JAMA news releases are made available to the public after 3 pm US Central time on the first 4 Tuesdays of each month. The Archives Journals news releases are made available to the public after 3 pm Central time on Mondays. We also provide a list of previous news releases.
THIS WEEK'S CONTENTS
ARCHIVES OF GENERAL PSYCHIATRY NEWS RELEASES
Embargoed Until: 3 P.M. (CT), Monday, August 7, 2006
STUDY SUGGESTS ANESTHETIC AGENT MAY HAVE RAPID ANTIDEPRESSANT EFFECTS
CHILDREN AND TEENS TAKING ANTIDEPRESSANTS MIGHT BE MORE LIKELY TO ATTEMPT, COMPLETE SUICIDE
ARCHIVES OF PEDIATRICS & ADOLESCENT MEDICINE NEWS RELEASES
Embargoed Until: 3 P.M. (CT), Monday, August 7, 2006
SOCIALLY ISOLATED CHILDREN MAY BECOME UNHEALTHY ADULTS
PARENTS OF TEENS MORE LIKELY THAN PARENTS OF YOUNGER CHILDREN TO STORE FIREARMS UNSAFELY
TAILORED HIV PREVENTION PROGRAM EFFECTIVE FOR LATINO YOUTH
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EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, August 7, 2006
Media Advisory: To contact Carlos A. Zarate Jr., M.D., call Susan Cahill at 301-443-4536.
STUDY SUGGESTS ANESTHETIC AGENT MAY HAVE RAPID ANTIDEPRESSANT EFFECTS
CHICAGO—A single intravenous infusion of a drug known as ketamine, which is a general anesthetic agent, may relieve symptoms of depression within two hours and remain effective for up to one week, according to a report in the August issue of the Archives of General Psychiatry, one of the JAMA/Archives journals.
The discovery of antidepressant medications has revolutionized the treatment of depression, according to background information in the article. However, most currently available medications do not begin to relieve the symptoms of depression for several weeks. During this lag period, patients are at risk for self-harm and even suicide, especially within the first nine days of treatment. "Pharmacological strategies that have rapid onset of antidepressant effects within hours or even a few days and that are sustained would therefore have an enormous impact on public health," the authors write.
Carlos A. Zarate Jr., M.D., and colleagues at the National Institute of Mental Health, Bethesda, Md., studied the effects of ketamine in 12 women and six men (average age 46.7 years) with treatment-resistant depression, meaning that they were unsuccessfully treated with other antidepressants at least twice. After a two-week drug-free period, participants received two intravenous infusions one week apart, one with ketamine (.5 milligrams per kilogram of body weight) dissolved in saline and the other with 50 milliliters of pure saline (placebo). Patients were randomly assigned to receive either the ketamine or the placebo infusion first. They underwent tests to assess the severity of their depression one hour before the infusion as well as 40, 80, 110 and 230 minutes and one, two, three and seven days afterward.
Within 110 minutes after the infusion, patients who received ketamine rather than placebo showed significant improvement. The effect lasted through the following week. On the day after treatment, 71 percent of the 17 participants who received the ketamine (one dropped out of the study after receiving only the placebo infusion) responded to the drug and 29 percent met criteria for remission from depression, compared with none who received the placebo. Thirty-five percent of those who received ketamine had effects that lasted for at least one week. "To our knowledge, there has never been a report of any other drug or somatic treatment (i.e., sleep deprivation, thyrotropin-releasing hormone, antidepressant, dexamethasone or electroconvulsive therapy) that results in such a dramatic rapid and prolonged response within a single administration," the authors write. No serious adverse events occurred during the study.
Most currently available antidepressants work by increasing the levels of chemicals in the brain known as monoamines, including serotonin and dopamine, the authors write. Over time, this accumulation of chemicals acts to improve a patient's mood. However, ketamine directly targets a different brain pathway-the glutamatergic system, which is important to learning and memory. "This line of research holds considerable promise for developing new treatments for depression with the potential to alleviate much of the morbidity and mortality associated with the delayed onset of action of traditional antidepressants," the authors conclude. "Future studies need to be carried out in an attempt to develop strategies for maintaining the rapid antidepressant response obtained with ketamine long-term."
