FDA Clears Addiction Drug to treat Narcotic Abuse

Associated Press

Drugmaker Alkermes Inc. says it has received U.S. approval to market its addiction medication for use in heroin addiction treatment and with other narcotics.

The Food and Drug Administration approved the company's drug Vivitrol as a monthly injection to treat addiction to opioids, highly addictive drugs often abused for their euphoric effects. Vivitrol is already approved for alcohol addiction treatment.

The drug is designed to block brain receptors that deliver the pleasurable sensations associated with alcohol and drug abuse.

The FDA approved the drug based on company studies that showed patients taking Vivitrol were more likely to be free of opioids than those taking a dummy injection. The typical Vivitrol patient reported opioid-free urine samples 90 percent of the time, compared with 35 percent for those not taking the drug.

Addictive Web Use Linked to Teen Depression

USA Today

 

Teens who spend far too much time on the Internet run the risk of developing depression, a new Australian study suggests.

Since the 1990s, uncontrolled or unreasonable Internet use has been identified as a problem with signs similar to other addictions, researchers say. Pathological Internet use has been linked with relationship problems, health problems, aggressive behavior and other psychiatric symptoms, they added.

"Parents should be vigilant about their children's online behavior," said lead researcher Lawrence T. Lam, from the School of Medicine, Sydney, and the University of Notre Dame Australia. "Should there be any concern about young people involving problematic Internet-use behavior, professional help should be sought immediately."

This sort of behavior may be a manifestation of some underlying problems that are more insidious, Lam said.

"Given the results obtained from the study, even mentally healthy young people may succumb to depression after a long exposure of problematic use of the Internet. The mental health consequences of problematic Internet use for those who have already had a history of psychological or psychiatric problems would be more damaging," he said.

The report is published in the Aug. 2 online edition of the Archives of Pediatrics & Adolescent Medicine, in advance of publication in the October print issue.

For the study, Lam and his colleague Zi-Wen Peng, from the Ministry of Education and SunYat-Sen University in Guangzhou, China, collected data on pathological Internet use among 1,041 Chinese teens aged 13 to 18.

Lam and Peng tested the teens for depression and anxiety, and questioned them about pathological Internet use and common addictive behaviors.

At the start of the study, the researchers classified 6.2% of the teens as having a moderately pathological Internet problem and 0.2% as seriously at risk.

Nine months later, the teens were reassessed for depression and anxiety. The researchers found 0.2% had symptoms of anxiety and 8.4% had become depressed.

The risk of becoming depressed was 2.5 times higher among teens who were addicted to the Internet compared with those who weren't, Lam and Peng found.

However, there was no association between pathological Internet use and anxiety, they noted.

"This study has a direct implication on the prevention of mental illness among young people," Lam said. "The results of the study indicated that young people who use the Internet pathologically are most at risk of mental problems and would develop depression when they continue with that behavior."

Early intervention and prevention that targets at-risk groups with identified risk factors is effective in reducing the burden of depression among young people, Lam added.

"Screening for at-risk individuals in the school setting could be considered as an effective early prevention strategy," he said. "Hence, a screening program for pathological use of the Internet could also be considered in all high schools in order to identify at-risk individuals for early counseling and treatment."

Michael Gilbert, a senior fellow at the Center for the Digital Future at the University of Southern California's Annenberg School for Communication, said that "it's not a revolutionary thought that kids get caught up on the Internet and it can lead to certain kinds of psychological behavior."

For Gilbert, the question remains whether or not the teens who became depressed were at risk for depression before they became addicted to the Internet. Moreover, were they also at risk for other addictive behaviors.

One factor to the link between overuse of the Internet and psychological problems like depression may be that the Internet is actually isolating and alienating, Gilbert said.

"Parents are indicating to us that a lot of their children's friendship circles are contracting by reason of the fact they are spending too much time on the Internet," he said. "This ties in generally with the notion that Internet behavior is becoming disruptive in the family."

Spending too much time on the Internet is a so-called "process addiction," like gambling and pornography, Gilbert said.

"We are going to see more of these problems, and (they) are especially acute in adolescence when kids are struggling with defining their social circumstances," he said.

