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 of 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, July 2, 2007)
ALMOST ONE-THIRD OF ADULTS REPORT HAVING SOME FORM OF ALCOHOL USE PROBLEM DURING THEIR LIFETIME
DIFFICULTY IDENTIFYING ODORS MAY PREDICT COGNITIVE DECLINE
ARCHIVES OF PEDIATRICS & ADOLESCENT MEDICINE NEWS RELEASES
(Embargoed Until: 3 P.M. (CT), Monday, July 2, 2007)
ANTIDEPRESSANT WARNINGS APPEAR TO BE ASSOCIATED WITH DECREASED PRESCRIPTION RATES AMONG TENNESSEE CHILDREN
STUDY EXAMINES VIDEO GAME PLAY AMONG ADOLESCENTS
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EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, July 2, 2007
Media Advisory: To contact corresponding author Bridget F. Grant, Ph.D., Ph.D., call Ann Bradley at 301-443-0595.
ALMOST ONE-THIRD OF ADULTS REPORT HAVING SOME FORM OF ALCOHOL USE PROBLEM DURING THEIR LIFETIME
CHICAGO—– About 30 percent of Americans report having some form of alcohol use disorder at some point in their lifetimes, including 17.8 percent with alcohol abuse and 12.5 percent with alcohol dependence, according to a report in the July issue of Archives of General Psychiatry, one of the JAMA/Archives journals.
Alcohol abuse and dependence are marked by patterns of alcohol consumption that contribute to significant impairment or distress, according to background information in the article. These disorders lead to a variety of negative consequences, including car crashes, domestic violence, birth defects and economic costs.
Deborah S. Hasin, Ph.D., of Columbia University Medical Center, New York, and colleagues analyzed data from face-to-face interviews conducted between 2001 and 2002 with 43,093 adults selected to represent the national population. Interviewers asked about all symptoms of alcohol abuse and dependence listed in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV). A diagnosis of alcohol abuse required one or more of the criteria for abuse, while a diagnosis of alcohol dependence required three or more of the seven criteria for dependence. The participants were also screened for depression, bipolar disorder, anxiety disorders, substance abuse disorder and other psychiatric conditions.
During the 12 months prior to the survey, 8.5 percent of adults had an alcohol use disorder, including 4.7 percent with alcohol abuse and 3.8 percent who were alcohol-dependent. "Alcohol dependence was significantly more prevalent among men, whites, Native Americans, younger and unmarried adults and those with lower incomes," the authors write. "Current alcohol abuse was more prevalent among men, whites and younger and unmarried individuals while lifetime rates were highest among middle-aged Americans." Alcohol abuse developed at an average age of 22.5, while dependence began at an average age of 21.9.
Alcohol dependence was associated with disability, and disability levels increased steadily as dependence became more severe. "On average, respondents with alcohol dependence manifested less disability than those with drug dependence and anxiety disorders, but their disability was comparable with that among respondents who had drug abuse, mood and personality disorders," the authors write.
Alcohol abuse and dependence were strongly associated with other substance use disorders, though these associations weakened somewhat when controlling for other conditions. "Significant associations between mood, anxiety and personality disorders and alcohol dependence were reduced in number and magnitude when controlling for other comorbidity," the authors write. This suggests that a common underlying factor may exist for alcohol and other substance abuse disorders, while the link between alcohol problems and personality and mood disorders might be attributed to factors shared among these other disorders.
Of those who had alcohol dependence during their lifetimes, only 24.1 percent ever received treatment, and 12.1 percent of those with alcohol dependence during the previous year received treatment during that time. The average age at which patients first received treatment for dependence was 29.8 years—eight years later than the average age at which they developed the condition. In addition, treatment rates are slightly lower than those found 10 years earlier, where 23.5 percent of those with lifetime dependence and 13.8 percent of those with dependence in the previous 12 months sought treatment.
"Alcohol abuse and dependence remain highly prevalent and disabling," the authors conclude. "Persistent low treatment rates given the availability of effective treatments indicate the need for vigorous education efforts for the public and professionals."
(Arch Gen Psychiatry. 2007;64(7):830-842. Available to the media pre-embargo at www.jamamedia.org).
Editor's Note: The National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) is funded by the National Institute on Alcohol Abuse and Alcoholism with supplemental support from the National Institute on Drug Abuse. This research was supported in part by the Intramural Program of the National Institutes of Health, National Institute on Alcohol Abuse and Alcoholism. Support is also acknowledged from the New York State Psychiatric Institute. 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, July 2, 2007
Media Advisory: To contact Robert S. Wilson, Ph.D., call Kim Waterman at 312-942-7820.