(Arch Gen Psychiatry.
2006;63:856-864. Available pre-embargo to the media at www.jamamedia.org)
Editor's Note: This study was supported by the Intramural Research Program at the National Institute of Mental Health, National Institutes of Health, and Department of Health and Human Services. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.
For more information, contact JAMA/Archives media relations at 312/464-JAMA (5262) or e-mail mediarelations{at}jama-archives.org.
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EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, August 7, 2006
Media Advisory: To contact Mark Olfson, M.D., M.P.H., call Craig LeMoult at 212-305-0820.
CHILDREN AND TEENS TAKING ANTIDEPRESSANTS MIGHT BE MORE LIKELY TO ATTEMPT, COMPLETE SUICIDE
CHICAGO—Antidepressant medications may be associated with suicide attempts and death in severely depressed children and adolescents but not in adults, according to an article in the August issue of the Archives of General Psychiatry, one of the JAMA/Archives journals.
The U.S. Food and Drug Administration (FDA) recently began requiring drug manufacturers to include a warning regarding the risk of suicidal behavior among children and teens treated with antidepressants after a large analysis of clinical trials revealed a potential link. It is uncertain whether there is an association between treatment with antidepressants and suicidal behavior in adults, according to background information in the article. Because relatively few completed suicides occur, suicidal behavior is used instead in studies assessing the risks associated with antidepressant medications and few studies have examined the risk of suicide attempts or deaths in patients treated with antidepressants.
Mark Olfson, M.D., M.P.H., College of Physicians and Surgeons of Columbia University Medical Center and New York State Psychiatric Institute, New York, and colleagues analyzed the medical records of 5,469 Medicaid patients who were hospitalized for depression at least once in 1999 or 2000. The researchers first selected all cases of completed suicides (eight children and adolescents and 86 adults) and suicide attempts (263 children and adolescents, 521 adults). They then matched each case with one to five controls based on demographic information, period following hospital discharge, presence or absence of a suicide attempt prior to hospital admission, state of residence, other medication use and presence or absence of a substance abuse disorder.
Severely depressed children and adolescents ages 6 to 18 years were 1.5 times as likely to attempt suicide and also significantly more likely to complete suicide if they were treated with an antidepressant medication than if they were not treated with an antidepressant. More specifically, children and adolescents who died from suicide (eight cases) were more likely to have been treated with an SSRI antidepressant than their matched controls (39 controls, 37.5 percent vs. 7.7 percent). Among adults age 19 to 64 years, however, treatment with antidepressants was not associated with either suicide attempts or suicide deaths.
The link between completed suicides and antidepressants in young patients was based on only eight cases, and it is possible that the sickest children were more likely to be treated with such medications, skewing the results, the authors write. "With these caveats in mind, the present findings are consistent with the recommendations for careful clinical monitoring during the treatment of depressed children and adolescents with antidepressant medications," they conclude. "In practice, physicians face the difficult challenge of balancing safety concerns against evidence that depression is a key risk factor for adult and adolescent suicide and that antidepressant agents are effective for adult and adolescent depression."
(Arch Gen Psychiatry.
2006;63:865-872. Available pre-embargo to the media at www.jamamedia.org)
Editor's Note: Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.
For more information, contact JAMA/Archives media relations at 312/464-JAMA (5262) or e-mail mediarelations{at}jama-archives.org.
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EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, August 7, 2006
Media Advisory: To contact Avshalom Caspi, Ph.D., e-mail: a.caspi{at}iop.kcl.ac.uk.
SOCIALLY ISOLATED CHILDREN MAY BECOME UNHEALTHY ADULTS
CHICAGO—Social isolation in childhood may be associated with an increased risk for cardiovascular disease in adulthood, according to a report in the August issue of the Archives of Pediatrics & Adolescent Medicine, one of the JAMA/Archives journals.
Social isolation and loneliness can affect both psychological and physical health, according to background information in the article. Adults who lack social support have been shown to be at higher risk for coronary artery disease and have a poorer prognosis once they develop the condition. In addition, evidence from an emerging field known as life-course epidemiology is beginning to suggest that early life experiences are also important in determining risk factors for disease in adulthood.
