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, August 4, 2008)
LESS TIME SPENT IN RAPID EYE MOVEMENT SLEEP ASSOCIATED WITH BEING OVERWEIGHT AMONG CHILDREN AND TEENS
PSYCHIATRISTS SHIFT AWAY FROM PROVIDING PSYCHOTHERAPY
VOLUNTARY EXERCISE DOES NOT APPEAR TO ALLEVIATE ANXIETY AND DEPRESSION
ESTROGEN RELIEVES PSYCHOTIC SYMPTOMS IN WOMEN WITH SCHIZOPHRENIA
ARCHIVES OF PEDIATRICS & ADOLESCENT MEDICINE NEWS RELEASES
(Embargoed Until: 3 P.M. (CT), Monday, August 4, 2008)
POSITIVE PARENTING ASSOCIATED WITH LESS AGGRESSION IN EARLY-MATURING TEEN GIRLS
U.S. IMMIGRANT CHILDREN MAY BE LESS PHYSICALLY ACTIVE THAN U.S.-BORN CHILDREN
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EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, August 4, 2008
Media Advisory: To contact Xianchen Liu, M.D., Ph.D, call Megan Grote Quatrini at 412-647-3555.
LESS TIME SPENT IN RAPID EYE MOVEMENT SLEEP ASSOCIATED WITH BEING OVERWEIGHT AMONG CHILDREN AND TEENS
CHICAGO—Children and teens who get less sleep, especially those who spend less time in rapid eye movement (REM) sleep, may be more likely to be overweight, according to a report in the August issue of Archives of General Psychiatry, one of the JAMA/Archives journals.
The obesity rate has more than tripled among children aged 6 to 11 years in the past 30 years, and approximately 17 percent of U.S. adolescents are now overweight or obese, according to background information in the article. Obesity results from an imbalance between calorie intake and energy expenditure from physical activity, but little is known about other factors that can alter this balance. A number of studies have documented an association between fewer hours of sleep and higher body mass index (BMI) in both adults and children.
Xianchen Liu, M.D., Ph.D., of the Western Psychiatric Institute and Clinic, Pittsburgh, and colleagues studied 335 children and adolescents age 7 to 17 years (average age 10.8). For three consecutive nights, participants’ sleep was monitored through polysomnography, which assesses total sleep time, time spent in REM, the time it takes to fall asleep and other variables. Weight and height were measured to calculate BMI.
A total of 49 participants (14.6 percent) were at risk for becoming overweight and 45 (13.4 percent) were overweight. Compared with children at a normal weight, those who were overweight slept about 22 minutes less per night and had lower sleep efficiency (percentage of time in bed that an individual is asleep), shorter REM sleep, less eye activity during REM sleep and a longer wait before the first REM period.
After adjusting for other related factors, one hour less of total sleep was associated with two-fold increased odds of being overweight and one hour less of REM sleep was associated with three-fold increased odds.
“Although the precise mechanisms are currently under investigation, the association between short sleep duration and overweight may be attributed to the interaction of behavioral and biological changes as a result of sleep deprivation,” the authors write. Sleep loss causes changes in hormone levels that may affect hunger, and also provides an individual with more waking hours in which to eat. In addition, sleep loss contributes to fatigue the following day, which may decrease physical activity and calorie expenditure.
“Given the fact that the prevalence of overweight among children and adolescents continues to increase and chronic sleep insufficiency becomes more prevalent in modern society, family- and school-based sleep interventions that aim to enhance sleep hygiene and increase sleep duration may have important public health implications for the prevention and intervention of obesity and type 2 diabetes in children,” the authors conclude. “Furthermore, our results demonstrate an important relationship between REM sleep and high BMI and obesity, suggesting that the short sleep–obesity association may be attributed to reduced REM sleep time and decreased activity during REM sleep.”
(Arch Gen Psychiatry. 2008;65[8]:924-932. Available to the media pre-embargo at www.jamamedia.org).
Editor's Note: This study was supported by a grant from the National Institute of Mental 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, August 4, 2008
Media Advisory: To contact Ramin Mojtabai, M.D., Ph.D., M.P.H., call Natalie Wood-Wright at 410-614-6029.
PSYCHIATRISTS SHIFT AWAY FROM PROVIDING PSYCHOTHERAPY
CHICAGO—A declining number of office-based psychiatrists appear to be providing psychotherapy to their patients, according to a report in the August issue of Archives of General Psychiatry, one of the JAMA/Archives journals.
