<?xml version="1.0" encoding="utf-8"?>
<recommendedContent xmlns="http://api.mspoke.com">
    <recommendedItem id="20100101_19_405"
                     title="Difficult Childhood Lingers in the Mind (CME/CE)"
                     score="0.013"
                     href="http://www.medpagetoday.com/Psychiatry/GeneralPsychiatry/tb/18312?impressionId=1265785929417"
                     
      &lt;p&gt;Adversities faced in childhood have effects on mental health far into the future, researchers affirmed.&lt;/p&gt;
&lt;p&gt;Mental illness in adulthood was increasingly likely the more traumas faced in childhood, Ronald C. Kessler, PhD, of Harvard, and colleagues reported in the February issue of the &lt;em&gt;Archives of General Psychiatry&lt;/em&gt;.&lt;/p&gt;
&lt;p&gt;Childhood difficulties potentially explained 32.4% of all the psychiatric disorders examined, they said, based on analyses of the National Comorbidity Survey Replication.&lt;/p&gt;
&lt;p&gt;Adversities relating to family dysfunction  --  substance-abusing parents, sexual or physical abuse in the home, neglect, etc.  --  appeared to have the strongest link to onset and persistence of psychiatric disorders, they reported.&lt;/p&gt;
&lt;p&gt;These findings match folk wisdom and decades of research into the negative effects of child maltreatment, commented John McGrath, MD, PhD, of the Queensland Centre for Mental Health Research in Wacol, Australia, and colleagues in an accompanying editorial.&lt;/p&gt;
&lt;p&gt;But the lack of specificity between certain exposures to particular mental health outcomes  --  such as the death of one&apos;s mother leading to depression  --  was notable, the editorialists said.&lt;/p&gt;
&lt;p&gt;&quot;Thus, childhood trauma upsets the orderly psychological and biological cascades of development, leaving the affected individual at increased risk of a wide range of adverse mental health outcomes,&quot; they wrote.&lt;/p&gt;
&lt;p&gt;Rather than continue to rehash the epidemiology, it&apos;s time to focus on prevention and intervention, McGrath&apos;s group emphasized.&lt;/p&gt;
&lt;p&gt;&quot;It is unrealistic to think that we could protect all children from all adversities, but can we identify factors that bolster resilience and focus our efforts on the most vulnerable subgroups?&quot; they asked.&lt;/p&gt;
&lt;p&gt;The researchers examined joint associations of 12 retrospectively reported childhood adversities with lifetime incidence of disorders meeting Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) criteria in the National Comorbidity Survey Replication I, a cross-sectional survey of a nationally-representative sample of adults in 9,282 American households.&lt;/p&gt;
&lt;p&gt;Among the respondents, 53.4% reported at least one childhood adversity, most commonly parental divorce (17.5%), family violence (14.0%), family economic problems (10.6%), and parental mental illness (10.3%).&lt;/p&gt;
&lt;p&gt;These adversities were all individually and significantly linked to first onset of psychiatric disorders with odds ratios of 1.5 to 1.9 for dysfunctional family factors (physical abuse, sexual abuse, neglect, parental mental illness, parental substance abuse, parental criminality, or family violence) and 1.0 to 1.5 for other factors like life-threatening childhood physical illness, extreme poverty, parental divorce, or loss of or separation from parents.&lt;/p&gt;
&lt;p&gt;Despite some apparent but not significantly meaningful variation in type of adversity with type of psychiatric disorder, the researchers said they could rule out that all types were the same for future mental health risk (&lt;em&gt;P&lt;/em&gt;&amp;lt;0.001).&lt;/p&gt;
&lt;p&gt;Problems tended to cluster, though. Among people who faced one adversity in childhood, 51.2% to 95.1% faced others as well, depending on the adversity.&lt;/p&gt;
&lt;p&gt;Risk of mental illness rose with number of issues faced in childhood from an odds ratio of 1.3 for one up to 3.4 for six and 3.2 for seven or more adversities.&lt;/p&gt;
&lt;p&gt;&quot;This subadditive pattern has important implications for intervention because it means that prevention or amelioration of only a single childhood adversity in youths exposed to many childhood adversities is unlikely to have important preventive effects,&quot; the researchers wrote.&lt;/p&gt;