DIFFICULTY IDENTIFYING ODORS MAY PREDICT COGNITIVE DECLINE
CHICAGO—Older adults who have difficulty identifying common odors may have a greater risk of developing problems with thinking, learning and memory, according to a report in the July issue of Archives of General Psychiatry, one of the JAMA/Archives journals.
Mild cognitive impairment—or a decline in thinking, learning and memory abilities—is increasingly recognized as a precursor to Alzheimer’s disease, according to background information in the article. Impairments in the ability to recognize odors have been associated with more rapid cognitive decline and also with the development transition from mild cognitive impairment to Alzheimer’s disease. However, little is known about factors that predict the development of mild cognitive impairment.
Robert S. Wilson, Ph.D., of Rush University Medical Center, Chicago, and colleagues studied 589 older adults (average age 79.9) who did not have cognitive impairment in 1997. At that time, the participants took a smell identification test, during which time 12 familiar odors were placed under their nose. They were asked to match each odor to one of four possible alternatives, and were scored from one to 12 based on the number of correct responses. At the beginning of the study and again every year for up to five years, the participants underwent a clinical evaluation that included a medical history, neurological examination and testing of their cognitive function.
During the study, 177 individuals (30.1 percent) developed mild cognitive impairment. Risk of developing mild cognitive impairment increased as odor identification decreased, so that those who scored below average (eight) on the odor identification test were 50 percent more likely to develop the condition than those who scored above average (11). This association did not change when stroke, smoking habits or other factors that might influence smell or cognitive ability were considered. Impaired odor identification was also associated with lower cognitive scores at the beginning of the study and with a more rapid decline in episodic memory (memory of past experiences), semantic memory (memory of words and symbols) and perceptual speed.
"The neurobiological bases of age-associated olfactory dysfunction are uncertain," the authors write. Evidence suggests that even before the symptoms of Alzheimer’s disease develop, hallmark tangles develop in certain areas of the brain that may be associated with the processing of smells. Because difficulty identifying odors is associated with other neurological diseases, including Parkinson’s disease, other mechanisms are likely involved. "Further clinicopathological and clinicoradiological research on age-related olfactory dysfunction is needed," they continue.
"Among older persons without manifest cognitive impairment, difficulty in identifying odors predicts subsequent development of mild cognitive impairment," the authors conclude. "The findings suggest that olfactory dysfunction can be an early manifestation of Alzheimer’s disease ... and that olfactory assessment may be useful for early disease identification."
(Arch Gen Psychiatry. 2007;64(7):802-808. Available to the media pre-embargo at www.jamamedia.org).
Editor's Note: This study was supported by grants from the National Institute on Aging and by the Illinois Department of Public 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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EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, July 2, 2007
Media Advisory: To contact corresponding author William O. Cooper, M.D., M.P.H., call Craig Boerner at 615-322-4747.
ANTIDEPRESSANT WARNINGS APPEAR TO BE ASSOCIATED WITH DECREASED PRESCRIPTION RATES AMONG TENNESSEE CHILDREN
CHICAGO—Regulatory warnings regarding the risk of suicidal thoughts and behaviors appear to be associated with reductions in the number of antidepressant medication prescriptions among children and adolescents covered by Tennessee’s expanded Medicaid program, according to a report in the July issue of Archives of Pediatrics & Adolescent Medicine, one of the JAMA/Archives journals.
Antidepressant medications are frequently used to treat depression among children and teens, but in 2003 data emerged regarding an increased risk of suicidal thinking and behavior among young patients taking these drugs, according to background information in the article. "In December 2003, the Committee on Safety of Medicines [the U.K. drug regulatory agency] declared the risk-benefit profile of all selective serotonin reuptake inhibitor (SSRI) antidepressants (as well as venlafaxine hydrochloride and mirtazapine), with the exception of fluoxetine, to be unfavorable for the treatment of major depressive disorders in children and adolescents," the authors write. "Shortly thereafter in 2004, the Food and Drug Administration convened a Psychopharmacology Advisory Committee meeting in February, issued a public health advisory in March, and in October required black box warning labels for all antidepressants (including fluoxetine) highlighting the potential increase in suicidal thinking and behavior in children and adolescents. The warning recommended more intense therapeutic monitoring to mitigate these risks but did not suggest avoiding the pediatric use of antidepressants."
Benji T. Kurian, M.D., M.P.H., and colleagues at Vanderbilt University School of Medicine, Nashville, Tenn., examined monthly antidepressant prescription data among patients age 2 to 17 years covered by the TennCare expanded Medicare program. "The study included the 45 months from Jan. 1, 2002, through Sept. 30, 2005, 12 months following the FDA black box warning," the authors write. "The study months were divided into two periods. The period before the regulatory warnings included the 24 months from Jan. 1, 2002, through Dec. 31, 2003, and that after the regulatory warnings included the 21 months from Jan. 1, 2004, through Sept. 30, 2005." An average of 405,000 children and teens qualified for the study each month.
