiation treatment and chemotherapy. These treatments often make it difficult to eat and talk for many months, and patients may be embarrassed by their appearance after surgery. As many as 40% of head and neck cancer patients become depressed, according to Dr. William J. Burke of the University of Nebraska Medical Center, who presented the prophylaxis study. This high rate of depression was his motivation for studying whether the occurrence of depression could be reduced or prevented by pre-treating non-depressed, newly diagnosed head and neck cancer patients with an antidepressant medication. Dr. Burke purposefully excluded patients with pre-existing depression. Most of the patients had advanced squamous cell carcinomas, in stages III and IV. Thyroid cancer was not included in this study. In a prospective, double-blind design, he randomized 24 people with head and neck cancer to receive a 12-week course of either the antidepressant citalopram or placebo, begun at the time they were about to receive treatment for their cancer. Citalopram was used at a dose of 40 mg per day and was well tolerated, with only two patients dropping out because of side effects. Using a modified intention to treat analysis, by week 12, depression developed in 40% of the placebo group but only 17% of the citalopram group. Dr. Burke said that the results were both exciting and surprising because this is the first time that an antidepressant has been given prophylactically to cancer patients and shown to improve outcomes. Nevertheless, he cautions that these data should be interpreted cautiously because of the small sample size. Dr. Burke has applied for funding for a larger, more comprehensive study to confirm these results. These data support the benefits of prophylactic depression treatment in a group of cancer patients known to be at high risk for depression.
Soldiers Under 21 are More Vulnerable to Psychiatric Disability Younger military personnel are dramatically more likely to develop psychiatric disability requiring evacuation than others. Service personnel evacuated for psychiatric causes are rarely able to be returned to the war zone. Women more than men, and African-Americans and Hispanics more than Caucasians, are also more likely to be evacuated for psychiatric reasons. The study, presented November 18 by principal author James Rundell, MD at the Academy of Psychosomatic Medicine annual meeting in Tucson, was performed on 1,264 consecutive service men and women evacuated from the war theater from November 4, 2001 to July 30, 2004. 10% of all medically evacuated veterans were removed for psychiatric causes. Such evacuations are 25 times more likely in recruits aged 18-20 than those older, and twice as likely in women as in men. 80% of the evacuations occurred within the first 6 months of service in Iraq and/or Afghanistan . Psychiatric disorders were predominantly identified as acute adjustment and depressive problems (50%) and infrequently due to posttraumatic stress disorder or shell shock (<5%). African-Americans were 30% more likely and Hispanics were twice as likely as the average recruit to develop psychiatric problems requiring evacuation. Only 5% of psychiatric evacuees were returned to duty, most being returned to a rear unit out of the country of conflict. Dr. Rundell believes younger soldiers are more likely to be psychiatrically evacuated because “they are just out of high school, often away from home for the first time, of the lowest rank, and the most inexperienced in the world. They are predominantly single without marriage and social support back home.” Younger recruits new to war zones have a much greater difficulty adjusting psychologically than those who are older and who have been in the service longer. Combat exposure, while important, was not clearly the most important causal factor. He stated that psychiatric evacuations are approximately the same as those from previous wars, such as WWII, Korea, and Viet Nam. Women are evacuated for psychiatric casualties twice as often as men for reasons largely related to experiencing the similar war zone stresses as well as special stressors such as sexual assault. African-American and Hispanic recruits may be psychiatrically evacuated in larger numbers than Caucasians, although these numbers were less dramatic than the age- and sex-related psychiatric casualties. Dr. Rundell emphasized that these data concerned a small proportion of those who developed psychiatric problems in the field; that most remain deployed to the combat theater and are not evacuated. There is a high threshold for evacuation, typically representing danger to oneself or to one's fellows as being required for such removal. Prior psychiatric maladjustment, while not studied, did not appear to be a contributor to these evacuations. The military is sensitive to psychiatric casualties and is working to ensure mental health in its recruits.