Psychotherapy has been part of the practice of psychiatry for generations, the authors write as background information in the article. Various forms of psychotherapy, either alone or in combination with medications, are recommended for the treatment of major depression, post-traumatic stress disorder, bipolar disorder and other psychiatric illnesses. “Yet, despite the traditional prominence of psychotherapy in psychiatric practice and training, there are indications of a recent decline in the provision of psychotherapy by U.S. psychiatrists—a trend attributed to reimbursement policies favoring brief medication management visits rather than psychotherapy and the introduction of newer psychotropic medications with fewer adverse effects,” the authors write.
Ramin Mojtabai, M.D., Ph.D., M.P.H., then of Beth Israel Medical Center and now of the Johns Hopkins Bloomberg School of Public Health, Baltimore, and Mark Olfson, M.D., M.P.H., of the Columbia University Medical Center and New York State Psychiatric Institute, New York, analyzed trends in psychotherapy provision using data from national surveys of office-based psychiatrist visits from 1996 through 2005.
Over the 10-year period, psychotherapy was provided in 5,597 (34 percent) of 14,108 visits lasting longer than 30 minutes. The percentage of visits involving psychotherapy declined from 44.4 percent in 1996-1997 to 28.9 percent in 2004-2005. “This decline coincided with changes in reimbursement, increases in managed care and growth in the prescription of medications,” the authors write.
The number of psychiatrists who provided psychotherapy to all of their patients also declined over the same time period, from 19.1 percent to 10.8 percent. “Psychiatrists who provided psychotherapy to all of their patients relied more extensively on self-pay patients, had fewer managed-care visits and prescribed medications in fewer of their visits compared with psychiatrists who provided psychotherapy less often,” the authors write.
“These trends highlight a gradual but important change in the content of outpatient psychiatric care in the United States and a continued shift toward medicalization of psychiatric practice,” they conclude. “A key challenge facing the future generation of psychiatrists will likely involve maintaining their professional role as integrators of the biological and psychosocial perspectives while working within the constraints of the strong market forces of third-party payers and managed care to implement advances in the diagnosis and treatment of mental disorders.”
(Arch Gen Psychiatry. 2008;65[8]:962-970. Available to the media pre-embargo at www.jamamedia.org).
Editor's Note: This study was supported in part by a grant from the Agency for Healthcare Research and Quality. Dr. Mojtabai has received research funding from Bristol-Myers Squibb and AstraZeneca pharmaceutical companies and consultant fees from Bristol-Myers Squibb. Dr. Olfson has received research funding from Eli Lilly, Bristol-Myers Squibb and Jansen pharmaceutical companies and has worked as a paid consultant to Pfizer and McNeil Pharmaceuticals. Please see the article for additional information, including 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 4, 2008
Media Advisory: To contact Marleen H. M. De Moor, M.Sc., e-mail: mhm.de.moor{at}psy.vu.nl.
VOLUNTARY EXERCISE DOES NOT APPEAR TO ALLEVIATE ANXIETY AND DEPRESSION
CHICAGO—Voluntary physical activity does not appear to cause a reduction in anxiety and depression, but exercise and mood may be associated through a common genetic factor, according to a report in the August issue of Archives of General Psychiatry, one of the JAMA/Archives journals.
In the general population, regular exercise is associated with reduced anxious and depressive symptoms, according to background information in the article. Experiments involving specific clinical populations have suggested that exercise causes this reduction in anxiety and depression. However, it is unclear whether this causal effect also occurs in the larger population or whether there is a third underlying factor influencing both physical activity and the risk for mood disorders.
Marleen H. M. De Moor, M.Sc., of VU University Amsterdam, the Netherlands, and colleagues studied 5,952 twins from the Netherlands Twin Register, along with 1,357 additional siblings and 1,249 parents. Participants, all aged 18 to 50, filled out surveys about leisure-time exercise and completed four scales measuring anxious and depressive symptoms.
Associations observed between exercise and anxious and depressive symptoms “were small and were best explained by common genetic factors with opposite effects on exercise behavior and symptoms of anxiety and depression,” the authors note. “In genetically identical twin pairs, the twin who exercised more did not display fewer anxious and depressive symptoms than the co-twin who exercised less.” Exercise behavior in one identical twin predicted anxious and depressive symptoms in the other, meaning that if one twin exercised more, the other tended to have fewer symptoms.
However, the same was not true of dizygotic (fraternal) twins or other siblings, who share only part of their genetic material. In addition, analyses over time showed that individuals who increased their level of exercise did not experience a decrease in anxious and depressive symptoms.
“It is unknown which genes might be involved in voluntary exercise behavior and in the risk for anxiety and depression,” the authors write, but genes involved in the brain pathways that process dopamine, norepinephrine, opioids or serotonin are likely candidates.