&lt;p&gt;Overall, childhood adversities were projected to account for 44.6% of childhood-onset disorders, 32.0% of adolescent-onset disorders, and 28.6% of adult-onset disorders.&lt;/p&gt;
&lt;p&gt;The researchers also looked at persistence through the second part of the National Comorbidity Survey Replication which went beyond just core diagnostic assessment in 5,692 respondents.&lt;/p&gt;
&lt;p&gt;In a complex multivariate interactive analysis, childhood adversity from dysfunctional family factors appeared significantly linked to persistence in a given year (&lt;em&gt;P&lt;/em&gt;&amp;lt;0.001) whereas the number of factors was not significant.&lt;/p&gt;
&lt;p&gt;These significant factors were parental mental illness, physical abuse, sexual abuse, and neglect, but they carried modest effects individually with odds ratios of 1.2.&lt;/p&gt;
&lt;p&gt;But in one simulation, not being exposed to childhood trauma would only increase the time since the most recent episode of psychiatric illness by 1.6%, suggesting &quot;quite modest&quot; substantive importance in determining persistence.&lt;/p&gt;
&lt;p&gt;&quot;These results indirectly suggest that the public health implications of childhood adversities are greater for primary than for secondary prevention because the associations of childhood adversities with disorder onset are much stronger than the associations with persistence,&quot; Kessler&apos;s group wrote.&lt;/p&gt;
&lt;p&gt;The researchers cautioned that recall bias may have limited their study such that the results could be considered an &quot;upper bound&quot; for the real association and that the study could not prove causality.&lt;/p&gt;
&lt;div style=&quot;float:left;border-style:solid;border-width:1px;border-color:#8dabbc;font-family:arial;font-size:12px;background-color:#DBE9F2;padding:5px;&quot;&gt;&lt;p&gt;The National Comorbidity Survey Replication is supported by a grant from the National Institute of Mental Health with supplemental support from the National Institute on Drug Abuse, the Substance Abuse and Mental Health Services Administration, a grant from the Robert Wood Johnson Foundation, and the John W. Alden Trust.&lt;/p&gt;&lt;p&gt;The analyses were supported by a grant from the NIMH; the John D. and Catherine T. MacArthur Foundation; the Pfizer Foundation; grants from the U.S. Public Health Service; an award from the Fogarty International Center; the Pan American Health Organization; Eli Lilly; Ortho-McNeil Pharmaceutical; GlaxoSmithKline; and Bristol-Myers Squibb.&lt;/p&gt;&lt;p&gt;Kessler reported financial conflicts of interest with GlaxoSmithKline, Kaiser Permanente, Pfizer, sanofi-aventis, Shire Pharmaceuticals, Wyeth-Ayerst, Eli Lilly, Bristol-Myers Squibb, Johnson &amp;amp; Johnson Pharmaceuticals, and Ortho-McNeil Pharmaceutical.&lt;/p&gt;&lt;p&gt;The editorialists reported no conflicts of interest.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
    </recommendedItem>
    <recommendedItem id="20100101_19_124"
                     title="Morphine Cuts Both Pain and PTSD (CME/CE)"
                     score="-0.005"
                     href="http://www.medpagetoday.com/PublicHealthPolicy/MilitaryMedicine/tb/17938?impressionId=1265785929417"
                     
      The use of morphine may prevent the development of post-traumatic stress disorder (PTSD) in military personnel injured in combat, an observational study showed.&lt;br&gt;
&lt;br&gt;Those who received the drug during resuscitation or trauma care were about half as likely to later develop PTSD (OR 0.47, &lt;em&gt;P&lt;/em&gt;&amp;lt;0.001), according to Troy Lisa Holbrook, PhD, of the Naval Health Research Center in San Diego, and colleagues.&lt;br&gt;
&lt;br&gt;&quot;Our findings suggest that the use of morphine after serious injury may be a first-line defense against the development of PTSD,&quot; they wrote in the Jan. 14 issue of the &lt;em&gt;New England Journal of Medicine&lt;/em&gt;.&lt;br&gt;
&lt;br&gt;They said that any benefits, if causal, would likely be seen with other opiates as well.&lt;/p&gt;
&lt;p&gt;Previous studies have found that pharmacotherapy following trauma may be effective for secondary prevention of PTSD, with the primary goal of interfering with memory consolidation and the associated conditioned response to fear, according to the researchers.&lt;/p&gt;