Avshalom Caspi, Ph.D., University of Wisconsin, Madison, and King's College, London, England, and colleagues studied 1,037 children from birth through age 26 years. Participants underwent follow-up assessments at ages 5, 7, 9, 11, 13, 15, 18 and 21 years, during which the individuals or their parents provided information about social factors, body mass index was calculated and intelligence was evaluated. A final physical examination and evaluation was conducted at age 26 years. At that time, those who did not have a partner or had not dated in the past year and those who said they had no one to provide emotional support were considered socially isolated adults.
Twenty-six-year-olds who were socially isolated as children were significantly more likely to be unhealthy as adults, as measured by six cardiovascular risk factors, including weight, blood pressure and HDL (good) and LDL (bad) cholesterol levels. This association remained significant even when the researchers considered established childhood risk factors for poor cardiovascular health, such as low socioeconomic status, low IQ and being overweight. Unhealthy adult behaviors, including smoking, drinking and lack of exercise, also could not explain the connection, nor could the greater exposure to stressful situations typically experienced by isolated children in adulthood.
Social isolation tended to persist throughout life, and the longer an individual was isolated the worse their adult health, the authors report. "A useful concept for understanding how repeated social isolation can lead to poor health is allostatic load, which refers to the cumulative wear and tear caused by repeated adaptations to psychosocial stressors (such as social isolation) in childhood, adolescence and adulthood," they write. "It is also possible that social isolation disrupts constructive and restorative processes that enhance physiological capacities, as suggested by evidence that lonely individuals experience disrupted sleep and engage in passive rather than active coping strategies in their everyday lives."
(Arch Pediatr Adolesc Med.
2006;160:805-811. Available pre-embargo to the media at www.jamamedia.org)
Editor's Note: This study was supported by grants from the UK Medical Research Council, the National Institute of Mental Health, the William T. Grant Foundation, the National Heart Foundation of New Zealand and the Health Research Council of New Zealand. Dr. Moffitt is a Royal-Society Wolfson Research Merit Award Holder. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.
For more information, contact JAMA/Archives media relations at 312/464-JAMA (5262) or e-mail mediarelations{at}jama-archives.org.
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EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, August 7, 2006
Media Advisory: To contact Renee M. Johnson, Ph.D., call Todd Datz at 617-432-3952.
PARENTS OF TEENS MORE LIKELY THAN PARENTS OF YOUNGER CHILDREN TO STORE FIREARMS UNSAFELY
CHICAGO—Even though most youth firearms injuries involve teens, guns are more likely to be stored unsafely in homes with adolescents age 13 to 17 than in those with only younger children, according to an article in the August issue of the Archives of Pediatrics & Adolescent Medicine, one of the JAMA/Archives journals.
About one-third of U.S. households with children also contain firearms, and many firearm injuries among children take place in the home, according to background information in the article. Previous research indicates that despite the fact that safe storage practices may reduce the risk of unintentional injury or suicide, 14 to 30 percent of these households store at least one firearm loaded and about 43 percent store one unlocked. Nearly 2 million children may live in homes with loaded, unlocked firearms.
Renee M. Johnson, Ph.D., and colleagues at the Harvard School of Public Health, Boston, surveyed 392 parents nationwide who had firearms in their homes in the spring of 2004. Respondents were asked about their attitudes and beliefs surrounding firearms, their ownership and storage practices and demographic information about themselves and other members of their households.
About 22 percent of parents reported having a loaded gun, 31.5 percent had an unlocked gun and 8.3 percent had an unlocked, loaded gun. In 110 (28.1 percent) of the 392 households, all children were ages 13 to 17 years; these households had the highest rates of unsafe storage practices. Nearly 42 percent of these parents had an unlocked firearm in the home, compared with 28.8 percent of parents whose children were all age 12 years or younger. The researchers also found a slight association between having teenagers and storing guns loaded or loaded and unlocked.