The results do not mean that exercise cannot benefit those with anxiety or depression, the authors note, only that additional trials would be needed to justify this type of therapy. “Only voluntary leisure-time exercise is influenced by genetic factors, whereas the other type of exercise [directed and monitored by someone else] is environment-driven. The absence of causal effects of voluntary exercise on symptoms of anxiety and depression does not imply that manipulation of exercise cannot be used to change such symptoms,” they write. “The antidepressant effects of exercise may only occur if the exercise is monitored and part of a therapeutic program.”
(Arch Gen Psychiatry. 2008;65[8]:897-905. Available to the media pre-embargo at www.jamamedia.org).
Editor's Note: This study was supported by grants from the Netherlands Organization for Scientific Research. 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 4, 2008
Media Advisory: To contact Jayashri Kulkarni, M.B.B.S., M.P.M., F.R.A.N.Z.C.P., Ph.D., e-mail: j.kukarni{at}alfred.org.au.
ESTROGEN RELIEVES PSYCHOTIC SYMPTOMS IN WOMEN WITH SCHIZOPHRENIA
CHICAGO—When combined with antipsychotic medications, the estrogen estradiol appears to be a useful treatment in women with schizophrenia, according to a report in the August issue of Archives of General Psychiatry, one of the JAMA/Archives journals.
The link between estrogen and mental illness was recognized more than a century ago, according to background information in the article. However, scientific evidence regarding estrogen as a therapy for mental illness has only recently emerged. “Epidemiologic observations of sex differences in the onset and course of schizophrenia prompted exploration of estrogen’s role in schizophrenia,” the authors write.
Jayashri Kulkarni, M.B.B.S., M.P.M., F.R.A.N.Z.C.P., Ph.D., of The Alfred and Monash University and The Alfred Hospital, Melbourne, Australia, and colleagues conducted a randomized, double-blind study involving 102 women of child-bearing age with schizophrenia. For 28 days, 56 women were randomly assigned to receive 100 micrograms of estradiol daily via a skin patch and 46 women received a placebo skin patch in addition to their regular medications. Psychotic symptoms, which include delusions and hallucinatory behavior, were assessed weekly with a commonly used scale.
The group of women taking estradiol exhibited a greater improvement in psychotic symptoms over time than did the women taking antipsychotic medications alone. They also experienced a decline in positive symptoms—those which represent a distortion of normal functions. No difference was observed between the two groups regarding negative symptoms, those which occur when normal functions are lost or diminished.
“Estrogen’s neuroprotective and psychoprotective actions may be mediated by a variety of routes, ranging from rapid actions, including antioxidant effects and enhancement of cerebral blood flow and cerebral glucose utilization, to slower, genomic mechanisms, which may include permanent modification of neural circuits,” the authors write. “The lack of effect for negative symptoms is consistent with literature reporting that negative symptoms are less responsive to treatment than other symptoms of schizophrenia. It is possible that longer-term treatment is required for negative symptoms to respond to treatment. Alternatively, brain regions implicated in negative symptoms may be less responsive to gonadal hormone effects.”
Estrogen may have a preventive role in women with schizophrenia who undergo hormonal changes shown to cause a deterioration of their condition, such as those following childbirth and menopause, the authors note. “Estrogen treatment is a promising new area for future treatment of schizophrenia and potentially for other severe mental illnesses,” they conclude.
(Arch Gen Psychiatry. 2008;65[8]:955-960. Available to the media pre-embargo at www.jamamedia.org).
Editor's Note: This study was supported by the Stanley Medical Research Institute and the National Health and Medical Research Council of Australia. Co-author Dr. Fitzgerald is supported by a National Health and Medical Research Council Practitioner Fellowship and NARSAD Young Investigator award. 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 4, 2008
Media Advisory: To contact Sylvie Mrug, Ph.D., call Gail Short at 205-934-8931.
POSITIVE PARENTING ASSOCIATED WITH LESS AGGRESSION IN EARLY-MATURING TEEN GIRLS
CHICAGO—Adolescent girls who go through puberty early and have parents who do not nurture them, communicate with them or have knowledge of their activities appear more likely to display aggressive behavior, according to a report in the August issue of Archives of Pediatrics & Adolescent Medicine, one of the JAMA/Archives journals.
Early puberty in girls is related to conduct problems, delinquency and substance use, according to background information in the article. Many of these problems persist through adolescence and into early adulthood. “As adults, early-maturing girls demonstrate lower academic and occupational achievement and report lower relationship quality and life satisfaction,” the authors write. “It is thus important to identify protective factors that may mitigate negative effects of early maturation on girls’ adjustment.”
