Dennis Thompson reports:
Medical marijuana can be useful in treating chronic pain, but may be less effective for other conditions, a new analysis reveals.
A review of nearly 80 clinical trials involving medical marijuana or marijuana-derived drugs revealed moderately strong evidence to support their use in treating chronic pain, says a report published June 23 in the Journal of the American Medical Association.
The evidence also showed that the medications could help multiple sclerosis patients who suffer from spasticity, which involves sustained muscle contractions or sudden involuntary movements.
But the review found weaker support for the drugs’ use in treating sleep disorders; nausea or vomiting related to chemotherapy; for producing weight gain in people with HIV; or for reducing symptoms of Tourette syndrome, a nervous system disorder characterized by repetitive movements or sounds.
Read more on HealthDay.
More – and better – research is needed on the potential efficacy of medical marijuana. I’ve had a number of patients tell me that marijuana decreases their Tourette’s symptoms, but it’s not clear if the tics are actually decreasing or if the patients are just less aware of the tics or just less concerned about them.
As children return to school, parents are often swamped with forms and informational packets. One of them, however, is something that you really need to pay attention to if you want to protect your child’s privacy.
Under FERPA, schools that receive public education funds must notify parents every year as to what types of information the school district considers “Directory Information” that they can share with others – without your knowledge or consent – unless you opt out of information sharing.
Given how massive databases compile more and more data about ourselves and our children, and given that you do not know how that information may be used against your child in the future, you may want to be cautious and opt your child OUT of sharing of directory information.
Remember: if you do not actively opt your child out by returning the opt out form, they will be able to share lots of information about your child without your consent throughout the school year. Read the form they provide and then decide what is best for your child.
Keep in mind that opting out of sharing directory information has nothing to do with opting out of Common Core testing. They are totally separate issues.
For more information on the dangers of directory information sharing, see this informative site from the World Privacy Forum.
If your child is over the age of 18 or attends college, they will receive the notice about directory information and the opt-out form. Remind them to look for it.
So we should have moved to the mountains?
Recent research has linked the thin air of higher elevations to increased rates of depression and suicide. But a new study shows there’s also good news from up in the aspens and pines: The prevalence of attention deficit hyperactivity disorder (ADHD) decreases substantially as altitude increases.
In Utah, for example, an analysis of information from two national health surveys correlated with the average state elevation of 6,100 feet showed that the rate of diagnosed ADHD cases is about 50 percent of states at sea level. In Salt Lake City, whose elevation is about 4,300 feet, diagnosed ADHD prevalence is approximately 38 percent less than at sea level.
One potential reason for the decreased rate of ADHD, University of Utah researchers believe, is higher levels of dopamine produced as a reaction to hypobaric hypoxia—a condition caused when people breathe air with less oxygen at higher elevations. Decreased dopamine levels are associated with ADHD so when levels of the hormone increase with elevation, the risk for getting the disorder diminishes. There are other potential reasons for the disparities in the rates of the disorder, such as regional inconsistencies in diagnosing ADHD.
The study findings, published in the Journal of Attention Disorders online, have important implications for potentially treating ADHD, according to Douglas G. Kondo, M.D., assistant professor of psychiatry and senior author on the study. “Our previous studies of mood disorders and suicide consistently suggest that hypobaric hypoxia associated with altitude may serve as a kind of environmental stressor,” Kondo says. “But these results raise the question of whether, in the case of ADHD, altitude may be a protective factor.
Rebekah Huber, a doctoral candidate in educational psychology at the University of Utah, is the first author. Huber works in the research group of Perry F. Renshaw, M.D., Ph.D., M.B.A., a University of Utah professor of psychiatry, USTAR investigator and a co-author on the study.
Huber, Kondo, Renshaw and their colleagues conducted the study with data from two national health surveys and information on average state elevations taken from NASA’s Shuttle Radar Topography Mission and the National Geospatial-Intelligence Agency.
The National Survey on Children’s Health contacted 91,642 households in 2007 and found that 73,123 children ages 4-17 had been diagnosed with mild, moderate or severe ADHD by a physician or other health care provider. The 2010 National Survey of Children with Special Healthcare Needs contacted 372,689 households and found that 40,242 children in that age range had been diagnosed with full ADHD.
The researchers correlated the number of cases of diagnosed ADHD with average elevations in the lower 48 states and the District of Columbia as reported by the federal agencies to determine rates of ADHD. From this, they derived data on ADHD rates at sea level and above and found that for every 1-foot increase in elevation, the likelihood of being diagnosed with ADHD by a healthcare provider decreases by .001 percent.
The data showed that North Carolina, whose average elevation is 869 feet above sea level, had the highest percentage of children diagnosed with ADHD – 15.6 percent. Delaware, Louisiana and Alabama—all states with an average elevation of less than 1,000 feet—followed closely behind North Carolina with high percentages of ADHD.