During the period before the regulatory warnings, there was little change from month to month in the rate of new antidepressant prescriptions, with an average of 23 per 10,000 patients. By the end of the study—a total of 21 months after the U.K. warnings—this proportion had decreased by 33 percent to an average of 15 per 10,000 per month.
The decrease was most pronounced for SSRIs (except for fluoxetine) and another type of antidepressant linked to suicidal thoughts and behaviors, selective norepinephrine reuptake inhibitors. New users of fluoxetine, the only antidepressant approved by the FDA for the treatment of depression in children and adolescents, increased by 60 percent. "However, there was no evidence of an increase in discontinuations of therapy with antidepressant or other psychotropic drugs, which suggests that the primary effect of the warnings was to alter the decision to treat a newly presenting patient," the authors write.
Previous studies have shown that the use of antidepressants among TennCare patients is similar to that of children and adolescents in the entire United States, suggesting that a similar decrease may have occurred in other populations. Because there is so much uncertainly regarding the pediatric use of antidepressants, the implications of these changes are unclear, the authors note. "Thus, while it is now evident that regulatory interventions can alter patterns of practice, whether this is desirable is uncertain," they conclude. "There is an urgent need for better data on the efficacy and safety of antidepressants to guide pediatric practice."
(Arch Pediatr Adolesc Med. 2007;161(7)690-696. Available to the media pre-embargo at www.jamamedia.org)
Editor's Note: This work was supported in part by a grant from the Centers for Education and Research on Therapeutics, Agency for Healthcare Research and Quality. 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, July 2, 2007
Media Advisory: To contact Hope M. Cummings, M.A., call Jared Wadley at 734-936-7819.
STUDY EXAMINES VIDEO GAME PLAY AMONG ADOLESCENTS
CHICAGO—On school days, teen boys who play video games appear to spend less time reading and teen girls who play video games appear to spend less time doing homework than those who do not play video games, according to a report in the July issue of Archives of Pediatrics & Adolescent Medicine, one of the JAMA/Archives journals. Overall, video game players did not spend less time than non-video game players interacting with parents and friends.
"The rapid growth of video game popularity has generated concern among practitioners, parents, scholars and politicians," according to background information in the article. "Particularly during adolescence, when social interactions and academic success lay the groundwork for health in adulthood, there is concern that video games will interfere with the development of skills needed to make a successful transition to adulthood."
Hope M. Cummings, M.A., of the University of Michigan, Ann Arbor, and Elizabeth A. Vandewater, Ph.D., of the University of Texas at Austin collected survey data from a nationally representative sample of 1,491 10- to 19-year olds during the 2002 to 2003 school year. Twenty-four−hour time use diaries were collected from the participants on one randomly chosen weekday and one randomly chosen weekend day. The teens recorded their time spent playing video games, with parents and friends, reading and doing homework and in sports and active leisure.
A total of 534 teens (36 percent) played video games. Most of these (425 [80 percent]) were boys and 109 (20 percent) were girls. "Female gamers spent an average of 44 minutes playing on the weekdays and one hour and four minutes playing on the weekends," the authors write. "Male gamers spent an average of 58 minutes playing on the weekdays and one hour and 37 minutes playing on the weekends."
"For boys on the weekends and for girls on the weekdays, more time spent playing video games without parents was related to less time spent with parents doing other activities," the authors write. The more time girls spent playing video games with their parents, the more time they spent in other activities with them as well. On weekends, the more time boys and girls spent playing video games without their friends, the less time they spent in other activities with them and the more time they spent playing video games with their friends, the more time they spent in other activities with them. Compared with non-video game–players, adolescents who played video games spent 30 percent less time reading and 34 percent less time doing homework.
"Although we focused on the relationship between time spent in video game play and other activities among adolescents, an important next step for future research will be to assess the ways in which video game play is related to academic and social outcomes among American youth," they conclude. "...Our results indicate that game play has different social implications for girls and boys who play. Future studies aimed at understanding how and why girls vs. boys use game play to fulfill different social needs are warranted."
(Arch Pediatr Adolesc Med. 2007;161(7):684-689. Available to the media pre-embargo at www.jamamedia.org)
Editor's Note: This study was funded by grants from the National Institute of Child Health and Human Development. The Children’s Digital Media Center at the University of Texas at Austin is funded by a grant from the National Science Foundation. The Panel Study of Income Dynamics Child Development Supplement is funded by grants from the National Institute of Child Health and Human Development. 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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