Sylvie Mrug, Ph.D., of the University of Alabama at Birmingham, and colleagues interviewed 330 fifth-grade girls (average age 11) and their parents from three metropolitan areas. The girls reported how often they engaged in aggressive behavior, such as hitting, teasing and spreading rumors to hurt others; whether they displayed delinquency (fighting at school, getting injured in a fight or inflicting injuries); how often their mother was affectionate and how often they did things together; whether their parents had talked to them about violence, tobacco and sex; and whether and when they had started their periods. Parents responded to seven items measuring the extent to which they knew their child’s friends and how he or she spent her free time.
One-fourth of the girls had matured early, defined as beginning their period one year before the average age for females of their racial and ethnic group. Those who did were more likely to be delinquent, but not aggressive. However, those who matured early and also had low levels of parental nurturance, communication and knowledge were more likely to be aggressive. “Also, early maturation only predicted physical aggression when combined with low maternal nurturance,” the authors write.
Early-maturing girls may be at higher risk of aggression or delinquency because they are more likely to be accepted by and form relationships with older boys, who are more likely than younger children to engage in undesirable behaviors, the authors note. “Parental nurturance may decrease girls’ susceptibility to negative peer influence,” they write. “Also, parental nurturance may help girls cope with challenges associated with early puberty. By listening to their daughters’ difficulties and providing support and encouragement, nurturing parents can help them develop better coping skills and diffuse negative emotions that might otherwise manifest as aggression.”
Parental communication and knowledge may also protect girls from aggressive behavior, they continue. “By discussing difficult peer situations (e.g., provocation, peer pressure) and ways of dealing with them, parents may help their daughters develop a repertoire of adaptive responses that will minimize the need for inappropriate (i.e., aggressive) behavior,” they write. “In addition, knowing how their daughters spend free time may help parents identify and prevent negative peer and other influences.”
Clinicians may want to especially target communication, parental knowledge and nurturance education to parents of girls who mature at a young age. “Helping parents develop positive parenting skills may help early-maturing girls to grow into healthy, well-adjusted adolescents and adults,” the authors conclude.
(Arch Pediatr Adoles Med. 2008;162[8]:781-786. Available to the media pre-embargo at www.jamamedia.org).
Editor's Note: This research was supported by cooperative agreements from the Centers for Disease Control and Prevention. 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 4, 2008
Media Advisory: To contact Gopal K. Singh, Ph.D., call the HRSA Press Office at 301-443-3376.
U.S. IMMIGRANT CHILDREN MAY BE LESS PHYSICALLY ACTIVE THAN U.S.-BORN CHILDREN
CHICAGO—Immigrant children in the United States appear to be less physically active and less likely to participate in sports than U.S.–born children, according to a report in the August issue of Archives of Pediatrics & Adolescent Medicine, one of the JAMA/Archives journals.
“Because of a dramatic increase in the prevalence of childhood obesity and diabetes mellitus during the past two decades, physical activity has assumed an increasingly prominent role in disease prevention and health promotion efforts in the United States and is considered one of the 10 leading health indicators for the nation,” according to background information in the article. This has resulted in a closer monitoring of physical activity and sedentary behavior levels in children and adults in the U.S.
With immigrants now accounting for 12.6 percent of the total U.S. population, “it is important to know how patterns of physical activity, inactivity and sedentary behaviors for this increasing segment of the population differ from those of the majority native population,” the authors note.
Gopal K. Singh, Ph.D., of the Health Resources and Services Administration, U.S. Department of Health and Human Services, Rockville, Md., and colleagues analyzed data from the 2003 National Survey of Children’s Health, a telephone survey measuring regular physical activity, inactivity, television watching and lack of sports participation in U.S. children. Nativity/immigrant status was also noted.
Of the total participants, more than 11 percent of U.S. children were found to be physically inactive, while 73.5 percent engaged in physical activity three or more days per week. More than 42 percent of children did not participate in sports and 17 percent watched three or more hours of television per day.
“Physical inactivity and sedentary behaviors varied widely among children in various ethnic-immigrant groups,” the authors write. “For example, 22.5 percent of immigrant Hispanic children were physically inactive compared with 9.5 percent of U.S.-born white children with U.S.-born parents.” Immigrant children were more likely to be physically inactive and less likely to participate in sports than native children; “they were, however, less likely to watch television three or more hours per day than native children, although the nativity gap narrowed with increasing acculturation levels.”
“Given the health benefits of physical activity, continued higher physical inactivity and lower activity levels in immigrant children are likely to reduce their overall health advantage over U.S.-born populations during adulthood,” the authors conclude. “To reduce disparities in childhood physical activity, health education programs designed to promote physical activity should target not only children from socially disadvantaged households and neighborhoods but also children in immigrant families.”
(Arch Arch Pediatr Adolesc Med. 2008;162[8]:756-763. Available to the media pre-embargo 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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