Nevada—with an average elevation of 5,517 feet above sea level—had the lowest percentage at 5.6. Utah had one of the lowest rates of ADHD, 6.7 percent. All of the Mountain West states rated well below average for the percentage of children diagnosed with ADHD. The study also took into account other factors—such as birth weight, ethnicity, and sex (males are more likely to have ADHD)— that could affect ADHD diagnoses and influence the rate of the disorder in each state.
This study follows research in which Renshaw and colleagues at the University of Utah and in South Korea showed correlations between increased rates of suicide and depression with higher altitudes.
The decrease in ADHD at elevation doesn’t mean people need to start moving to the mountains, according to Renshaw. But the research results do have potential implications for treating the disorder.
“To treat ADHD we very often give someone medication that increases dopamine,” he says. “Does this mean we should be increasing medications that target dopamine? Parents or patients might want to take this information to their health care providers to discuss it with them.”
SOURCE: University of Utah
Finally we have a study that provides us with some analysis of comorbidity in Tourette Syndrome (TS) based on a large sample size.
The Tourette Syndrome Association International Consortium for Genetics has published a report that looked at lifetime prevalence, clinical associations, ages of highest risk, and etiology of psychiatric comorbidity in 1,374 individuals with TS who were compared to 1,142 TS-unaffected family members.
Some of the key findings include:
- The lifetime prevalence of any psychiatric comorbidity among individuals with TS was 85.7%;
- 57.7% of individuals with TS had 2 or more psychiatric disorders.
- 72.1% of individuals with TS met DSM-IV-TR diagnostic criteria for OCD or ADHD.
- Other disorders, including mood, anxiety, and disruptive behavior, each occurred in approximately 30% of the participants.
- The age of greatest risk for the onset of most comorbid psychiatric disorders was between 4 and 10 years, with the exception of eating and substance use disorders, which began in adolescence.
- TS was associated with increased risk of anxiety and decreased risk of substance use disorders independent from comorbid OCD and ADHD; however, high rates of mood disorders among participants with TS (29.8%) may be accounted for by comorbid OCD.
- Parental history of ADHD was associated with a higher burden of non-OCD, non-ADHD comorbid psychiatric disorders.
- Genetic correlations between TS and mood, anxiety, and disruptive behavior disorders may be accounted for by ADHD and, for mood disorders, by OCD.
Looking at their findings, there’s really nothing surprising in the rates of comorbidity nor the possibility that some comorbidity may be better accounted for by the presence of ADHD or OCD than by TS itself.
Hirschtritt ME, Lee PC, Pauls DL, Dion Y, Grados MA, Illmann C, King RA, Sandor P, McMahon WM, Lyon GJ, Cath DC, Kurlan R, Robertson MM, Osiecki L, Scharf JM, Mathews CA; for the Tourette Syndrome Association International Consortium for Genetics. Lifetime Prevalence, Age of Risk, and Genetic Relationships of Comorbid Psychiatric Disorders in Tourette Syndrome. JAMA Psychiatry. 2015 Feb 11. doi: 10.1001/jamapsychiatry.2014.2650. [Epub ahead of print]
I realize this post will likely distress or upset some readers, but sticking our heads in the sand about risks our loved ones or students may face won’t help. So as alarming as the research results may be, if it gets us off the dime in protecting our families or getting them help, it’s important to discuss.
People with attention-deficit hyperactivity disorder (ADHD) are more than twice as likely to die prematurely as those without the common disorder, a new study finds.
The risk is small, but it’s a clear indication that the disorder is a serious problem, the researchers said.
Risk significantly higher for women
In a study of more than 2 million people, Danish researchers found that accidents were the most common cause of premature death among people with ADHD. And the risk was significantly higher for women and those diagnosed in adulthood, the researchers added.
Read more on Health24.
Having read the full study, it’s important to note that although there is an increased risk, because ADHD is diagnosed more strictly in Denmark, the researchers appropriately note that the sample of ADHD patients may not be a representative sample of what we’d find here in the U.S. or elsewhere. Similarly, because ADHD tends to be underdiagnosed in females, the females with ADHD are likely to represent those with more severe cases. As to those first diagnosed as adults, well, again, they are more likely to be more severe/persistent cases. So their findings of increased risk may be somewhat overestimating the risk for a sample that might include milder or more moderate cases of ADHD.
As the researchers report, the primary factor appears to be the increased risk of accidents with more serious injuries, something I’ve been pointing out for over 15 years. What the Danish study didn’t look at, however, was whether treatment would reduce or normalize the risks.
But what about ADHD and suicide risk? In an unrelated study, Drs. Lan, Bai, and their colleagues in Taiwan recently reported that the presence of ADHD was independently associated with an increased risk of suicide in adolescents and young adults over and above the increased risk due to comorbid Bipolar Disorder. This study, too, did not look at whether treatment would change the outcomes or findings.
So what we have is a growing body of evidence that ADHD is associated with increased risk of both suicide and premature death due to accidents.
Yet when I go into schools or look at plans for students with ADHD, I generally do not see extra safety precautions. Isn’t about time we got schools to implement more safety protections for students with ADHD?