"As young people become adolescents, parents may become less vigilant about keeping firearms stored securely," the authors write. "This assertion is supported by the present research, as well as by studies on parents' attitudes about firearm safety, in which authors concluded that parents were more likely to believe that adolescents, compared with younger children, are old enough to exhibit good judgment around firearms. This belief creates a situation in which adolescents have easy access to a lethal means with which to kill themselves or to hurt others."
Future efforts to educate gun-owning parents about safe storage practices may have to specifically include messages for parents of teens as well as parents of young children, they conclude. For example, outreach efforts may have to move beyond pediatricians' offices, since teens often do not visit pediatricians and their parents may not accompany them to physician appointments.
(Arch Pediatr Adolesc Med. 2006;160:788-792. Available pre-embargo to the media at www.jamamedia.org)
Editor's Note: The National Firearms Study 2004 was supported by a grant from the Joyce Foundation to the Harvard Injury Control Research Center (principal investigator, Dr. Miller). Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.
For more information, contact JAMA/Archives media relations at 312/464-JAMA (5262) or e-mail mediarelations{at}jama-archives.org.
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EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, August 7, 2006
Media Advisory: To contact Antonia M. Villarruel, Ph.D., R.N., call Karl Bates at 734-764-7260.
TAILORED HIV PREVENTION PROGRAM EFFECTIVE FOR LATINO YOUTH
CHICAGO—An HIV prevention program emphasizing both abstinence and condom use may help decrease risky sexual behavior among Latino adolescents, according to a report in the August issue of the Archives of Pediatrics & Adolescent Medicine, one of the JAMA/Archives journals.
HIV and AIDS disproportionately affect Latino youth; the incidence of AIDS was more than three times higher among Latinos than non-Hispanic white teens and adults in 2001, according to background information in the article. Most Latino adolescents with HIV contract the disease through heterosexual contact. Latino youth are more likely than non-Hispanic white youth to have sexual intercourse before age 13 years and to have more than four sexual partners, and may also be less likely to use condoms than white or African American teens. However, few studies have been conducted to determine effective ways to prevent HIV among Latino youth.
Antonia M. Villarruel, Ph.D., R.N., School of Nursing, University of Michigan, Ann Arbor, and colleagues evaluated the effect of a program designed specifically for Latino youth in 553 adolescents (249 males and 304 females, average age 14.9 years). Between 2000 and 2003, the teens were recruited from high schools and community-based organizations in northeast Philadelphia and then randomly assigned to complete one of two eight-hour programs, one focusing exclusively on HIV prevention and the other a general health-promotion course. Both programs were offered in English and Spanish and included small-group discussions, videos, and interactive and skill-building activities. The HIV prevention program incorporated aspects of Latino culture-such as the importance of family-into sexual health education messages. Participants were surveyed before and immediately after completing the intervention and again three, six and twelve months later.
At the end of the study, participants in the HIV intervention group were significantly less likely to report having sex at all in the previous three months, were less likely to have multiple partners, reported fewer days of unprotected sex and were more likely to say they used condoms consistently than those in the health promotion group. Gender did not affect teens' responses to the program but sexual experience level and primary language did. Among those who were sexually inexperienced at the beginning of the study, those in the HIV prevention group reported fewer days of unprotected sex; those who participated in the Spanish HIV course were five times more likely than those in the Spanish health promotion course to have used a condom the last time they had intercourse and also had a greater proportion of protected vs. unprotected sex.
"Results of this study demonstrate the efficacy of a safer sex intervention in decreasing sexual intercourse and increasing condom use," the authors conclude. "It is an important effort in providing practitioners an evidence base from which to guide and support adolescents in sexual decision making. Much more research is needed with Latino adolescents to address the health disparity in HIV and AIDS."
(Arch Pediatr Adolesc Med. 2006;160:772-777. Available pre-embargo to the media at www.jamamedia.org)
Editor's Note: The project described was supported by a grant from the National Institute of Nursing Research (Dr. Villarruel). Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the National Institute of Nursing Research or National Institutes of Health. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.
For more information, contact JAMA/Archives media relations at 312/464-JAMA (5262) or e-mail mediarelations{at}jama-archives.org.
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