The key for parents is to monitor their children's media time and content, Gilbert said.

"The technology changes, the medium changes, but the issue always comes down to parents ascertaining control over their children's behavior and monitoring it," he said.

Big Changes Coming to DSM-V, the Psychiatrist's Bible

ABC News

New Diagnostic and Statistical Manual of Mental Disorders Makes Changes to Eating and Gambling Disorders But Leaves Sex Alone

Substantial changes are in the offing for the "psychiatrist's bible," the Diagnostic and Statistical Manual of Mental Disorders, according to a draft of the forthcoming fifth edition.

The American Psychiatric Association (APA) posted the draft of DSM-V on a special Web site, www.dsm5.org, to obtain comment from its members, other members of the mental health community, and the public.

At a telephone press briefing prior to the draft's release, members of the APA team leading the DSM revision highlighted several substantial innovations they are proposing:

* Re-categorizing learning disorders, including creation of a single diagnostic category for autism and other socialization disorders, and replacing the controversial term "mental retardation" with "intellectual disability"

* Eliminating "substance abuse" and "substance dependence" as disorders, to be replaced with a single "addiction and related disorders" category

* Creating a "behavioral addictions" category that will include addictions to gambling but not to the Internet or sex

* Offering a new assessment tool for suicide risk

* Including a category of "risk syndromes" for psychosis and cognitive impairment that are intended to capture mild versions of these conditions that do not always progress to full-blown psychotic disorders or dementia, but often do

* Adding a new disorder in children, "temper dysregulation with dysphoria," for persistent negative mood with bursts of rage

* Revising criteria for some eating disorders, including creation of a separate "binge eating disorder" distinct from bulimia

* Using "dimensional assessments" to account for severity of symptoms, especially those that appear in multiple diagnostic categories

The APA will accept comments through April 20. The work groups managing the revision will consider them and make further changes as needed to the draft, said Dr. David Kupfer, of the University of Pittsburgh and chairman of the DSM-V task force.

The draft diagnostic criteria will then undergo two years of field testing. The final DSM-V is scheduled for release in May 2013, a year later than originally planned.

In the area of neurodevelopmental disorders, DSM-V will put dyslexia and dyscalculia -- reflecting disabilities of reading and mathematics, respectively -- into a new category of learning disabilities.

Autism, Asperger's syndrome, childhood disintegrative disorder, and pervasive developmental disorder not otherwise specified will make up the new "autism and related disorders" category.

The head of the APA's work group on substance-related disorders, Dr. Charles O'Brien, of the University of Pennsylvania, told reporters on the press call that substance dependence and abuse had no basis in the research on addictions.

"We unanimously agreed that… there really isn't evidence for an intermediate stage [short of addiction] that is now known as abuse," he said. Instead, there will be substance use disorders for each of the major types of drugs that cause problems, such as alcohol.

He added that the term "dependence" was problematic as a psychiatric diagnosis because some types of physical dependence are "completely normal" for some medications, such as opioid painkillers.

In fact, under the draft the DSM-V will include "discontinuation syndromes" to allow physicians to properly assess symptoms of withdrawal from psychoactive substances which include caffeine, O'Brien said.

He also said his work group had considered including sex and Internet addictions as disorders, but decided there was insufficient evidence to develop reliable diagnostic criteria for them. Consequently, gambling addiction is slated to be the only disorder formally listed in the behavioral addictions category.

But O'Brien added that under current plans, sex and Internet addiction would be included in an appendix to DSM-V, intended to encourage additional research that could lead to their inclusion in future editions.

APA leaders also emphasized the two new suicide risk assessment scales planned for DSM-V, one for adolescents and one for adults.

Dr. David Shaffer, of Columbia University, told reporters on the press call that suicide nearly always occurs in the context of some psychiatric disorder, but not always depression.

The new risk assessment tools focus on risk factors such as impulsive behavior, heavy drinking, and chronic severe pain and illness.

In DSM-IV, suicidal ideation is treated as a symptom of major depression and certain other disorders.

Shaffer also explained the genesis of the proposed new childhood disorder, temper dysregulation with dysphoria (TDD).