Study Finds that Depression May Affect Survival in Advanced Lung Cancer Researchers at the Massachusetts General Hospital studied the effects of depression on survival in advanced lung cancer. Dr. William Pirl, who led the study, recently presented the findings for the first time on November 18th at the Academy of Psychosomatic Medicine (APM) Annual Meeting in Tucson . They recruited 43 patients with recently diagnosed stage III and IV non-small cell lung cancer where the median survival is only 10 months. They found 23% of this group to be significantly depressed. The depressed patients were significantly less likely to survive than non-depressed patients such that 6 months after entry into the study, 60% of depressed patients versus 21% of the non-depressed group had died. All depressed patients, as is ethically correct, were able to receive psychiatric “treatment as usual.” This meant that half of the depressed group actually were treated with antidepressants. However, at six months, there was no difference in deaths between the group that received antidepressants and those who did not (both had death rates of 60%). Even after adjusting for factors such as cancer stage, age, gender, and the patients' physical functional ability, depressed patients had 6 times the odds of dying within 6 months. Dr. Pirl said that although the findings were intriguing, further prospective studies are needed to replicate these results. The APM encourages better recognition and treatment of depression that occurs in the context of medical illnesses.
Depression Treatment Found Effective among Heart Patients Canadian researchers have demonstrated that the antidepressant citalopram is effective and safe in treating depression among patients with coronary artery disease (CAD). They reported their findings November 17 at the annual meeting of the Academy of Psychosomatic Medicine in Tucson, AZ. Research has shown that depression is a frequent companion to CAD. The World Health Organization predicts that by 2020, CAD and depression will be the first and second diseases in the world with regard to the burden of illness. François Lespérance, MD (University of Montreal) and Nancy Frasure-Smith, PhD (McGill University) and their team presented evidence from their new study, CREATE — Canadian Cardiac Randomized Evaluation of Antidepressant and PsychoTherapy Efficacy — conducted at six sites across Canada involving 284 subjects. The blinded randomized controlled study was conducted between May 2002 and December 2005. The Canadian research team found that citalopram was superior to placebo in improving depressive symptoms. By the end of 12 weeks of treatment, 52.8% of the patients taking citalopram improved in comparison to 40.1% of those taking placebo. Citalopram was chosen for the study because of its low risk of interaction with cardiac medications. In the same study, J. Robert Swenson, MD (University of Ottawa) reported that a short-term psychotherapy technique — Interpersonal Psychotherapy — was no more effective in relieving depression than was regular close monitoring by mental health and medical professionals. In a previous session, Dr Frasure-Smith presented work from the last several years that focused on depression as an important condition associated with CAD, but was careful not to label it a “risk factor” like smoking, cholesterol, or obesity. Rather, she said that depression was associated with a poorer outcome among CAD patients, while controlling for all these common risk factors. She and her colleagues found in previous studies that depressed CAD patients who have had a heart attack are two to three times more likely to have a second attack or die, than are heart attack patients without depression. However, there still remains no evidence from randomized controlled trials that improvement in depression has any effect upon physical outcome — morbidity or mortality — in CAD patients. A CREATE sub-study, reported by Louis vanZyl, MD (Queens University), explored some potential mechanisms for depression's effects on CAD. They found that citalopram improved a marker of endothelial function, nitrous oxide metabolites, in comparison to placebo. However to-date, no mechanism has been directly implicated in the relationship between depression and CAD. The team drew attention to the need for more effective means to treat depression in patients with CAD or other medical illness because the current study revealed that, although the improvement with medication was clinically significant and superior to placebo, about half of them didn't improve. In addition, the role of psychotherapy remains to be determined. The CREATE study is the latest in a series of important research findings to underscore the importance of understanding the relationship between depression and CAD, and the need to develop more effective treatment strategies for depression. Twelve to 20% of hospitalized patients with CAD have depression. This is about three times as many individuals with depression as in random samples of the general community. Additionally, 30-40% of hospitalized CAD patients have some degree of depressive symptoms. The Academy of Psychosomatic Medicine recognizes that depression and other mental disorders are frequent companions to medical conditions and deserve treatment.