&lt;p&gt;And a small study found a protective effect from morphine specifically in children with burn injuries.&lt;/p&gt;
&lt;p&gt;To evaluate the drug&apos;s effect in adults, Holbrook and her colleagues turned to a U.S. Navy-Marine Corps combat trauma database that included information on medications administered after injury.&lt;/p&gt;
&lt;p&gt;They analyzed data for 696 military personnel who were hurt during Operation Iraqi Freedom but who did not have serious traumatic brain injury.&lt;/p&gt;
&lt;p&gt;Nearly all of the injured personnel were male and the mean age was about 24.&lt;/p&gt;
&lt;p&gt;The most common mechanisms of injury were improvised explosive devices, gunshots, mortar fire, and rocket-propelled grenades.&lt;/p&gt;
&lt;p&gt;About one-third (35%) of the injured personnel developed PTSD. Those who did were less likely to have been administered morphine shortly after their injury (60% versus 76%).&lt;/p&gt;
&lt;p&gt;The use of morphine was associated with a significantly lower risk of PTSD (ORs ranging from 0.48 to 0.66, &lt;em&gt;P&lt;/em&gt;&amp;lt;0.05 for all) in models adjusting for several factors, including severity and mechanism of injury, need for amputation, resuscitation, and the presence of mild traumatic brain injury.&lt;/p&gt;
&lt;p&gt;Morphine dose had no effect on the relationship.&lt;/p&gt;
&lt;p&gt;Although causality could not be established, any beneficial effect morphine might have on PTSD risk might involve pain reduction; previous studies have identified associations between lower pain levels after serious injury and a reduced risk of developing the disorder.&lt;/p&gt;
&lt;p&gt;&quot;The logical conclusion to be made on the basis of these data is that a reduction in perceived pain levels through the use of morphine or other opiates as part of trauma care may lower the rate of PTSD onset after major trauma,&quot; Holbrook and her colleagues wrote.&lt;/p&gt;
&lt;p&gt;In an accompanying editorial, Matthew Friedman, MD, PhD, of the National Center for PTSD at the VA Medical Center in White River Junction, Vt., said, &quot;This finding adds to a small but growing body of observational and experimental studies that have reported similar results.&quot;&lt;/p&gt;
&lt;p&gt;&quot;Since physical injury from a traumatic event (especially injury that is associated with severe pain) is a risk factor for the later development of PTSD, such findings suggest a potential for prophylactic use of rapid pain reduction among injured, traumatized persons in both military and civilian acute care settings,&quot; he said.&lt;/p&gt;
&lt;p&gt;He noted, however, that use of opioids would likely not be an acceptable treatment for individuals exposed to trauma who had not suffered major, painful injuries.&lt;/p&gt;
&lt;p&gt;The findings of the current study, he wrote in his editorial, are consistent with theories about the adrenergic mediation of fear-conditioned traumatic memories.&lt;/p&gt;
&lt;p&gt;&quot;These results should motivate researchers to redouble efforts to test adrenergic antagonists such as propranolol and clonidine (an &amp;#945;&lt;sub&gt;2&lt;/sub&gt;-adrenergic agonist) in the search for a morning-after pill to prevent the later development of PTSD among persons after major trauma.&quot;&lt;/p&gt;
&lt;p&gt;Holbrook and her colleagues acknowledged that the study was limited by its observational design, missing or incomplete data on medication for patients who were ultimately excluded from the study, and the inability to thoroughly address the question of a dose-response relationship.&lt;/p&gt;
&lt;div style=&quot;float:left;border-style:solid;border-width:1px;border-color:#8dabbc;font-family:arial;font-size:12px;background-color:#DBE9F2;padding:5px;&quot;&gt;&lt;p&gt;The study was supported by the U.S. Navy Bureau of Medicine and Surgery under the Wounded, Ill, and Injured-Psychological Health-Traumatic Brain Injury Program.&lt;/p&gt;&lt;p&gt;Neither the study authors nor the editorialist reported any conflicts of interest.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
    </recommendedItem>
    <recommendedItem id="20090101_1_29"
                     title="When Mom and Dad Fight, Jack and Jill Can&apos;t Sleep"
                     score="-0.005"
                     href="