"About 40 percent to 60 percent of the cases [seen by child psychiatrists] will be children who are doing things that other people don't want them to do," he said. Many of these are children who are "stubborn and resistant and disobedient and moody."

There is currently a recognized syndrome known as oppositional defiant disorder, but some children also display severe aggression and negative moods that go beyond mere stubbornness, according to Shaffer.

Such children are often tagged as having juvenile bipolar disorder, but research has shown that the label is often inappropriate, since they usually do not qualify for a bipolar disorder diagnosis when they reach adulthood, though they remain dysfunctional. More often, these children are diagnosed as depressed when they become adults.

He said the addition of TDD would better describe the severity and frequency of irritable behavior while also recognizing the mood disorder that goes with it.

Another innovation in DSM-V will be the extensive use of so-called dimensional assessments. Whereas DSM-IV relied heavily on present-absent symptom checklists, the new edition will include severity scales for symptoms such as anxiety or insomnia that may appear to larger or smaller degrees in many different mental illnesses.

Dr. Darrel Regier, the APA's research director, said such checklists "don't always fit the reality that someone with a mental disorder experiences." Often, a symptom like insomnia isn't on the checklist for a particular disorder, he said, "but they can still affect patients' lives and affect the treatment planning."

Incorporating quantitative dimensional assessments should allow clinicians to develop treatment and response-monitoring plans better tailored to individual patients' needs, Regier said.

A closely watched issue in the DSM-V revision has been whether to change or do away with gender identity disorder, now listed in DSM-IV. At this point, the draft retains the designation but with some changes, officials said.

People who consider themselves "transgendered" have long criticized DSM-IV and previous editions for labeling them with a mental disease when their problems, they believe, are purely somatic -- that is, they have the wrong genitalia and hormonal balance.

At the APA's annual meeting last May, members of the transgender community made a case for dropping gender identity disorder from DSM-V, but keeping some kind of "gender variance" diagnosis as a medical condition. Such an approach would eliminate the stigma of a psychiatric diagnosis while leaving a pathway for third-party (insurance) payment for gender transition treatments, they said.

Dr. William Narrow, the APA's research director for DSM-V, told reporters that the draft does remove the term "disorder" from the condition when applied to children, renaming it as "gender incongruence."

For adults, gender identity disorder will remain in DSM-V but with substantially altered diagnostic criteria, Narrow said.

But APA officials said the organization planned more discussions with members of the transgender community.

Kupfer, the DSM-V task force chairman, stressed that further changes in many diagnostic categories are likely following the comment period and field trials. Final revisions will be submitted in 2012 for approval by the APA's two governing bodies, the Assembly and the board of trustees.

The Science Of Junk Food

from Tonic.com

It’s a nutrition study that totally puts the crack in pork cracklings.

As ScienceNews reports, a neuroscience study reveals why our sense of self-control may get tossed out the window when the salty, fatty snacks are close at hand. An investigation into the linkage between nutrition and the brain indicates that brain circuitry is actually rewired as a result of consuming certain junk foods, closely mirroring the changes in the brain that stem from heroin use.

Study co-author Paul Johnson of the Scripps Research Institute in Florida observes of his team’s findings that “[t]his is the most complete evidence to date that suggests obesity and drug addiction have common neurobiological underpinnings.”

According to ScienceNews, the study began with Johnson and team returning from the grocery store loaded with such fare as snack cakes, bacon, sausage and other tasty-but-ghastly treats. Half of the team’s test rats were fed appropriately portioned nutritious food, and the other half were given all-you-can-eat buffet privileges at the junk food cafe set up for the study.

Those in the latter group were observed to lose any sense of moderation, going back for more on a routine basis, taking in double the caloric intake of their healthy diet peers, and rapidly developing obesity.

The gluttonous behavior resulted from changes that occurred in the brain. Johnson and team discovered that the junk food diet activated the pleasure and reward functions in the brain, and altered them permanently. Precisely in the same manner observed in those addicted to drugs such as opiates, more and more of the substance — in this case, junk food — was required to activate the reward response in the brain.