APM announces Annual Award recipients for 2006-2007 The Academy of Psychosomatic Medicine (APM) is proud to announce the recipients of three major awards given during our 54th annual scientific program in Tuscon, Arizona, November 15-19, 2006. The APM Research Award is given to honor the accomplishments and stature of a currently active researcher in the field of Psychosomatic Medicine. This year's recipient is Mary Amanda Dew, PhD, Professor of Psychiatry, Psychology and Epidemiology at the University of Pittsburgh/Western Psychiatric Institute and Clinic, whose work on patterns and predictors of psychopathology and factors relating to quality of life and outcomes in heart and liver transplantation has been fundamental to the field of transplantation. She has been the principal investigator on 12 NIH-funded grants and a co-investigator on, or participant on, 23 other NIH funded grants. The Stoudemire Award is given for excellence, innovation and impact in creatively educating medical students and residents in consultation-liaison psychiatry and psychosomatic medicine. It is named for the late Alan Stoudemire, MD, a highly respected clinician and educator and prolific author and editor who was Professor of Psychiatry at Emory University Medical School . This year's recipient is Robert Schneider, MD, Associate Professor of Psychiatry and Medicine at Virginia Commonwealth University for a unique approach to teaching psychiatry to nonpsychiatric physicians through a special curriculum that incorporated the way internists think. The Hackett Award is APM's highest award, is given in recognition of outstanding achievement across an entire career in psychosomatic medicine, and is named in honor of the late Thomas Hackett, MD, Professor and Chair of the Department of Psychiatry for many years at Massachusetts General Hospital. He was an outstanding teacher/clinician and mentor in consultation-liaison psychiatry. This year's recipient is Russell Noyes, MD, Professor of Psychiatry at the University of Iowa who in 1970 pioneered the University of Iowa Hospitals and Clinics p sychiatric consultation-liaison service. Recognized for skillful interviewing, his clinical research interests and 275 publications focused on depersonalization, panic disorder and hypochondriasis. Doctor Noyes served APM for many years on Council and other offices, and during a critical period as President 1990-1991 when APM consolidated and asserted its organizational focus toward subspecialty recognition of psychosomatic medicine, personally leading the first application to the American Board of Psychiatry and Neurology for a certificate of added qualifications. He received the Academy's Distinguished Service Award and the Paul Huston Award from the Iowa Psychiatric Society in recognition of career achievement.
APM announces Webb Fellowships for 2006-2007 The Academy of Psychosomatic Medicine (APM) is proud to announce our 2006-07 Webb Fellows who will receive awards during our 54th annual scientific program in Tuscon , Arizona , November 15-19, 2006. The Webb Fellow Award, initiated in 1994, is highly competitive, recognizes those in later years of psychiatric training who exemplify the potential to become leaders in Psychosomatic Medicine, and offers the opportunity to attend two APM annual meetings to learn, network and participate on a committee. Each fellow is assigned two mentors, one from their home institution and one from APM and most do a research project that is presented in a symposium at a subsequent APM annual meeting. The APM Webb Fellowship is named in honor of Dr. William Webb, Jr. (1930-1992) who served as President of APM in 1986-87. A graduate of Princeton University and John Hopkins Medical School , he was tenured Professor of Psychiatry at the University of Pennsylvania and served as a Director of the American Board of Psychiatry and Neurology where he supported development of Psychosomatic Medicine to become an ABMS recognized subspecialty. Dr. Webb was especially cherished for his teaching/mentoring and service. He was a trustee of APA and awarded the Distinguished Medal of the American College of Psychiatrists. Please join APM in congratulating our newest Webb Fellows: Mark V. Bradley, MD Jason P. Caplan, MD Stephen E. Nicolson, MD Sanjeev Sockalingam, MD
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